Archived: The Meadows Medical Practice Also known as Drs Gray, Davies & Bennett

Updated 10 December 2015

The Meadows Medical Practice is located in Clun, Craven Arms, Shropshire with a branch location in Knighton, Wales. It is part of the NHS Shropshire Clinical Commissioning Group. All of the practice patients, including those in Knighton, come under the auspices of Shropshire CCG and NHS England. They are in a remote rural locality covering an area of approximately 200 square miles. This can present significant challenges for the practice with secondary care providers and transport services. Knighton has a railway station that connects services to Craven Arms and Shrewsbury, but Clun has no public transport at all, and is situated in a remote valley surrounded by hills. Patients who cannot drive can be at risk of extreme isolation. The practice covers all the surrounding villages and many very isolated rural hillside farms. The practice has on occasion required air ambulance support for their patients.

The total practice patient population is 3,707. The practice has a higher proportion of patients aged 65 years and above (46.1%) which is higher than the practice average across England (26.5%). It has a population which has a slightly percentage of patients with a long-standing health condition 58.4% when compared to the practice average across England (54%).

The staff team comprises a male and two female GP partners. The practice team includes two part time practice nurses, two part time healthcare assistants, a lead dispenser and two dispensing staff, a practice manager, office manager and five receptionists/administrative support staff. In total there are 17 staff employed either full or part time hours. The practice operates with one GP and one nurse at each site (Clun and Knighton) plus reception and dispensing staff.

The practice at both locations is open Monday to Friday 8.30am to 6pm. The practice does not provide an out-of-hours service to its own patients but has alternative arrangements for patients to be seen when the practice is closed through Shropdoc, the out-of-hours service provider. The practice telephones switch to the out-of-hours service at 6pm each weekday evening and at weekends and bank holidays.

The practice provides a number of clinics, for example long-term condition management including asthma, diabetes and high blood pressure. It also offers child immunisations, minor surgery, tele dermatology (the use of photography to gain a diagnosis using a dermatoscope, the results are emailed to secondary care).The practice offers a walking/ exercise group health checks and smoking cessation advice and support. The practice operates a dispensary from its Clun location and a limited GP led dispensing service from its Knighton location.

The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver general medical services to the local community or communities. They also provide some Directed Enhanced Services, for example they are a dispensing practice, offer minor surgery and the childhood vaccination and immunisation scheme and for their patients.

Updated 10 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Meadows Medical Practice on 26 October 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• The practice’s rural community dispensary and practice also provided the addition of a pharmacy in response to meeting the needs of their local community.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they found it easy to make an appointment with a named GP and that there was excellent continuity of care, with urgent appointments available the same day, as well as a walk in and wait service each morning.

We saw several areas of outstanding practice including:

Updated 10 December 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 December 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 10 December 2015

The practice is rated as outstanding for the care of older people. The practice had systems in place that reflected best practice in end of life care and demonstrated an ethos of caring and striving to achieve a preferred place dignified death for patients. This was actively supported by practice staff and local community initiatives. The practice has been able to support, with an integrated care approach, many patients in fulfilling their wish to die at home, which was not exclusive to patients on end of life care pathways. We found that the practice staff were familiar with the needs of patients nearing the end of their life and would take the initiative to facilitate care provision in difficult circumstances.

The practice provided cover for a local community hospital which involved weekly MDT meetings and ward rounds, and the admission of patients when they arrived from home or were transferred for rehabilitation or end of life care closer to home.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 10 December 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

Updated 10 December 2015

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia).

Practice staff told us that they considered risk factors such as patient’s mental health in areas of rural isolation within the local catchment area. The practice supported the 43 patients with enduring mental health and we found that to date 87% had a care plan in place and had regular blood tests completed in the management of their medicines as well as having annual physical health checks. There were 25 patients with organic mental health, such as dementia and 87% had a care plan in place to date and had received regular face to face consultations. This showed significant improvement from the 2013/14 Quality Outcomes Framework (QOF) data of 75% patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. The practice provided an in-house counsellor to support patients and a psychiatrist also provided clinical sessions at the practice. The practice were aware of the Mental Health Crisis Care Concordat which was a national agreement between services and agencies involved in the care and support of people in crisis. The Concordat outlines the work that was required at a national and local level so that organisations responding to people experiencing a mental health crisis work together collaboratively and that these agencies had a shared understanding of the local processes needed to deliver high quality crisis care. This included access to support before crisis point, making sure people with mental health problems can get help 24 hours a day and that when they ask for help, they are taken seriously. The practice had advertised this access within the waiting room and on the doors of the practice entrance.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 10 December 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. It had carried out annual health checks for people with a learning disability and all had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It informed vulnerable patients about how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out-of-hours.