Rowden Medical Partnership Also known as Rowden Surgery

Updated 23 November 2016

Rowden Medical Partnership is located near to the centre of Chippenham, a market town in Wiltshire. The practice is part of the Wiltshire Clinical Commissioning Group and has approximately 16,000 patients.

The area the practice serves is urban and semi-rural and has relatively low numbers of patients from different cultural backgrounds. The practice has a slightly higher than average patient population in the above 45 years age group and lower than average in the 20 to 40 years age group.

The practice area is in the low to mid-range for deprivation nationally and has a lower than average number of patients (0.7%) who are unemployed compared to the local average of 3%. The practice has a higher than average (61%) number of patients, compared to the local average (3%), living with a long term condition which can mean there is an increased demand for GP services.

The practice is managed by seven GP partners (five female and two male).The practice is supported by two salaried GPs(female), nine practice nurses, five health care assistants, a practice pharmacist and an administrative team led by the practice manager. Rowden Medical Partnership is a teaching and training practice providing placements for GP registrars and medical and nursing students.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available between 8am until 11.30am every morning and 2.30pm to 6.30pm every afternoon. Telephone appointments are also available to book. Extended hours appointments are offered from 7am on Wednesday and Friday mornings and from 6.30pm to 7.30pm on a Monday evening. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments were available for patients that needed them.

When the practice is closed patients are advised, via the practice website and telephone answer machine that all calls will be directed to the out of hour’s service. Out of hours services are provided by Medvivo.

The practice has a Primary Medical Services (PMS) contract to deliver health care services. A PMS contract is a locally agreed alternative to the standard General Medical Services contract used when services are agreed locally with a practice which may include additional services beyond the standard contract.

Rowden Medical partnership is registered to provide services from the following location:

Rowden Hill,

Chippenham,

Wiltshire

SN15 2SB

This inspection is part of the CQC comprehensive inspection programme and is the first inspection of Rowden Medical Partnership.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rowden Medical Partnership on 29 September 2016. Overall the practice is rated as outstanding.

• 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.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the initiation of complex care clinics.
• Information about safety was highly valued and was used to promote learning and improvement. For example the system developed by the practice to monitor patients on high risk medicines.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the implementation of an early home visiting service.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The partners recognised staff for their areas of expertise and demonstrated a willingness to learn and improve systems suggested by staff and there was a strong focus on staff development.
• The practice was a teaching and training practice and had been selected to provide training and mentoring for GP registrars who required additional support.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

• People’s individual needs were central to planning and the delivery of tailored services. For example, the practice had initiated a complex condition clinic where patients were seen by a GP, the pharmacist and the care coordinator to ensure patients received a comprehensive holistic review that met all health and social care needs .
• Patients with a care plan in place were given access to a dedicated urgent telephone line between 8am and 10am. Each day a GP was available to visit these patients between 9am and 10am. The purpose of this was to ensure that patients could be assessed and a management plan commenced early in the day, to help prevent unnecessary hospital admission . We saw a number of examples where patients had benefitted from this service.
• The practice had developed a system where all patients on high risk medicines were given written information, in a wallet sized card. Greater understanding had resulted in patients working in partnership with the practice and taking greater responsibility and ownership to ensure monitoring regimes were followed.
• The practices information technology administrator supported patients, who required it, on an individual basis or demonstration sessions during flu clinics, to gain access to online services which provided greater flexibility and convenience to access appointments and had increased the numbers of patients utilising on line services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 November 2016

The practice is rated as outstanding 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. Nursing staff had undertaken specialist diplomas in chronic disease to ensure high quality care was delivered to patients.
• The practice delivered an earlier home visiting service to ensure patients with deteriorating health, could be assessed and a management plan commenced early in the day, to help prevent unnecessary hospital admission.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was within target range (2014/15) was 85% compared to a local average of 80% and a national average 78%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check 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.

Updated 23 November 2016

The practice is rated as outstanding 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.
• The practice was a young person friendly practice and delivered the ‘No Worries’ service, a confidential sexual health service for all young people aged 13-24.
• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (2014/15 ) was 83% compared to a local average of 85% and a national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• GPs were always involved in child immunisation clinics which allowed for immediate decisions to be taken regarding unscheduled immunisations for poor attenders and for the children of a refugee family that were registered with the practice.

Updated 23 November 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice employed a care coordinator to enhance integrated care delivery, by liaising with other health and social care professionals, to help support and coordinate the care of older patients who had complex needs.
• The practice employed a practice pharmacist who worked with older patients who needed additional support to understand medicine regimes and to enhance compliance.
• A clinic to review older patients with complex needs had been initiated to ensure a comprehensive review that met all health and social care needs was delivered.

Updated 23 November 2016

The practice is rated as outstanding 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 services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Extended hours surgeries were offered for patients to be able to attend outside of working hours.

Updated 23 November 2016

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

• 91% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which was better than the local average of 88% and the national average of 84%.
• The percentage of patients with a serious mental health illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014/15) was 97% compared to a local average of 93% and a national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice 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.
• The practice 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 patients with mental health needs and dementia.
• The practice held an in house memory assessment clinic.

Updated 23 November 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• All patients with a care plan in place had access to an early morning dedicated telephone line to ensure these patients could be visited early in the day, to potentially prevent a hospital admission.
• The practice care coordinator supported vulnerable patients to gain access to appropriate social care packages.
• The practice 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.