Bridge View Medical

Updated 11 November 2016

The Southville Surgery is located in an urban area of Bristol. They have approximately 8678 patients registered.

The practice operates from one location:

Southville Surgery

Coronation Road

Southville

Bristol

The practice is sited in two adjacent houses in a four storey converted building. The consulting and treatment rooms for the practice are situated on the ground and first floors. There are three treatment rooms (for use by nurses, health care assistants and phlebotomists); reception and records room; and a waiting area on both floors. There is limited patient parking immediately outside the practice with spaces reserved for those with disabilities.

The practice is made up of three GP partners, five salaried GPs, the operations manager and the practice manager, working alongside three qualified nurses and two health care assistants. The practice is supported by an administrative team made of medical secretaries, receptionists and administrators. The practice is open from 8.30am until 6.30pm Monday to Friday for on the day urgent and pre-booked routine GP and nurse appointments. Extended opening hours are available for prebookable appointments on Tuesdays between 6.30pm - 8.30pm.

The practice has a General Medical Services contract with NHS England (a nationally agreed contract negotiated between NHS England and the practice). The practice is contracted for a number of enhanced services including extended hours access, facilitating timely diagnosis and support for patients with dementia, patient participation, immunisations and unplanned admission avoidance.

The practice does not provide out of hour’s services to its patients, this is provided by BrisDoc. Contact information for this service is available in the practice and on the website.

Patient Age Distribution

0-4 years old: 7.07% - higher than the national average

5-14 years old: 7.46%

15-44 years old: 59.14% - higher than the national average

45-64 years old: 18.12% - higher than the national average

65-74 years old: 4.47%

75-84 years old: 2.64%

85+ years old: 1.11%

Patient Gender Distribution

Male patients: 50.19 %

Female patients: 49.81 %

% of Patients from BME populations: 2.67 %

The Southville Surgery is currently experiencing a high demand for registration from new patients and has registered 780 new patients since October 2015. They operate at a consultation rate of 6 appointments per weighted patient per year against a national average of 5.5.

The practice was inspected in November 2013 and found to be compliant.

Updated 11 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Southville Surgery on 9 February 2016. Following our comprehensive inspection overall the practice was rated as good with requires improvement for the safe domain. Following the inspection we issued a requirement notice. The notice was issued due to a breach of Regulation 12 of The Health and Social Care Act (Regulated Activity) 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 against any risks associated with the safe management of the medicines, the checking of emergency equipment and the safe management of blank prescriptions. A copy of the report detailing our findings can be found at www.cqc.org.uk.

Our key findings during this inspection were as follows:

The areas where the provider must make improvement were:

• The medicine management policy was not fully implemented which impacted on the safe management of medicines by the practice specifically key security, storage of controlled medicines, ensuring patient medicines were returned to the pharmacy and ensuring regular checks of the stock kept in the practice.

The areas where the provider should make improvement were:

• The practice should ensure they undertake checks through the Disclosure and Barring Service for personnel employed to carry on the regulated activities.
• All pre-employment checks should be fully recorded.

• The practice should review how blank prescriptions were received and distributed around the practice.

• Ensure the checks for the emergency oxygen and the defibrillator were recorded.

• Arrangements for infection control should ensure areas identified for action were followed through.

• The practice should review the arrangements for checking results and introduce a formalised processed which ensured they were reviewed within an agreed timeframe.

We undertook this focused inspection on 17 October 2016 to follow up the requirement to assess if the practice had implemented the changes needed to ensure patients who used the service were safe.

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

• The practice had reviewed and rewritten their medicine management protocols, processes for prescription security and checking emergency equipment; these had been fully implemented by the practice.

• The practice had ensured Disclosure and Barring Service checks were completed for personnel employed to carry on the regulated activities, and that all pre-employment checks were recorded.
• The practice had undertaken checks through the Disclosure and Barring Service for personnel employed to carry on the regulated activities and ensured that all pre-employment checks such as references were recorded.

• The practice had reviewed the arrangements for checking results and introduced a formalised process which ensured they were reviewed within an agreed timeframe.

The remaining area where the provider should make improvement following the inspection on 9 February 2016 is :

• Arrangements for infection control should ensure areas identified for action are followed through.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 April 2016

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

• Nursing staff had specialist training for the management of chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice was active in the management of long term conditions for example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 84.97% compared to a national average of 80.53%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that 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 had a pharmacist who supported care delivery to this patient group and ran a weekly clinic for patients with hypertension.

Updated 8 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. The practice had an effective recall system which ensured they regularly exceeded the 90% threshold for immunising 2 year-old and 5 year-old children.

• 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 for example; all vulnerable families had a named GP.

• The practice had same day telephone consultations and created face-to-face appointments as needed for any unwell children.

Updated 8 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 patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• They engaged with a local community-based Retired Senior Volunteers Programme (RSVP) scheme which aimed to build a cohort of befrienders to reconnect patients with social opportunities in the local community to improve their health and wellbeing. 

• They provided a same day telephone advice service for older patients

• The practice nominated a GP lead for care homes who visited and provided a regular clinics for care home residents
• The practice undertook the Unplanned Admissions enhanced service; patients at risk had care plans and received medical reviews which the practice nurses made home visits to conduct for housebound patients.

Updated 8 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 reflected the needs for this age group.

• The practice offered same day telephone consultations and face-to-face appointments as needed for any concerns regarding contraception.  They fitted contraceptive implants and coils in the surgery as required. 

• They offered extended hours each week, offering working patients appointments outside the core contract hours, for example, from 6.30pm – 8.15pm on Tuesday evenings.

• The practice had GP triage and booked telephone consultations, this meant all patients who contacted the practice for appointments were reviewed by a GP.

Updated 8 April 2016

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

• The practice had lead GP and nurse for patients with mental illness and offered care plans for patients with severe and enduring mental illness.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 96.43% above the national average of 88.47%.

• 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.

• The practice had a lead GP and nurse lead for patients living with dementia and offered a care plan review and an enhanced dementia annual review which included assessment of physical symptoms, medicines review, and advance care planning for patients living with dementia.

•  73.53% of patients diagnosed with dementia had received a face to face review.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• The practice also offered a carer review for carers of patients living with dementia which included a health check and a carer support appointment.

Updated 8 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 homeless patients, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability, there was a designated lead GP for these patients.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice had told 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 had regular (at least 3 monthly) multidisciplinary case review meetings where all patients on the palliative care register were discussed.

• The practice hosted substance misuse counsellors for two days per week which ensured that vulnerable patients had appropriate shared care plans and patients were able to be seen at the practice, rather than travel to another location.