Wells Road Surgery

Updated 6 December 2016

Wells Road Surgery is a suburban practice providing primary care services to patients resident in the Knowle area of Bristol.

233 Wells Road,

Bristol

BS4 2DF

The practice is sited in a converted bungalow which has undergone extensive re-modelling to provide four consultation rooms and two treatment rooms. All patient services are located on the ground floor of the building. The practice has a patient population of approximately 7300.

Wells Road Surgery has four GPs, two of whom are partners. Between them they provide 28 GP sessions each week. Three GPs are female and one is male. There are two practice nurses, whose working hours are equivalent to a whole time employee and a newly engaged health care assistant due to start in December 2016. The GPs and nurses are supported by management and administrative staff including a practice manager.

The practice patient population has slightly more patients between the age of 0 and 4 years and between the ages of 25 – 49 years than the national average. Approximately 18% of the patients are over the age of 65 years compared to a national average of 27%. Approximately 45% of patients have a long standing health condition compared to a national average of 54%. Patient satisfaction scores are good with 83% of patients describing their overall experience at the practice as good compared to a national average of 85%.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the fifth least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the area is the same as the national average of 79 and 84 years respectively and one year higher than the clinical commissioning group average.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8am and emergency telephone access is available from 8am. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day. Extended hours appointments are offered on Wednesdays 8pm and the practice also offers telephone consultations. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services.

The practice has a Personal Medical Services (PMS) contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and a minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access NHS 111 or BrisDoc provide the out of hours GP service. Information on how to access these services is on the provider website.

Patient Gender Distribution

Male patients: 51 %

Female patients: 49 %

Other Population Demographics

% of Patients from BME populations: 4.5 %

Updated 6 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Wells Road Surgery 4 October 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 them with 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.
• 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 areas where the provider should make improvement are:

• The provider should monitor and ensure that there is an annual infection control audit of the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 December 2016

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

• Nursing and clinical staff had lead roles and specialist knowledge in long-term disease management and patients at risk of hospital admission were identified as a priority. Nurse and GP, patient diabetic leads are both trained in insulin and GLP-1 agonist conversion (medicines used and this is undertaken at the practice for suitable patients.

• The practice were involved in the H.G. Wells project, this is an “Integrated Model of Care for Diabetes Pilot” - a new project aimed at delivering significant and sustainable improvements in the management and treatment of patients with a diagnosis of diabetes commissioned by the South West Commissioning Support unit.

• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12months (01/04/2014 to 31/03/2015) was 80% higher than the clinical commissioning group (CCG) average of 76% and the national average of 78%.

• The practice proactively identified patients at risk of developing long-term conditions and took action to monitor their health and help them improve their lifestyle, for example we saw the care plans given to patients with asthma to help them recognise, self manage and control their illness.

• The practice GPs 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.

• Longer appointments and home visits were available when needed.

• All these patients 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. There was a designated reception lead for all major chronic disease to manage chronic disease clinics to ensure all patients are invited for review and have appropriate tests prior to appointment; patients with more than one long term condition were reviewed in a multi-morbidity appointment.

Updated 6 December 2016

The practice is rated as good for the care of families, children and young people.

• 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 relatively high for all standard childhood immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies. We found that the practice offered after school clinics for flu vaccines.

• We saw positive examples of joint working with midwives, health visitors and school nurses. They held weekly baby and postnatal clinics and undertook six week reviews of new mothers and their babies to coincide with their first vaccination visit. The practice had developed information pack for new mothers at the post-natal visit. The practice was a breast feeding friendly building and had designated areas.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications by offering rapid access to appointments and using the secondary care ‘hot clinics’ for advice. (This is a clinic is staffed by a consultant, available to GPs to refer patients they feel meet the referral criteria. It is intended to prevent the admission of patients to hospital.

• There was an extended family planning service offered by the practice for intrauterine contraceptive devices and implants and regular clinics were held for this.

Updated 6 December 2016

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

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

• 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 identified at an early stage older people who may be approaching the end of life and involved them in planning and making decisions about their care.

• The practice followed up on older patients who had been discharged from hospital and ensured that their named GP had updated care plans to reflect any extra needs. Care plan meetings were held every three months involving the clinical team and the community nursing services. Recent admissions to hospital were discussed and any learning regarding admission avoidance shared.

• Where older patients had complex needs, the practice shared summary care records with local care services such as the out of hours service.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible such as referral to the carers centre.

• The practice participated in pilot schemes such as the Bristol Rapid Assessment Clinic for older people based at the local community hospital (A rapid medical assessment and management plan are for a deteriorating patient who may otherwise end up in hospital). They allocated a practice GP to attend four sessions in which to observe the consultant and then take the learning to the practice to share with colleagues.

• The whole team were aware of the difficulties that older patients found in attending the practice so often the nursing team would fit in a patient for blood tests if they have just seen the doctor rather than asking them to come back at another time.

Updated 6 December 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, for example, there was an extended hours with two GPs and one practice nurse every Wednesday until 8pm.

• 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.

• Students who were previous patients were seen as temporary residents during university holidays.

Updated 6 December 2016

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

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

• The practice carried out advance care planning for patients with dementia

• The practice specifically considered the physical health needs of people with poor mental health, with a clinical lead to ensure their needs were met. The reception lead for mental health was responsible for booking all patients on the mental health register for review, including blood tests for medicines monitoring where needed, as per the practice protocol. Annual mental health reviews achieved 25.6 out of 26 points of the quality and outcomes framework in 15/16.

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015)

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. They had access to email consultations with an allocated consultant psychiatrist.

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

• 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 6 December 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. The practice made home visits to a care home to complete the patient’s annual health check. The practice nurse arranged home to vaccinate patients who were unable to attend the surgery

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

• The practice informed 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. All staff had in house training on the Mental Capacity Act and Safeguarding Adults; safeguarding was an agenda item on the monthly practice meeting.

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