Pontesbury & Worthen Medical Practice

Updated 3 November 2016

Pontesbury Medical Practice is located in Pontesbury, Shropshire. It is part of the NHS Shropshire Clinical Commissioning Group. The total practice patient population is 7,200. The practice, in line with the local

Clinical Commissioning Group (CCG), has a higher proportion of patients aged 65 years and when compared with the practice average across England. For example the percentage of patients aged 65 and above at the practice is 25%, the local CCG practice average is 24% and the national practice average, 17%.

The staff team comprises four GP partners and three salaried GPs. The clinical practice team includes three practice nurses, two healthcare assistants, and dispensary staff, a dispensary delivery driver and a dispensary administrator. The practice is managed and supported by a practice manager and a data administrator/deputy practice manager, three receptionists, an apprentice receptionist, a medical secretary, and a cleaner.

The practice is open Monday to Friday 8.30am to 6.30pm (excluding bank holidays). The dispensary opening hours are Monday to Friday 8.45am to 1pm and 2pm to 6.30pm. In addition, the practice offers pre-bookable appointments. Urgent appointments are also available for patients that need them. 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 switched 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 and diabetes. It also offers child immunisations, minor surgery, and travel vaccinations. The practice offers NHS 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 minor surgery, childhood vaccinations and immunisation scheme.

The practice is a training and teaching practice for medical students and GP registrars. GP registrars are attached to the practice for four to 12 months. The practice also has doctors on the returner scheme, these are doctors who have previously worked in the NHS but have recently had a career break.

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pontesbury Medical Practice on 3 March 2016. After the comprehensive inspection, the practice was rated as good overall with requires improvement in providing safe services. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pontesbury Medical Practice on our website at www.cqc.org.uk. We undertook a focussed follow up inspection on 20 September 2016 to check that improvements had been made. The practice is rated as good for providing safe services and rated good overall.

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

• Patients were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• General health and safety risk assessments had been completed, this included fire exits and maintenance records of all equipment including the wheelchair.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Training included a documented induction system and safeguarding adults and children to the appropriate levels as well as basic life support.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice ensured their recruitment arrangements included Disclosure and Barring Service (DBS) checks were completed for staff who had contact with potentially vulnerable patients and staff references recorded.
• Staff who provide a chaperone service were in receipt of chaperone training and had a Disclosure and Barring Service (DBS) check completed.
• The practice proactively sought feedback from staff including annual appraisals and patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 April 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. For example, the practice had specific diabetes management appointments with the nurses. One of the GPs had a special interest in diabetes and met with the nurses every Tuesday to discuss patients’ management.

• Patients were referred into the Expert Patient Programme, a self-management programme which helps people to improve their health and wellbeing by learning new skills to manage their condition.

• 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.
• Patients were referred when appropriate to the pulmonary rehabilitation clinic.

Updated 15 April 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.

• 82.52% of patients diagnosed with asthma, and on the register, had had an asthma review in the last 12 months when compared with 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.

• 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.

• The practice had a ‘Young Person Friendly Award’ and saw young people at short notice following a call from the school nurse.

• The practice participated in the ‘Condom Scheme’ and provided access for patients who needed emergency contraception. The practice provided a coil fitting service and contraceptive implants.

• The practice had a very low teenage pregnancy rate but could refer to the specific teenage pregnancy midwife for support when required.

Updated 15 April 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 provided a GP service to the 1% of their patient list at three care homes. The practice had actively engaged in the Care Homes Advanced Scheme (CHAS) for care homes in the locality. The aim of the project was to increase clinical input into care homes. The project was evaluated and recognised by the local CCG as an important initiative in preventing unplanned hospital admissions and providing more continuity to patients’ in care homes. All GP practices had agreed to provide a service to a small number of care homes. Before this, patients living in care homes received care and treatment from as many as 14 practices. This included time spent with individual patients and their families, creating or reviewing care plans and discussing issues such as current medical concerns, ‘just-in-case’ or rescue medication, resuscitation orders and how to avoid admission to hospital in general.

• The practice referred patients to their Compassionate Community Co-ordinator who assisted patients by signposting them to the most appropriate support groups for their needs.

• The practice provided a home delivery service to all dispensary patients but this benefitted the older patients and those unable to attend the practice the most.

• In 2015 the practice had a 32% uptake for the shingles vaccination of their eligible older population.

Updated 15 April 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 reflects the needs for this age group.

Updated 15 April 2016

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

• The practice hosted a monthly Specialist Memory Nurse clinic. The nurse saw all newly diagnosed patients at the practice as the practice was felt to be more familiar to patients.

• 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.

Updated 15 April 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 including travellers and those with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice held regular ‘Avoiding Unplanned Admissions Meetings’ and discussed their most vulnerable and frail population.

• 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 engaged with the local Compassionate Communities group known as Co Co. The initiative is not run by any one organisation but the community itself with the support of the hospice which provided training and ongoing guidance for volunteers. The scheme involved working with a number of local communities and medical practices.