Archived: Almondsbury Surgery

Updated 25 October 2016

On 7th July 2016 we inspected Almondsbury Surgery, Sundays Hill, Almondsbury, Bristol, where all registered regulated activities were carried out.

The practice serves approximately 4800 patients and sees patients who live in Almondsbury and the surrounding areas of South Gloucestershire. The national general practice profile shows the practice has a higher than average in England population of patients aged between the ages of five to 14 years old. They are below the national average for 15 to 34 years. The practice is above average for being one of the least deprived areas in this practice catchment area.

The practice provides additional services from the practice premises holding clinics for treating patients with Deep Vein Thrombosis and dietician clinics.

There was one GP partner and three salaried GPs; one male and three female. Each week all the GPs work the equivalent to approximately three full time GPs.

There were five female members of the nursing team which consisted of one practice nurse, one health care assistant and three part-time phlebotomists.

The practice is open from 8:30am Monday to Friday, the practice closed between 12:30pm and 2pm. On a Monday they were open until 7pm, Tuesday 7:30pm, Wednesday 6pm, Thursday 7pm and Friday until 5:30pm. Appointments were available from 9am to 11am every morning and varying times between 2:50pm to 5:50pm daily. Extended hours appointments are offered at the following times from 6:30pm to 7:30pm on Tuesdays. Arrangements were in place for patients to contact other services when the practice was not open.

The practice had a Personal Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice). The practice was contracted for a number of enhanced services including extended hours access, facilitating timely diagnosis and support for patients with dementia, learning disabilities and remote care monitoring. The practice referred their patients to Brisdoc for out-of-hours services to deal with urgent needs when the practice was closed.

The practice had patients registered in one nursing home for people living with dementia and a residential home for older people.

Updated 25 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Almondsbury Surgery on 15 April 2015. Following our comprehensive inspection overall the practice was rated as good with requires improvement for the well- led domain. Following that inspection we issued a requirement notice. This notice was due to a breach of Regulation 17 of The Health and Social Care Act (Regulated Activity) Regulations 2014, Good Governance. The requirement notice was for the practice to ensure it evaluates and improves their practice in respect of the processing of the information particularly through monitoring performance through clinical audit cycles and ensuring policy and procedures were up to date with legislation and latest guidance. A copy of the report detailing our findings can be found at www.cqc.org.uk.

We undertook this focused inspection on 7 July 2016 to follow up the requirement and to assess if the practice had implemented the changes necessary to ensure patients who used the service were protected against the risks associated with no monitoring of the performance of the service.

We found that the provider had made the required improvements since our last inspection. Following this focused inspection we have rated the practice as good for providing a well led service. The overall rating for the practice is good.

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

• Policies had been updated, reviewed and audited when required. Policies now contained detailed information to ensure staff followed correct procedures.

• The practice was compliant with ‘The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections and related guidance’.

• Clinical audits undertaken by the practice evidenced the monitoring of quality systems and documented the actions taken by the practice when required. This evidenced the monitoring of quality systems and the practice had documented subsequent action.

• Risks associated with the security of the premises had been assessed, actions had been taken and risks had been mitigated.

• The practice had an active patient participation group (PPG) who work with the practice to improve services and the quality of care.

• Complaints information for patients had been updated to include contacts for external organisations which allow patients to seek further advice should the practice’s response not be satisfactory.

• Staff had received up to date training and appraisals. A schedule had been implemented to indicate when future training and appraisals were due to be completed.

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 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.

Updated 23 July 2015

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

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 patients were treated in an age-appropriate way and were recognised as individuals. 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 23 July 2015

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

Quality and outcome framework data showed that outcomes for patients were good for conditions commonly found in older patients. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in facilitating the timely diagnosis and support for patients with dementia. They were responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs including those residing in nursing and residential homes.

Updated 23 July 2015

The practice is rated as good for the care of working-age patients (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).

We saw 96% of patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. They carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations. They had a system in place to follow up patients who had attended accident and emergency (A&E) when they may have been experiencing poor mental health.

Updated 23 July 2015

The practice is rated as good for the care of patients 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. They had carried out annual health checks for patients with a learning disability. The practice had seven patients registered with a learning disability and six of these had received an annual check-up. They offered longer appointments for patients with a learning disability.

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