The Wellbridge Practice

Updated 15 February 2017

The Wellbridge Practice is located in Wool which is close to Wareham, a market town in the county of Dorset. The practice has occupied its current, purpose-built facility since 2006 and is arranged over two floors. There are seven GP consulting rooms on the ground floor along with rooms for nurse treatment, phlebotomy and minor operations. A general office is also on the ground floor and situated away from the front reception desk. A library and administration offices are located on the first floor, as well as rooms for health visitors, district nurses and psychological counsellors. The first floor can be accessed by stairs or a lift, and the premises are fully accessible for disabled users.

The Wellbridge Practice is one of 97 GP practices in the NHS Dorset Clinical Commissioning Group (CCG) area. The practice has around 6,290 registered patients, most of whom live within a two to three mile radius of the practice. The practice patient populations do not align with the England average for some age groups, thus giving an indication of the area’s demography. These deviations are most noticeable for the 65 to 69 age group, which is well above the England average; and the 25 to 29 age group, which is well below the England average.

96% of the practice population describes itself as white British, and around 4% as having a Black, Asian and Minority Ethnic background. A measure of deprivation in the local area recorded a score of 8, on a scale of 1-10. A higher score indicates a less deprived area. (Note: an area itself is not deprived, it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and not all deprived people live in deprived areas). Most of the practice patients live within a two to three mile radius of the location.

The practice team consists of three GP partners (two male, one female) and three salaried GPs (two female, one male). The nursing team consists of one lead nurse and a practice nurse. There are two health care assistants (HCAs). The clinicians are supported by a practice manager, and teams of receptionists, administrators and secretaries. The practice has a Personal Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice).

The practice is open from 8.30am to 1pm and from 2pm to 6.30pm, Monday to Thursday. On Friday the practice is open from 8.30am to 12.30 pm and from 2.30pm to 6.30pm. Routine GP appointments are available from 8.30am to 11.40am and from 4pm to 5.50pm, Monday to Friday. A duty doctor is available between 8am and 8.30am, Monday to Friday.

The practice provides extended hours appointments with a GP from 7am to 7.45am on two mornings per week, and from 6.30pm to 7.15pm on two evenings per week. The practice also offers a later evening cervical screening clinic on one evening every fortnight (a cervical screening test is a method of screening women for the earliest signs ofcancer of the neck, or cervix, of the womb). All appointments can be pre-booked up to four weeks in advance.

The Wellbridge Practice has a dispensary and a member of the dispensary team is available from 8.30am to 1pm and from 2pm to 6.30pm, Monday to Thursday. On Friday, a member of the dispensary team is available from 8.30am to 12.30pm and from 3.30pm to 6.30pm. The dispensary dispenses to 57% of patients, and only to those who live more than a mile from their nearest pharmacy.

The practice has opted out of providing Out Of Hours services to its own patients. Outside of normal practice hours, patients can access NHS 111, and an Out Of Hours GP service is available. Information about the Out Of Hours service was available on the practice website, on the front door, in the patient registration pack, and as an answerphone message.

The Wellbridge Practice provides regulated activities from its sole location at Meadow Lane, Wool, Wareham BH20 6DR.

Updated 15 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Wellbridge Practice on 9 January 2017. 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.
• 90% of patients said they could get through easily to the practice by phone (national average 73%).
• The practice worked closely with a volunteer car service. The service transported patients who could not attend to the practice and the local hospital, and collected prescriptions from the practice dispensary.
• The practice participated in a social prescribing scheme to support patients who attend their GP surgery but did not necessarily require medical care. Social prescribing supported patients with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs.
• Staff had lead roles that improved outcomes for patients such as a carer’s lead.
• 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.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
• The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.

We saw one area of outstanding practice:

• There were several examples of the practice proactively working with its patient participation group (PPG) to make changes to the practice management team. These suggestions had been acted upon and as well as this, the group had raised awareness to patients about practice services. The practice and PPG set up a support group for patients who had experienced bereavement. A member of practice staff who was a trained CRUSE bereavement counsellor facilitated the sessions. Each session was attended by an average of six patients and the group met weekly for a total of eight weeks. The practice and PPG also established monthly ‘Health Education Evenings’, for hard to engage patients. Invited health care professionals focused on issues such as exercising, smoking cessation and diabetes management. The education evenings attracted around 30 patients.

We saw one area where the provider should make improvement:

• The provider should continue to make efforts to identify a greater proportion of carers from its patient list, to better support the population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 February 2017

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

• Nursing staff had lead roles in chronic disease management, such as in diabetes care and patients at risk of hospital admission were identified as a priority.
• Performance for patients with long-term conditions compared with national averages. For example, 75% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 76%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
• 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.
• The practice routinely offered longer appointments for patients with complex medical needs.
• The practice identified patients at risk of developing diabetes and implemented changes that could help to delay or prevent the progression of this health condition.

Updated 15 February 2017

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 patients 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 assessed the capability of young patients using Gillick competencies. These competencies were an accepted means to determine whether a child was mature enough to make decisions for themselves.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 82%, which was comparable to the national average of 81%.
• 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.

Updated 15 February 2017

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 patients in its population.
• Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• A carer’s lead worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
• The practice initiated the use of a recognised clinical measure of fitness and frailty in older patients to assess their health needs.

Updated 15 February 2017

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.
• The practice offered extended hours morning and evening appointments with a GP, as well as extended hours evening appointments with a nurse for cervical screening tests.
• Patients were able to book appointments and order repeat prescriptions online.
• The practice offered text reminders for appointments.
• Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

Updated 15 February 2017

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

• 83% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which compared with both the clinical commissioning group (CCG) average of 86% and national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 83%, which was slightly below the national average of 89%.
• 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.

Updated 15 February 2017

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 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.
• 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 was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.