Prestbury Medical Practice

Updated 30 August 2016

Prestbury Medical Practice is registered to provide medical services over three sites within the Wolverhampton area. The main practice is based at Prestwood Road West Surgery, 81 Prestwood Road West, Wednesfield, Wolverhampton WV11 1HT. The branches are located at Bushbury Health Centre, Hellier Road, Bushbury, Wolverhampton WV10 8ED and Dunkley Street Surgery, 41 Dunkley Street, Wolverhampton WV1 4AN. For this inspection a visit was made to the main practice and the branch practice located at Bushbury Health Centre. The practice and branches have good transport links for patients travelling by public transport and parking facilities are available for patients travelling by car. There is level access at all sites. Services are provided to patients on the ground floor of each of the premises and all areas are easily accessible by patients with mobility difficulties, patients who use a wheelchair and families with pushchairs or prams. There is a higher practice value for income deprivation affecting children and older people in comparison to the practice average across England.

The practice team consists of six GP partners and two salaried GPs (two female and six male). The GPs are supported by an advanced nurse practitioner, four part time practice nurses and three part time healthcare assistants. Clinical staff are supported by a practice management team consisting of a practice manager, a human resources office, finance officer, IT leader, and a practice administrator. Members of the clinical team which includes the advanced nurse practitioner are also part of the management team. There are 17 reception staff (two senior receptionists) and three secretaries. In total there are 52 staff employed either full or part time hours to meet the needs of patients. The practice also use GP locums at times of absence to support the clinicians and meet the needs of patients at the practice. The practice is accredited as a teaching and training practice for medical students and GP trainees.

The main practice and branches are open between the following times:

Prestwood Road West Surgery - This practice is open between 8.30am and 6.30pm on Monday, Wednesday and Friday, 8.30am to 5pm on Thursday and from 8.30am to 1.30pm and 3pm to 6.30pm on Tuesday. The practice is closed for staff training on Tuesdays between the hours of 1.30pm and 3pm.

Bushbury Health Centre - This branch is open between 8.30am and 6.30pm on Monday, Tuesday and Friday, 8.30am to 5pm on Thursday and from 8.30am to 1.30pm and 3pm to 6.30pm on Wednesday. The practice is closed for staff training on Wednesdays between the hours of 1.30pm and 3pm.

Dunkley Street Surgery - This branch is open from 8.30am to 11.45pm and 3.45pm to 6.30pm on Monday, Tuesday, Wednesday and Friday and 8.30am to 11.45am on Thursday. Calls to the Dunkley Street branch site between 8am and 8.30am are transferred to the Bushbury Health Centre branch.

The reception telephone lines are open at 8am, Monday to Friday at all practice sites. The practice telephone lines are closed on Thursday at 1pm at the main practice and also at the Bushbury Health Centre branch site. Extended hours appointments are offered on Saturday from 8.30am to 11.30pm at the Prestwood Road West Surgery. This practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service provided by West Midlands Doctors Urgent Care via the NHS 111 service.

The practice has a General Medical Services contract with NHS England to provide medical services to approximately 14,000 patients over the three sites. It provides Directed Enhanced Services, such as childhood vaccinations and immunisations, minor surgery and the care of patients with a learning disability. The practice has a higher proportion of patients; mainly female patients aged 50-59 and 65 years plus when compared with the average across England. The practice is located in one of the most deprived areas of Wolverhampton. People living in more deprived areas tend to have a greater need for health services. The level of income deprivation affecting children of 27% is higher than the national average of 20%. The level of income deprivation affecting older people is higher than the national average (26% compared to 16%).

Updated 30 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Prestwood Road West Surgery on 14 June 2016. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they could not always get through to the practice on the telephone.
• Patients said that there was not always continuity of care as they did not find it easy to make an appointment with a named GP. Urgent appointments were 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.

We saw areas where the practice should make improvements:

• Consider pro-actively identifying carers and establishing what support they are provided with.
• Review the arrangements for ensuring curtains used in patient areas are changed in a timely way.
• Consider carrying out a risk assessment to review access at the reception desk for patients who use wheelchairs.

• Review the arrangements for recording minutes of meetings so that staff involvement in decisions made are clearly demonstrated.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 August 2016

The practice is rated as good for the care of people with long-term conditions.

• The GPs and practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The GP and practice nurses worked with relevant health care professionals to deliver a multidisciplinary package of care to patients with complex needs.
• The practice Quality and Outcomes Framework (QOF) for the care of patients with long-term conditions was higher overall compared to the local and national average. For example the practice performance for diabetes related clinical indicators overall was higher than the local Clinical Commissioning Group and England average (93% compared to the local average of 82% and England average of 89%).
• 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 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.
• Individual longer clinics led by all three practice nurses were held to review patients with more than one long-term condition to prevent multiple appointments for patients.

Updated 30 August 2016

The practice is rated as good for the care of families, children and young people.

• The practice used an assessment tool to identify and trigger follow up of children living in disadvantaged circumstances and those at risk. This included for example children who repeatedly attended A&E and out-of-hours services.
• 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.
• Babies were given their first immunisations on the same day as mothers were offered their six week postnatal check.
• The practice’s uptake for the cervical screening programme was 79% which was comparable to the local CCG average of 78% and England average of 82%.
• Appointments were available outside of school hours and urgent appointments were available for children.
• We saw positive examples of joint working with other professionals.

Updated 30 August 2016

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

• The practice offered personalised care to meet the needs of the older people in its population. Home visits and flexible appointments were available for older patients.
• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.
• The practice maintained a register of housebound older patients and older patients who required a home visit.
• The practice clinic arrangements included allocating one of the GPs to carry out daily home visits during the practice appointment times.
• The practice had a proactive working relationship with six care homes. Three of the care homes had a named GP and a weekly ward round was carried out at these homes.
• Older patients were offered urgent appointments for those with enhanced needs plus longer appointments which gave them more time to discuss health issues with a clinician.

Updated 30 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice had adjusted some of the services it offered to meet the needs of the working age population, those recently retired and students to provide improved accessibility and flexibility.
• The practice offered on the day pre-bookable appointments, the last pre-bookable appointment was offered at 6pm. Telephone consultations were available.
• Extended hours appointments were offered on Saturday from 8.30am to 11.30pm at the main practice site.
• The practice was proactive in offering online services which included making online prescription and appointment requests.
• Patients were signposted to a full range of health promotion and screening that reflects the needs for this age group.

Updated 30 August 2016

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 who experienced poor mental health, including those with dementia.
• The practice maintained a register of patients diagnosed with dementia and
• The practice held a register of patients who experienced poor mental health. Clinical data for the year 2014/15 showed that 91% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Counselling clinic sessions were held at the practice with an experienced mental health counsellor based in the community.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 90%, which was higher than the national average of 84%.

Updated 30 August 2016

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

• The practice held a register of vulnerable patients which included patients with a learning disability. The practice offered longer appointments for patients with a learning disability.
• An easy read (pictorial) letter was sent to patients with a learning disability inviting them to attend the practice for their annual health check and updating care plans.
• The practice was alerted to other patients whose circumstances may make them vulnerable to ensure that they were registered with the practice if appropriate.
• The practice supported patients who misused substances that could negatively affect their health.
• The practice provided a service to patients who suffered domestic abuse.
• Staff were aware of their responsibilities regarding confidentiality, information sharing, documentation of safeguarding concerns and how to contact relevant agencies.
• The practice had told vulnerable patients about how to access various support groups and voluntary organisations. The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.