Archived: The Bounces Road Surgery

Updated 18 January 2017

The Bounces Road Surgery provides primary medical services in Edmonton to approximately 4600 patients and is one of 49 member practices in the NHS Enfield Clinical Commissioning Group (CCG).

The practice population is in the second most deprived decile in England with greater than CCG and national average representation of income deprived children (39% of children were affected by income deprivation compared to a CCG average of 31% and a national average of 20%) and older people (31% of older people were affected by income deprivation compared to a CCG average of 22% and a national average of 16%). The practice had surveyed the ethnicity of approximately 66% of the practice population and had determined that 36% of patients identified as having white ethnicity, 9% Asian, 28% black and 27% as having mixed or other ethnicity.

The practice operates from a purpose built property with patient facilities on the ground that are wheelchair accessible. There are offices for administrative and management staff on the ground floor.

The practice operates under a General Medical Services (GMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract). The enhanced services it provides are: childhood vaccination and immunisation scheme; extended hours access; facilitating timely diagnosis and support for people with dementia; improving patient online access; influenza and pneumococcal immunisations; minor surgery; risk profiling and case management; rotavirus and shingles immunisation; unplanned admissions.

The practice team at the surgery is made up of one full-time female and one full-time male GP partner. Bounces Road Surgery is a training practice with one full-time female GP Registrar and one male full-time GP trainee. The doctors provide 32 clinical sessions per week.

The nursing team consists of three part-time female practice nurses and a part-time female anti-coagulation nurse.

There are three administrative and clerical staff and one part-time practice manager. There are three reception staff including a part-time senior receptionist.

The practice is open between 8.00am and 6.30pm Monday Tuesday, Thursday and, Friday and from 8.00am to 1.00pm on Wednesday ,

GP appointments are available:

8.30am to 9.00am (Telephone consultations)

9.00am -12.00pm

1.00pm to 2.00pm (Telephone consultations), except Wednesday

3.00pm to 6.00pm, except Wednesday

Nurse appointments are available:

9.00am to 1.00pm

2.00pm to 7.00pm, except Wednesday

Extended surgery hours are offered from 6.30pm until 7.00pm Monday Tuesday, Thursday and Friday. The practice does not open on a weekend. The practice has opted out of providing out of hours (OOH) services to their own patients between 6.30pm and 8.00am and directs patients to the OOH provider for NHS Enfield CCG.

The Bounces Road Surgery is registered as a partnership with the Care Quality Commission to provide the regulated activities of Maternity and midwifery services; Diagnostic and screening procedures; Family planning; Treatment of disease, disorder or injury; and Surgical procedures.

The Bounces Road Surgery was previously inspected in June 2014. At that time the following issues were identified for the practice to improve:

• To ensure that the defibrillator and oxygen supply was checked.

• Cleaning audits were not being carried out.

• There was no online appointment system.

• It was not making patients aware that chaperones were available.

• To fully document appraisals, including outcomes and to record training for all staff.

• To improve the process of involving patients in decisions about their care.

On this occasion we found that these previously identified issues had improved. Though, patient satisfaction for involvement in their care was still below the national average.

Updated 18 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Bounces Road Surgery on 29 September 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.
• Issues identified during our previous inspection on 2 June 2014 had all been rectified.
• 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 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 area where the provider should make improvement is:

• To review feedback received from the national GP patient survey to identify how patient satisfaction could be improved.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 18 January 2017

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 the care of diabetic patients was comparable to CCG and national averages.

• 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.

Updated 18 January 2017

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.

• 84% of women aged 25-64 notes recorded that a cervical screening test had been performed in the preceding 5 years, compared to a CCG average of 81% and a national average of 82%.

• 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.

Updated 18 January 2017

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.

• When families suffered bereavement a GP would phone to offer their condolences, the practice also sent families an informative booklet that signposted them to sources of support and assistance.

Updated 18 January 2017

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 practice offered extended hours clinics until 7.00 pm on Monday, Tuesday, Thursday and Friday for the benefit of patients who were unable to attend during working hours.

Updated 18 January 2017

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

• 95% of patients with physical and/or mental health conditions notes’ recorded their smoking status in the preceding 12 months compared to a CCG average of 94% and a national average of 94%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice 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.

• 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 18 January 2017

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 patients with a learning disability.

• 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.