Archived: The Medical Centre Ridingleaze

Updated 27 July 2017

The location is part of the Pioneer Medical Group, which is situated in the North of Bristol with over 20,000 patients in Brentry, Henbury, Southmead, Westbury on Trym, Coombe Dingle, Hallen, Lawrence Weston, Easter Compton, Henleaze, Avonmouth, Severn Beach, Shirehampton and Sea Mills. Patients can attend appointments at any site but are encouraged to consult with the same clinician.

The location address is:

The Medical Centre

Ridingleaze

Lawrence Weston

Bristol

BS110QE

The Medical Centre in Ridingleaze at Lawrence Weston has been at its current site since the 1980’s. It is a purpose-built surgery which is located in a deprived urban location in North West Bristol. The surgery is close to the M5 and is approximately 4 miles from the City Centre of Bristol. The surgery has car parking for 12 cars including a space for blue badge holders.

All consulting and treatment rooms are on the ground floor as are the accessible facilities.

The service runs its own paediatric surveillance/childhood immunisation and substance misuse clinics.

Pioneer Medical Group has a shared list which means that patients do not have to see the doctor they are registered with. However, patients are encouraged to keep with the same doctor for any one episode of illness. All patients have a named GP. Patients can visit any of the Pioneer sites for care as they have one clinical database which can be accessed from all sites.

The surgery is open between 8am and 6.30pm Monday to Friday. There is a mixture of appointments available on the day and appointments that can be booked in advance. Patients can pre-book an appointment from 7.30am on Tuesday, Wednesday and Thursday, until 7pm Monday, Tuesday and Wednesday, and between the hours of 8.00am and 11am on a Saturday morning.

The Pioneer Medical Group take GPs returning to general practice, trainee GP placements, hospital training doctors and medical students from the University of Bristol.

Community staff are separately accommodated locally by Bristol Community Health.

The location was inspected in June 2015 when it was registered with the previous provider.

Updated 27 July 2017

Letter from the Chief Inspector of General Practice

The Medical Centre Ridingleaze is part of the Pioneer Medical Group which was formed in April 2016 from the merger of three GP practices the others being the Bradgate Surgery (rated as outstanding), and the Avonmouth Medical Centre (previously rated as good). We carried out an announced comprehensive inspection at this location The Medical Centre Ridingleaze on 17 May 2017.

Overall the location is rated as outstanding.

The findings from this inspection are for the Pioneer Medical Group overall unless identified as being specific to the Medical Centre Ridingleaze.

The key findings from the inspection were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The service had clearly defined and embedded systems to minimise risks to patient safety.
• The service used innovative and proactive methods to improve patient outcomes, working with other local providers to share best service. For example, the service had worked in partnership with the One Care Consortium to develop integrated IT systems across the service. They won an Innovation Award from NHS England South in 2016 for best use of technology.
• Feedback from patients from the Friends and Family Test was consistently positive.
• The service had strong and visible clinical and managerial leadership and governance arrangements.
• The service had clearly defined and embedded local and organisational systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The location had good facilities and was equipped to treat patients and meet their needs. The service had secured funding through the NHS England's Estates and Technology Transformation Fund (ETTF) to work in partnership with local services to build a new community facility which would provide health and social care from one central site.
• There was a clear leadership structure and staff felt supported by management. The service proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the service complied with these requirements.

The areas where the provider should make improvement are:

• The provider should review the arrangements for the storage of the emergency equipment so that if needed they can be assured it has not been tampered with.

• The provider should review the arrangements for intrauterine device insertion in respect of the environmental infection control risks.

• The provider should ensure that medicines stored in refrigerators are secure.

• The provider should review the potential risks and arrangements for the control of prescription paper.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 July 2017

The location is rated as overall outstanding for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The service followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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.

• There had been specific work within the service to target the high risk groups detailed in the April 2016 health profile. The service was proactive in accessing supportive networks and projects such as the H G Wells project for patients who were diagnosed with diabetes to enhance the treatment for patients.

• The service ensured attendance at the Air Quality Meeting (which is a community group concerned with the air quality in the area which is industrialised) by a member of the management team to support respiratory patients.

Updated 27 July 2017

The service is rated as outstanding for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were similar to England averages for all standard childhood immunisations for the 5 year age group.

• We observed that children and young people were treated in an age-appropriate way and were recognised as individuals.

  Appointments were available outside of school hours and the premises were suitable for children and babies.

• The service worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The service had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The service participated in the 4YP scheme (for young people) and had a drop in clinic for sexual health.

• The Pioneer Group worked closely with the local schools to promote health education for young people including supporting young people to access mental health services such as the ‘Off the Record” service. GPs routinely were involved in visiting schools and educating children about health and well-being; they also contributed articles to the local community newsletters.

• The service had the Paediatric Handi-app available to download through their website and Facebook page which provided expert support to parents/carers looking after children with the most common childhood illnesses.

Updated 27 July 2017

The location is rated as overall outstanding for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The service offered proactive, personalised care to meet the needs of the older patients in its population. the service employed a care co-ordinator who liaised with patients and community or secondary services

• The service was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. They ensured continuity of care by matching the clinician with the best knowledge of the patient to the home visits.

• The service identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The care co-ordinator for the service followed up on patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the service shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible, and could be referred for inclusion in the ‘Community Web’ project to support them to access other support services.

• The service had close links with local facilities for older people and provided specific clinics at a care home and a sheltered housing site and signposted non-residents to activities run on the site to reduce social isolation. The service also referred to the Red Cross befriending services.

Updated 27 July 2017

The location is rated as overall outstanding for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the service had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, routine appointments were bookable in advance with a 'sit and wait' surgery on a daily basis from 11am for patients that need to be seen that day, on the day telephone consultations, appointments, extended opening hours and Saturday appointments.

• The service 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 27 July 2017

The location is rated as overall outstanding for the care of people experiencing poor mental health (including people with dementia).

• The service carried out advance care planning for patients living with dementia.

• The service specifically considered the physical health needs of patients with poor mental health and dementia. Those patients with a diagnosed mental illness were seen by the same GP who had a specialist interest in mental health.

• The service had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The service regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The service had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The service had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. Such as signposting patients to the local or community farm. Routinely referring to the local Polish counselling service.

• The service had complex patients with dual diagnosis mental illness and addiction. They had a one hour appointment on a Saturday which is booked by the clinician to review complex and/or poly-pharmacy patients.

Updated 27 July 2017

The location is rated as overall outstanding for the care of people whose circumstances may make them vulnerable.

• The service held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. People who are homeless can register using the service address and then access the open surgery for appointments.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The service offered longer appointments for patients with a learning disability. There was a practice nurse who had a specialist interest in these patients who ran a ‘Healthy Home’ project with patients carers educate them about the specific risks, such as diabetes and heart disease, for the patients in their care.

• The service regularly worked with other health care professionals in the case management of vulnerable patients. The service employed a care co-ordinator who liaised with patients and community or secondary services. The service also liaised with the health visitor for travellers to share information and support attendance for health care.

• The service had information available for vulnerable patients about how to access various support groups and voluntary organisations. We observed the service had information discreetly available relating to domestic abuse, and ensured staff had attended training in this topic.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 Pioneer group promoted staff training about domestic violence and they participated in two local schemes IRIS (Identification and Referral to Improve Safety) for women and HERMES (Health professionals responding to men for safety) for men. The IRIS newsletter for February 2017 newsletter indicated that the group had made more referrals than any other practice in Bristol (8 in the last quarter) which demonstrated their commitment to the safety of their patients.