Archived: Much Wenlock Medical Practice

Updated 24 December 2015

Much Wenlock and Cressage Medical Practice is located in Much Wenlock with a branch location in Cressage, Shropshire. It is part of the NHS Shropshire Clinical Commissioning Group (CCG). They are a dispensing practice situated in a rural locality. The two sites are the base for all members of staff of the Much Wenlock & Cressage Medical Practice.

The total practice patient population is 7,906. The practice has a higher proportion of patients aged 65 years and above (37.9%) which is higher than the practice average across England (26.5%). They have a lower than average number of patients aged 0-4 years (3.7%) when compared to the practice average across England (6%).

The staff team comprises seven GPs, five female and two male. Four GPs are partners in the practice and three are salaried GPs. The nursing team includes a Nurse Manager, two practice nurses and a healthcare assistant. The practice management team includes a practice manager, office manager, data manager and dispensary manager. The practice is supported by two dispensary assistants, a personal assistant, nine receptionists and two medical secretaries. There are a total of 29 staff employed working full or part time hours with two part time staff vacancies recently advertised.

The practice is a training practice for medical students from Keele University who visit the practice at various stages of their medical education. The practice also provides one year placements for GP Registrars (qualified doctors who wish to specialise in general practice), prior to commencement of their career in that field. Qualified nurses are also received on placement to gain experience in practice nursing prior to joining primary care.

The practice is open at Much Wenlock from Monday to Friday between 8.30am to 6pm, with appointments also available 6.30pm to 8.30pm on Monday evenings. The practice at Cressage is open between 8.30am to 12.30pm and 2pm to 6.00pm, but closes on Fridays at 12.30pm. The GPs work on a rota system across both locations and details of which days they are on duty are shown on the website and within the practice brochure. 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. There is a thriving walking/exercise group in Much Wenlock. The practice offers health checks and smoking cessation advice and support. The practice also provides a nurse led osteoarthritis clinic and a nurse led telephone service for general health promotion advice and explanation of test results. The practice provides an in-house counselling service, phlebotomy service (blood taking), family planning clinic and a dispensary service for Cressage registered patients.

One of the practice staff vacancies is for one of the community care coordinators, a local CCG initiative, where staff sign post patients or their families/carers to various local organisations to promote and enable independent living.

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 for their patients.

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Much Wenlock and Cressage Medical Centre on 16 November 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.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• There was a strong focus on continuous learning and improvement at all levels.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

• Ensure all staff complete regular staff fire safety awareness training.

• Consider individual risk assessments for staff who provide a chaperone service without a Disclosure and Barring Service (DBS) check rather than a group risk assessment.

• Consider surveying staff opinion on their views on the group appraisal system in place for non-clinical staff on a biennial basis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 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.

• Patients with long-term conditions had a named GP and a structured annual review to check that their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice participated in the Care Homes Advance Scheme (CHAS) and also some Directed Enhanced Services (DES) such as avoiding unplanned admissions to support patients with long term condition management.

Updated 24 December 2015

The practice is rated as good for the care of families, children and young people. Twenty-two point seven five percent of the practice patients were aged 0 to 19.

• 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.

• The practice’s uptake for the cervical screening programme was 80.76%, which was comparable to the national average of 81.88%.

• 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.

• The practice offered a specific child immunisation clinic at both practice locations once a week in an afternoon to allow parents to work around school collection times.

• The practice offered a full family planning service.

• There was a term time weekly nurse led drop in clinic at the local secondary school, where the practice nurse deals with both registered patients of the practice and students from outside the practice area. They provided medical services to an independent private co-educational international day/boarding school with approximately 404 pupils.

Updated 24 December 2015

The practice is rated as good for the care of older people.

• The practice had 2669 patients aged 60 plus with 507 over the age of 80 years. The practice offered proactive, personalised care to meet the needs of the older people in its population.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• One of the practice GPs provided a weekly ward round at a residential home for older people with a dementia care unit and one nursing care home. They were looking to increase this service to a twice weekly to improve patient care and timeliness of response.

• They provided a domiciliary flu vaccination programme to patients assessed as unable to visit the practice and to the local nursing and residential homes.

Updated 24 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 online and telephone services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice ran flu clinics on Saturday mornings and during the extended opening hours sessions on a Monday evening.

Updated 24 December 2015

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

• 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 where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support people with mental health needs and dementia.

• The practice understood the needs of patients who self-harm and monitored, completed regular reviews and communicated with secondary care providers, such as consultant psychiatrists.

Updated 24 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. The Practice actively identifies patients who are considered to be “Frail and Vulnerable” and held monthly multi-disciplinary team meetings to discuss their care.

• It offered longer appointments for patients with a learning disability and sign posted vulnerable patients in how to access various support groups and voluntary organisations.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.