The Merrywood Practice

Updated 30 June 2016

The Merrywood Practice is an urban area of Bristol. It operates from one location:

William Budd Health Centre,

Bristol,

BS4 1WH

The practice shares the purpose built building with another GP practice and other NHS health care services. All patient services are located on the ground floor of the building. The practice has a patient population of approximately 6600.

The practice has four GP partners (male and female), three salaried GPs (including one academic GP), a practice manager, four practice nurses, a phlebotomist and a health care assistant. Each GP has a lead role for the practice and nursing staff have specialist interests such as diabetes and asthma.

The practice is open Monday to Friday 8am-6.30pm. GP appointments were available outside core hours on different days until 8.30pm. There is an open surgery Monday - Friday between 9am & 11am for patients.

The practice had a Personal Medical Services contract (PMS) with NHS England to deliver general medical services. The practice provided enhanced services which included facilitating timely diagnosis for patients with dementia and childhood immunisations.

The practice is situated within a significantly more deprived area than the England average and is in the most deprived area in Bristol. Patients at the practice experience the highest levels of health inequality in the South West of England. Patients at this practice have a lower than England average life expectancy for men of 76 years. Patients also develop chronic ill health 15 years earlier than other population groups. The practice had the highest number of children with a life limiting illness or disability and the highest number of under five year olds in the local practice cluster group. They offered 14,660 routine appointments, 7,087 urgent appointments (open surgery) and 8,898 telephone appointments in 2015/16 to meet the demand.

Other services based at the practice include:

Community nurses and community matron

Health visitors

Midwives

Physiotherapy (patient self-referral pilot)

Dermatology

Podiatry

Speech and Language therapy

Sessional consultant obstetrician

Alcohol and Substance misuse counsellors.

The practice is a teaching practice for trainee GPs from the Severn deanery and offers placements to medical students and sixth form students with an interest in studying medicine ( there were no studnets on placement when we visited).

The national GP patient survey (January 2016) reported that patients were more than satisfied with the opening times and making appointments. The results were above local and national averages.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access NHS 111 and BrisDoc provide the out of hours GP service.

Patient demographics:

0-4 years old: 8.1%

5-14 years old: 17.21%

15-44 years old: 42.08%

45-64 years old: 21.34%

65-74 years old: 6.1%

75-84 years old: 4%

85+ years old: 1.16%

Patient Gender Distribution

Male patients: 49.87 %

Female patients: 50.13 %

Other Population Demographics

% of Patients from BME populations: 13.62 %

% with a long-standing health condition 65%

Working status – Unemployed 9.7% (national average is 5.4%)

% of Patients from BME populations: 13.62 %

Updated 30 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Merrywood Practice on 3 May 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide 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.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• All patients were also encouraged to telephone the practice and speak directly to their named GP for advice.

• The practice was part of the primary care home pilot(a National Association of Primary Care test site).

• The practice had a high number of families with family members in prison and so reception staff had attended ‘Hidden Sentence’ training.
• The leadership, governance and culture were used to drive and improve the delivery of high quality, person-centred care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider should make improvement was:

• The practice should complete a specific risk assessment for the shared sluice area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 June 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.

• Longer appointments and home visits were available when needed.

• The practice had the highest levels of patients with long term condition in the local area. All had a named GP and 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. Due to the complexity of need of patients attending the practice all GP appointments were twelve minutes long.

• The practice had a pharmacist specifically employed to assist the review of patients with long term conditions.

Updated 30 June 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 accident and emergency attendances were followed up by the practice. We saw they routinely contacted patients who had attended accident and emergency because of self-harming to offer support.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, with policies in place to address any consent issues.

• Appointments were available outside of school hours and the premises were suitable for children and babies. We saw positive examples of joint working with midwives, health visitors and school nurses. The practice undertook six week post-natal checks and offered immunisation at the same time.

• The practice had a system in place to follow up patients who had been referred to secondary care to ensure they attended for appointments and to follow up non-attenders.

• Teenagers over 15 years were invited for a health check and immunisation screen.

Updated 30 June 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.

• The practice undertook the admissions avoidance enhanced service which identified those patients most at risk and ensured they had a care plan in place to support them to remain out of hospital.

• The practice was part of the primary care home pilot(a National Association of Primary Care test site).

Updated 30 June 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.

• The daily open surgery facilitated patients having appointments when needed.

Updated 30 June 2016

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

• 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 allocated GP also undertook a risk assessment to determine further action if patient with mental illness failed to attend for their annual review.

• The practice 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 patients with mental health needs and dementia.

Updated 30 June 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 and those with a learning disability.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients, for example, transgender patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The staff at the practice attended annual training to identify and support victims of domestic abuse.

• 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.