The Three Shires Medical Practice - Wick

Updated 7 September 2018

The Three Shires Medical Practice provides GP services from four surgeries in rural areas of South Gloucestershire and Wiltshire. Although each surgery is registered as a separate location (or GP practice) with the Care Quality Commission they operate as one practice with a centralised management structure. The practice is a partnership of five GPs, who are responsible for all regulated activities across all four surgery locations. The regulated activities are delivered from surgeries at:

• Three Shires Medical Practice - Pucklechurch, 12 Becket Court, Pucklechurch, South Gloucestershire, BS16 9QG.
• The Three Shires Medical Practice - Colerne, 35 High Street, Colerne, Wiltshire, SN14 8DD.
• The Three Shires Medical Practice - Marshfield, 2 Back Lane, Marshfield, South Gloucestershire, SN14 8NQ.
• The Three Shires Medical Practice - Wick, 111 High Street, Wick, South Gloucestershire, BS30 5QQ.

We visited all four surgeries on the same day during this inspection. Details of all the surgeries can be accessed via a single practice website:

The Three Shires Medical Practice has a single patient list of approximately 9,280 patients and whilst patients can use any of the surgeries, they tend to see a GP at the surgery nearest to where they live. Each of the four surgeries is able to offer dispensing services to those patients on the practice list who lived more than one mile (1.6km) from their nearest pharmacy. The practice has signed up to Dispensary Services Quality Scheme (DSQS) which rewards practices for providing high quality care to their dispensing patients.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the tenth least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas).

As well as the five GP partners, there are three salaried GPs who collectively provide 5.9 whole time equivalent (WTE) GPs. The practice also employs two nurse practitioners and six other nurses along with phlebotomy, reception, administrative and managerial staff.

The Colerne practice support approximately 1,940 patients including those from a local military base. There are a higher number of patients under 10 years of age and creased demand on maternity services than at the other surgeries. The practice is open from 8.30am to 5.30pm Monday to Friday and remains open until 6.30 pm on Wednesday each week.

The Marshfield practice supports approximately 2,560 patients, with more patients aged 40 to 60 years old because of its proximity to the motorway system and suitability for patients who commute to work. Locally there is a mixture of farming and rural housing; and a mixture of affluence and deprivation. The practice is open from 8.30am to 5.30pm Monday to Friday and remains open until 6.30 pm on Tuesday each week.

The Pucklechurch practice is close to the Avon Ring Road and supports approximately 2,240 patients from Pucklechurch (which has some areas of deprivation) and the villages of Dyrham and Hinton. There are new housing developments at Emersons Green and the local patient list is growing. The surgery is open from 8.30am to 5.30pm Monday to Friday and remains open until 6.30 pm on Thursday each week.

The Wick practice supports approximately 2,500 patients and provides services mainly to those who live in local villages including Abson and Doynton. Some patients commute into nearby Bath and Bristol; and others live in a local sheltered housing complex. The practice is open from 8.30am to 5.30pm Monday to Friday and remains open until 6.30 pm on Monday each week.

The practice is a member of the South Gloucestershire Clinical Commissioning Group (CCG) and holds a personal medical services (PMS) contract. A range of other enhanced services are offered which provide services in addition to what is required under a core PMS contract. These enhanced services include; delivering meningitis and childhood vaccinations, facilitating timely diagnosis and support for patients with dementia and offering annual health checks for patients with learning disabilities.

When the practices are closed patients who live in South Gloucestershire can access Out Of Hours services provided by Brisdoc; and those who live in Wiltshire can access services provided by Wiltshire Medical Services.

Updated 7 September 2018

This practice is rated as Good overall.

The key questions at this inspection are rated as: Are services safe? – Good

When we visited The Three Shires Medical Practice on 21 November 2017, to carry out a comprehensive inspection, we found the practice was not compliant with the regulation relating to safe care and treatment. Overall the practice was rated as Good. They were rated as good for providing effective, caring, responsive and well-led services, and requires improvement for providing safe services. The full report on the November 2017 inspection can be found by selecting the ‘all reports’ link for The Three Shires Medical Practice  on our website at www.cqc.org.uk.

This report covers the announced follow up focused inspection we carried out at The Three Shires Medical Practice on 3 July 2018, to review the actions taken by the practice to improve the quality of care and to confirm that the practice was meeting legal requirements.

At this inspection we found:

• The practice had commissioned an external consultant to carry out a fire risk assessment and had taken action to address the recommendations made in the report. For example, they had fitting new fire signage at all four sites and installed emergency lighting at the Marshfield and Colerne sites.
• Each site had a premises folder which included an up to date fire log book which evidenced that evacuation drills and fire equipment tests had been carried out at the appropriate intervals.
• The practice had reviewed their security arrangements and had taken a range of actions to improve their security. For example, key safes had been installed at all four locations, the vaccine fridges were routinely kept locked and the keys stored in the key safe, and new doors had been commissioned for the cabinets used to store the old style patients records.

The practice is now rated as good overall and for the five key questions.

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Updated 31 January 2018

Updated 31 January 2018

Updated 31 January 2018

Updated 31 January 2018

Updated 31 January 2018

Updated 31 January 2018