Wem and Prees Medical Practice

Updated 17 March 2016

The Wem and Prees Medical Practice main surgery is located in Wem, Shropshire. It also has a new purpose built branch practice in Prees. This new build was provided by the Grocott Family Trust and rented back to the practice located in Prees. The main practice at Wem has also had significant recent building improvements. It is part of the NHS Shropshire Clinical Commissioning Group. The total practice patient population is 10,722. The practice catchment area is an eight mile diameter which covers Wem, Prees and surrounding villages. The practice is a rural dispensing practice, the main local employers are farming and light industry. The practice has a majority of patients (97-98 %) who speak English and the majority of patients were born in England (89%), the largest minority group are Polish. The practice provides GP services to a traveller community and patients moored at a local marina on the Shropshire canal. They also provide services to two care homes, two residential learning disability/supported living homes and two Looked after Children’s homes.

The staff team comprises of seven GP partners and one salaried GP. The partners each work six sessions (three days) at the practice per week and the salaried GP provides four sessions (two days). The clinical practice team includes a lead practice nurse, three practice nurses, an assistant practitioner, and a phlebotomist (a person who takes blood). At Prees, the dispensary staff include a dispensary manager and four dispensary staff. Wem and Prees Medical Practice is managed and supported by a practice manager, receptionist manager, a receptionist/summariser, eight receptionists, two administration support staff, a secretary, a typist/receptionist, an IT administrator, and a community care-coordinator. In total there are 37 full or part time staff. All staff with the exception of the dispensary staff at Prees work at both the main and branch locations. The practice is a training practice for GP registrars (a GP Registrar is a qualified doctor who is training to become a GP through a period of working and training in a practice), and medical students.

The practice appointments are available Monday to Friday from 8.30am to 10.50am and 3pm to 5.30pm. Extended access includes late evening appointments on a Monday evenings at Wem, 6.30pm to 8.30pm and once a month on a Thursday evening at Prees, 6.30pm to 8.30pm. On the day urgent appointments are available from 11.30am Monday to Friday and what is ‘urgent’ is defined by the patient. The afternoon urgent appointments are with the duty doctor following a triage assessment. Telephone consultations are available daily and calls are returned after the morning and afternoon surgery. 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 support for patients for example with long-term condition management including asthma, diabetes and high blood pressure. It also offers child immunisations and minor surgery. The practice offers health checks and smoking cessation advice and support. 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 offer a dispensing service, minor surgery, and the childhood vaccination and immunisation scheme.

The practice are in the process of changing the registration of their location at Prees with the CQC to reflect that it is a branch location.

Updated 17 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wem and Prees Medical Practice on 12 February 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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.
• 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:

• Consider improvements to the documented system in place following learning from events or incidents.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2016

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.

• The percentage of patients with Chronic Obstructive Pulmonary Disease (COPD) who had a review undertaken including an assessment of breathlessness in thepreceding 12 months was 93.28% which was slightly higher than the national average of, 89.9%.(COPD is an umbrella term used to describe a number of conditions including emphysema and chronic bronchitis).

• The percentage of patients with atrial fibrillation with CHADS2 score of 1, who were treated with specific medicines was 100% and slightly higher than the national average of 98.36%. (The CHADS2 score is a clinical prediction rule for estimating the risk of stroke in patients with atrial fibrillation (AF), a common abnormal heart rhythm).

• All patients with long-term conditions 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.

• Patients with a long term condition were called for a ‘birth month review’ (unless needed more frequently). Reminder letters and leaflets were sent to patients each month if a review was due.

Updated 17 March 2016

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 diagnosed with asthma, on the register, who had had an asthma review in the last 12 months was 70.83% compared to the national average of 75.35%.

• 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 80.2% which was comparable to the national average of 81.83%.

• 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, the local sure start centre and school nurses.

• Confidential Help and Advice for Teens (CHAT)for young people (sexual health) and condom service was available at the practice. (CHATincludes services in secondary schools, GP practices who display the CHAT logo, and some Youth Service buildings. It is a free, confidential service for young people, aged 11 to 19 years). This enabled open access for school age children registered elsewhere for sexual health needs.

• The practice had baby changing facilities and was breast feeding friendly.

Updated 17 March 2016

The practice is rated as good 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 monitored on a weekly basis their avoiding unplanned admissions to hospital register supported by the community care-coordinator, ensuring patients were contacted and any concerns/needs identified and acted upon appropriately. This included flagging any concerns with the out of hours service for continuity of care.

• The practice added alerts onto their electronic systems for patients with particular needs, for example hearing or visual impairment. This enabled staff to be aware if a longer appointment was required and of the patients communication or access requirements.

• Care home patients were visited on scheduled routine weekly visits by the GPs, with visits on other days for acute conditions.

Updated 17 March 2016

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 services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice offered a minor injuries service for patients.

• The practice offered a pharmacy collection service and a dispensary service at the Prees practice.

Updated 17 March 2016

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

• Performance for mental health related indicators was similar to the national average. For example, the percentage of 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 was 89.13% when compared to the national average of, 88.47%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 facilitated Community Mental Health Liaison appointments weekly at the practice.

• The practice in house counsellor attended the practice twice a week.

Updated 17 March 2016

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 which could include travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability and annual health check appointments were made.

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

• 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.

• The practice community care coordinator visited the practice twice a week, to coordinate the support offered within the community and within the voluntary sector to meet the needs of patients with complex needs.

• Patients whose circumstances may make them vulnerable were flagged with the out of hours provider (Shropdoc) system for continuity and a handover of care.