The Lennard Surgery

Updated 17 January 2017

The Lennard Surgery, 1 Lewis Road, Bedminster Down, Bristol, BS13 7JD provides support for approximately 8060 patients in the Bedminster Down area in South Bristol and in the neighbouring communities of Hartcliffe and Withywood, where there are high levels of deprivation. With one of the highest proportions of elderly patients in Bristol (20% over the age of 65), there is a higher number of people with multiple chronic diseases and age related conditions.

The Lennard Surgery is made up of three houses, previously domestic dwellings, and there are a number of adaptations that have been made including ramps to the entrance and one of the fire exits; a lift that serves the first floor consulting rooms and patient controlled self opening

entrance doors. There are nine consulting rooms over two floors; three treatment rooms and a phlebotomy room on the ground floor. The waiting room is not large but has been improved to accommodate wheelchair users and parents with baby buggies. There are three patient toilets including one with facilities for patients with disabilities. Administrative offices, staff toilets, common room, kitchen and meeting room are also on the first floor. There are staff parking spaces but no car park for patients.

There are five partners and two salaried GPs, three male and four female. There are three practice nurses, who include nurse prescribers and an advance nurse practitioner. The practice has two health care assistants and a phlebotomist. The clinical staff are supported by a general manager, practice manager and an administration team. The practice is a training practice for Foundation Level 2 doctors, post graduate training for newly qualified medical practitioners and is also involved in clinical research.

The practice telephone lines are open from 8:30am until 6:30pm Monday to Friday. Appointments are available for on the day urgent and pre-booked routine GP and nurse appointments from 08:30am to 1:00pm and 2:00pm to 6:30pm each day. Additional surgeries are open on two

Saturday mornings per month for booked appointments for those patients who are not able to attend during the week. The practice provides 50/50 appointments, 50% of appointments are able to be pre-booked from six weeks in advance, and the rest are available on the day.

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 contracted for a number of enhanced services including extended hours access, facilitating timely diagnosis and

support for patients with dementia, patient participation, remote care monitoring and childhood vaccination and immunisation scheme.

The practice does not provide Out Of Hour services to its patients, this is provided by BrisDoc.

Contact information for this service is available in the practice and on the website.

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced follow up inspection at The Lennard Surgery on 15 December 2016 to check if improvements had been made in response to our previous comprehensive inspection on 29 September 2015.

On 29 September 2015 we found the practice required improvement in the safe domain and was rated by us as good for effective, caring, responsive and well-led domains. Overall the practice was rated as good. We issued a requirement notice with regards to the breach of Regulation 19 of the Health and Social Care Act (Regulated Activity) Regulations 2014, Fit and proper persons employed:

• The requirement notice was for the provider to make improvements to ensure recruitment arrangements included all necessary employment checks for all staff. During our inspection we saw personnel employed to carry on the regulated activity did not have the appropriate checks through the Disclosure and Barring Service or risk assessments to identify they were not required. The practice did not hold the required specified information in respect of persons employed by the practice as listed in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition we told the provider they should:

• Evidence that action plans were implemented and completed to rectify concerns found during infection control audits.
• Have a system of recording comments / verbal complaints made to the service for audit purposes.
• Continue to develop a system of clinical audits and re-audits to improve patient outcomes.
• Have a risk assessment and policy for the management, testing and investigation of legionella (a bacterium which can contaminate water systems in buildings).

A copy of the report detailing our findings can be found at www.cqc.org.uk.

Our key findings across the areas we inspected on 15 December 2016 were as follows:

• There was a system to ensure appropriate recruitment checks had been undertaken prior to employment. For example, proof of identification, references, qualifications, registration with the appropriate professional body and the appropriate checks through the Disclosure and Barring Service.
• Infection prevention and control systems for healthcare-associated infection were in place.
• The practice assessed, planned and effectively managed potential risks to the service from fire.
• The practice monitored patient care and treatment outcomes through clinical audits and re-audits.
• There was a system to record and respond to patient verbal complaints and concerns.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The practice is rated as good for the care of people 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.

• Performance for diabetes related indicators was similar to the CCG and better than national average. For example the percentage of the patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 92.06% with the national average 88.35%.

• 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 people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 January 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.

• 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’s uptake for the cervical screening programme was 84.27%, which was better than the national average of 76.9%.

• 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.

Updated 7 January 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 people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Care plans were in place for those identified at greater risk.

Updated 7 January 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 reflects the needs for this age group.

Updated 7 January 2016

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

• Performance for mental health related indicators was better to the national average. For example the percentage of patients with recognised/diagnosed disorder who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 88.37%, the national average was 86.04%

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 84.91% which was comparable to the CCG and national average of 83.82%.

• 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.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• It 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 people with mental health needs and dementia.

Updated 7 January 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 people, travellers and those with a learning disability.

• The practice offered longer appointments for people with a learning disability.

• 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.