Stroud Practice

Updated 23 December 2016

Stroud Practice is in Walsall an area of the West Midlands. The practice is registered with the Care Quality Commission to provide primary medical services. The practice has a general medical services contract (GMS) with NHS England. Under this contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care. The practice runs an anti-coagulation clinic and also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes.

The practice is situated in a multipurpose building with two other GP practices and a pharmacy. Based on data available from Public Health England, the levels of deprivation in the area served by Stroud practice are ranked at four out of ten, with ten being the least deprived. The practice has a registered list size of approximately 4,700 patients. The practice had a lower than average number of patients aged 75 years and over with 5% of the practice population being in this age group, which was lower than the local average of 8%.

There are two GP partners (1 male, 1 female). The nursing team consists of one nurse prescriber, one practice nurse and one health care assistant. The non-clinical team consists of a practice manager, administrative and reception staff. Some of the reception staff also carry out the role of phlebotomy. At the time of the inspection we were advised that a new GP Partner will be commencing in January 2017 and the female GP partner will be leaving the practice.

The practice is open to patients between 8am and 6.30pm Monday to Friday. Extended hours appointments are available 6.30pm to 7.30pm on Tuesday. Telephone consultations are also available and home visits for patients who are unable to attend the surgery.

When the practice is closed, primary medical services are provided by Primecare, an out of hours service provider accessed via the NHS 111 telephone service and information about this is available on the practice website.

The practice is part of NHS Walsall Clinical Commissioning Group (CCG) which has 63 member practices. The CCG serve communities across the borough, covering a population of approximately 274,000 people. A CCG is an NHS Organisation that brings together local GPs and

experienced health care professionals to take on commissioning responsibilities for local health services.

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stroud Practice on 2 November 2016. Overall the practice is rated as Good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. The practice had recently started using the National Reporting and Learning System (NRLS).
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• 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.
• The practice worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.
• The practice had good facilities and was well equipped to treat patients and we observed the premises to be visibly clean and tidy.
• Patients could access appointments and services in a way and at a time that suited them and 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.
• Patients surveyed reported high satisfaction with the helpfulness of receptionists and access to the practice by telephone.
• Notices in the patient waiting room told patients how to access a number of support groups and organisations and the practice leaflet encouraged patients to identify themselves to staff.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result. The provider was aware of and complied with the requirements of the duty of candour.
• There was a clear leadership structure and staff felt they were supported by the practice manager. The practice proactively sought feedback from staff and patients, which it acted on.

There were also areas of practice where the provider should make improvements:

• Continue to proactively identify registered carers

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. 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. We saw evidence that meetings were held every month.
• Patients had a named GP and a structured annual review to check their health and medicines needs were being met.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions.
• Longer appointments and home visits were available when needed and the practice nurse prescriber carried out home visits twice a week to patients who were unable to attend the surgery.
• A community diabetic nurse ran clinics twice a month to support patients with complex diabetes.

Updated 23 December 2016

• 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.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice offered extended family planning services including intra uterine devices (IUCD) fittings and contraceptive implants.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered walk in appointments for children who needed to see a GP during opening hours.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The midwife provided antenatal care every week at the practice.
• The practice’s uptake for the cervical screening programme was 88% which was higher than the national average of 82%.

Updated 23 December 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Care plans were in place for those at risk of unplanned admissions. The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included blood tests and vaccinations for those patients who were unable to access the practice.
• The practice worked closely with multi-disciplinary teams so patients’ conditions could be safely managed in the community and the practice had subscribed to consultant connect where consultants were available on a dedicated phone line for prompt advice.
• Data provided by the practice showed that 100% of patients on the practice palliative care register had a face to face review in the past 12 months.

Updated 23 December 2016

• 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 used electronic prescribing system (EPS) to assist patients who could not collect their prescriptions during opening hours.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years. Data provided by the practice showed 283 patients had received a health check in the past 12 months.
• The practice offered a choice of extended hours to suit their working age population, with later evening appointments available once a week. Results from the national GP survey in July 2016 showed 82% of patients were satisfied with the surgery’s opening hours which was higher than the local average of 77% and the national average of 76%.

Updated 23 December 2016

• 91% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• A counselling service was offered by a primary care mental health nurse once a week to support patients with mental health needs.
• 96% of patients on the practice’s mental health register had had their care plans reviewed in the last 12 months, which was higher than the national average of 89%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 December 2016

• The practice held a register of patients living with a learning disability, frail patients and those with caring responsibilities and regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice offered longer appointments and annual health checks for people with a learning disability. Data provided by the practice showed that 75% of patients on the learning disability register had received their annual health checks. The practice sent regular appointments to these patients and was encouraging them to attend their health checks.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and held meetings with the district nurses and community teams every month.
• 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’s computer system alerted GPs if a patient was also a carer. There were 34 patients on the practices register for carers; this was 0.7% of the practice list.