Archived: Willow Tree Surgery

Updated 9 August 2016

The Southmead and Henbury Family Practice provides services across two sites. The main practice is in Ullswater Road in Southmead and the other practice known as the Willow Tree Surgery in Trevelyan Walk in Henbury.

The practice register lists in excess of 11,300 patients with a higher than average number of children registered. Approximately 3,270 patients are registered at the Willow Tree surgery. There are eight partners and two salaried GPs comprising of six females and two males. There is a practice business manager and assistance practice business manager. The nursing team are managed by a senior nurse manager. There is also a business support team.

Information from Public Health England indicates the practice provides services in areas of high deprivation with higher than national rates for child poverty, older people living in poverty and long term unemployment. The practice told us the average life expectancy for people living in this area is 9.4 years less than neighbouring Henleaze.

The practice provides services under the standard personal medical services contract. These being essential, additional and enhanced services. The core (essential) services include GP consultations, asthma clinics, coronary heart disease clinics and diabetes clinics. Additional services include contraceptive services, maternity services and child health surveillance.

Enhanced services include dementia identification and management, diabetes management and learning disability management. The practice also provides a range of other services including minor surgery. There is an independent pharmacy within the Willow Tree Surgery.

We inspected both locations within this organisation. This report relates to the regulatory activities being carried out at:

1 Trevelyan Walk,

Bristol,

BS10 7NY

Updated 9 August 2016

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection on 18 March 2015. Overall the practice was rated as good with requires improvement for the safe domain. Following that inspection we issued a requirement notice. This notice was due to a breach of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment. The requirement notice was for the practice to implement the necessary changes to ensure patients who used the service were protected. A copy of the report detailing our findings can be found at www.cqc.org.

Our previous key findings across the areas we had inspected that needed to improve were as follows:

The provider must:

• Ensure the security of blank prescriptions at all times.

• Ensure the safe storage of combustible items and toxic chemicals.

• Maintain the premises to a safe standard at all times.

• To ensure all aspects of infection control are maintained. The provider must ensure there are suitable arrangements in place for the management of clinical waste and ensure all areas of the practice are maintained in a way to reduce the risk of cross infection. In addition, they must ensure there are suitable arrangements for the safe handling of and management of bodily fluids taken as specimens.

The provider should:

• Ensure that non-medical electrical equipment is maintained.

• Check the water supply to ensure there is no risk of legionella.

At the previous inspection in March 2015 we had also noted that there were gaps in the prescription paper management at the practice and that the practice did not have a sufficiently detailed business continuity plan.

At the inspection undertaken in June 2016 we found:

• Changes had been put in place for prescription paper management, however, minor amendments were made during the inspection for greater security, it is the practices responsibility to ensure these measures are sustained.

• The provider had implemented safe systems for the storage of combustible items and toxic chemicals.

• The provider had implemented changes to the fabric and fittings of the building and facilities to ensure that it is safe and fit for purpose.

• Safe systems were in place for infection control, the management of clinical waste and safe handling and management of bodily fluids taken as specimens.

• We also found that changes had been put in place for non- medical electrical equipment checks, assessment of the risks of legionella and fire safety assessments at the practice. It is the practices responsibility to ensure these measures are sustained.

The provider should:

• The provider should ensure that the new system of prescription paper security is sustained.

• The provider should ensure the storage of clinical stores for specimen collection is assessed to reduce the risk of cross infection from droplet infection.

• The practice should ensure that the learning from the staff fire drills is acted upon, reviewed and updated when required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 July 2015

The practice is rated as good for the care of patients 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. Longer appointments and home visits were available when needed. All these patients had a named GP and offered a structured annual review to check that their health and medication 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 monitored patients with long term conditions through the Quality and Outcomes Framework (QOF) and told us it was proactive in identifying chronic disease.

Through links with the Public Health Improvement Neighbourhood Team one of the receptionists had become a community health champion and was able to signpost patients to community health resources.

Updated 23 July 2015

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. Immunisation rates were relatively high for all standard childhood immunisations.

Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

There was a sexual health clinic at the Southmead Health Centre which was accessible to patients from Willow Tree surgery. Staff were refreshing the 4YP training (Wherever the 4YP logo is displayed patients can be sure that the services on offer are young people friendly) and had achieved standards to ensure it met the needs of young patients. The practice had initiated teenage health checks learning from the success of other local practices.

Updated 23 July 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The practice provided a service for two care homes close by that provided nursing care for older people. One of the GPs was linked with the homes and visited weekly. All of the patients in the homes had care plans and we saw the template used to record the plan. Where people expressed a wish to not be resuscitated (DNAR) the appropriate forms were completed. A copy of the patient’s care plan and DNAR was kept in the care home and a summary of the care plan was communicated to the Out of Hours service.

The practice maintained a register of all patients in need of palliative care. There were regular multidisciplinary case review meetings where all patients on the palliative care register were discussed.

Updated 23 July 2015

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 23 July 2015

The practice is rated as good for the care of patients experiencing poor mental health (including patients with dementia). 96% of patients experiencing poor mental health had an agreed care plan documented in their record in the preceding 12 months. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

One of the GPs was the identified lead GP for mental health and dementia. They told us they had booked refresher training for April 2015. They met with the community dementia care nurse monthly. There were an increasing number of patients with dementia for whom assessments had been carried out. Practice nurses had not received any dementia training.

The practice was committed to reducing social isolation through the ‘Well Aware’ initiative and the practice community health champion. It issued prescriptions for exercise and self-help books.

Updated 23 July 2015

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 homeless people, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice care coordinator had a role in the prevention of hospital admissions and facilitating discharge from hospital. The practice was registered to issue food-bank vouchers.