Updated 22 March 2017
The GP Support Unit (GPSU) is part of BrisDoc Healthcare Services Limited. BrisDoc is a limited company whose shareholders are the current employees.
GP Support Unit (GPSU)
Bristol Royal Infirmary
Upper Maudlin Street
Bristol
BS2 8HW
The GPSU is a stand-alone service run solely by GPs with support from University Hospitals Bristol NHS Foundation Trust Ambulatory Care Unit (ACU) nursing team. This service was hosted by the University Hospitals Bristol NHS Foundation Trust at the Bristol Royal Infirmary (BRI). BrisDoc GPSU oversees the admission pathway for 30-50% of urgent medical admissions to the Bristol Royal Infirmary.
This service was commissioned by Bristol Clinical Commissioning Groups to primarily support the GP services in the Bristol and North Somerset areas. Only patients who are registered with these GP practices can be referred by their GP, or community based clinicians working in these areas, to this service.
North and West Bristol has around 187,000 residents served by 17 GP practices. The locality covers some of the most affluent parts of Bristol where many benefit from longer life expectancy and better health. However, there is significant deprivation in some communities where people are more likely to die younger from cancer, heart disease and stroke. There is a difference in life expectancy of 9.6 years between the most deprived and the most affluent areas of this locality.
Inner City and East (ICE) Bristol area has around 145,000 residents served by 13 GP practices. This diverse community has areas of high deprivation in the inner city and the highest proportions of black and minority ethnic (BME) residents in Bristol. Local health challenges in this locality include higher rates of drug, smoking and alcohol use compared to Bristol overall.
South Bristol has around 159,027 residents served by 18 GP practices. The area has many 20 to 30 year olds and the number of babies under one year has increased by 20 per cent since 2001. The number of people over 85 years old has also increased by 20 per cent. Some parts of South Bristol are within the most deprived 10 per cent in the country.
North Somerset covers an area of 145 square miles on the coast of the south west of England. North Somerset’s boundaries stretch from the edge of Bristol and the River Avon in the north to the River Axe and the Mendip Hills in the south. Over two thirds of people live in the four towns of Clevedon, Nailsea, Portishead and Weston-super-Mare. The remaining third live in villages and countryside. The 2011 Census showed that there were a total of 88,227 households, an Increase of 8,225 since 2001. The 2011 Census showed our population to be 202,566, an increase of 14,002 since 2001. North Somerset has some of the most affluent communities in the country, but it also has some of the most deprived with two Weston-super-Mare communities being in the top 1% most deprived nationally.
The GPSU was established seven years ago at the Bristol Royal Infirmary (BRI) and the aims of the service are to provide a primary care interface with secondary care; to identify patients who would be suitable to be seen by the unit’s GPs in an ambulatory care setting and who did not necessarily need to be seen by the consultant-led hospital medical team, such as an acute exacerbation of a long term condition. The service supports the community GPs workload by giving them access to other medical expertise and hospital diagnostic services to potentially reduce hospital admissions. The impact for patients is a continuity of care provided by GPs, and priority access to diagnostic services and treatment which often negates the need to be admitted to hospital.
The service also provides a single telephone support line (‘The Professional Line’) which GPs, advanced nurse practitioners and paramedics could call between 8am and 6.30pm (outside these times calls are directed to the out of hours service). Clinicians use this line to discuss treatment of patients at risk of admission to hospital.
Based on these discussions the GPSU could:
a. Give clinical advice based on accepted guidance and pathways. For example, NICE or local guidelines.
b. Advise on suitable alternative care pathways such as a hot clinic (where patients can be seen urgently without going through the routine referral process) or community services.
c. Arrange to review the patient face to face at the hospital within the GP Support Unit at the BRI.
d. Arrange for the patient to be admitted to the BRI under the medical team.
The GPSU has access to hospital consultants for advice as needed. Currently the GPSU operates seven days a week with four GPs employed Monday to Friday and one GP covering a reduced service at weekends. During the week the service is open from 8am until 8pm. At weekends it is open between 11am and 5pm on Saturdays and 12 noon and 5pm on Sundays as part of the Out of Hours provision. On average the service sees between 6 and 7 patients a day on the unit and handles 16 to 20 calls from clinicians. The patients who are seen are primarily ones referred into the unit on the same day by their own GPs but the unit can also see any primary care patients who have been referred to them directly from the Emergency Department at the BRI.
In respect of external governance BrisDoc were members of Urgent Health UK, the federation of Social Enterprise Unscheduled and Community Care Providers. They have a contract with Audit Southwest for support.
There is a headquarters at Osprey Court, Hawkfield Way, Hawkfield Business Park, Whitchurch, Bristol, where the majority of the administration and human resources tasks are coordinated from. During our inspection we visited Osprey Court and the BRI sites.
We raised with the provider that the location should be registered for the regulated activity for transport services, triage and medical advice provided remotely.