Archived: The Willow Surgery

Updated 13 June 2017

The Willow Surgery is a suburban practice providing primary care services to patients resident in the Downend area of South Gloucestershire.

Hill House Road,

Downend,

Bristol,

BS16 5FJ

The practice owns the purpose built building which has two floors. All of the practice patient services are located on the ground floor of the building. The practice has a patient population of approximately 12,000 of which 36% are over 65 years of age which is higher than the clinical commissioning group average of 29%.

The practice has six GP partners, one of whom is also registered with the Care Quality Commission as the manager. In addition to this there are four salaried GP's, a practice management team, five practice nurses, and three health care assistants. Each GP has a lead role for the practice and nursing staff have specialist interests such as diabetes and infection control.

The practice is open Monday to Thursday 8am-7.30pm and until 6.30pm on Fridays.

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, support for patients with dementia and childhood immunisations.

The Willow Surgery, in line with other practices in the South Gloucestershire Clinical Commissioning Group, is situated within a less deprived area than the England average.

The practice is a teaching practice and takes medical students from the Bristol University and GP registrars from the Severn deanery; no students were available during the inspection.

The national GP patient survey reported that patients were satisfied with the opening times and making appointments. The results were comparable to local and national averages.

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

Patient Age Distribution

0-4 years old: 6.3%

5-14 years old: 10.9%

Under 18 years old: 20.5%

65-74 years old: 21.3%

75-84 years old: 10.8%

85+ years old: 3.7%

The practice has more patients over 65 years old than the local and national average.

Patient Gender Distribution

Male patients: 48.7 %

Female patients: 51.3 %

Other Population Demographics

% of Patients from BME populations: 3.57 %

Patients at this practice have a higher than average life expectancy for men at 81 years and women at 86 years.

The practice hosted a variety of services including:

NHS Community nurses

NHS Psychological services

Retinopathy screening

Other services available onsite included a pharmacy, pain management clinic and acupuncture.

Updated 13 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Willow Surgery 28 July 2016. The overall rating for the practice was good however the safe domain was rated as requiring improvement. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for The Willow Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 27 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 28 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

We found in the areas where the provider must previously make improvement that:

• The provider had ensured that the blank prescriptions held by the practice were fully recorded and maintained an auditable record.

• The provider had ensured that the systems for monitoring and recording the stock of medicines and emergency equipment used at the practice provided an auditable record which ensured an in date supply was available.

• The provider had ensured that patient specific directives were explicit to the staff member who administered the medicine.

• The provider had ensured the new system for monitoring refrigerator temperatures was sustained by the staff team.

• The provider had ensured the appropriate Disclosure and Barring Service checks for GPs were undertaken as part of the recruitment process.

• The provider had reviewed the audit documentation used for infection control to ensure the tool used encompassed a whole audit of the practice and its environment.

• The practice had obtained a risk assessment of the premises which controlled any risks associated with Legionella.

• The provider had devised systems which ensured the processes for checking test results was robust and fail safe.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 October 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 GP or nurse 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.

• The practice accessed a respiratory ‘hot clinic’ for urgent advice and treatment based at the local hospital to try to avoid hospital admissions. Patients were referred to the Lung Exercise & Education Programme (Leep) where breathing exercises and advice were given to help patients improve their respiratory symptoms.

• The diabetic treatment team of nurses, GPs and dietician met quarterly to discuss complex patients.

• There was a choice of afternoon and evening clinics for long term condition reviews to make it easier for those who worked.

Patients were supported with self-care and had personalised care plans.

Updated 6 October 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 A&E attendances. Immunisation rates were comparable with other practices 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice operated a minor injuries walk in service.

Updated 6 October 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 held weekly ‘virtual ward’ meetings with the multidisciplinary health care team in order to have proactive care planning for hospital admission avoidance. Every quarter all GPs met to discuss the patients who had been admitted to hospital in order to identify if the admission could have been prevented.

• The practice used emergency care practitioners from the community healthcare services to undertake some home visits. This was initiated by the duty doctor who triaged requests for home visits.

• Nominated GPs shared responsibility to run a regular clinic at an assisted living retirement complex.

Updated 6 October 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 offered extended hours on Monday to Thursday and some evening appointments with nurses for chronic disease management and other nurse led services; phlebotomy appointments started at 8.30am.

• 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 6 October 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 living with dementia.

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

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice could access the mental health primary liaison service which meant patient could be reviewed within a short timeframe.

• 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, and signposted patient to the South Gloucestershire dementia prescription programme. The practice also had access to a ‘crisis dementia nurse’ who could provide therapeutic interventions at short notice.

Updated 6 October 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 regularly worked with other health care professionals in the case management of vulnerable patients. For example, they worked with local hospice services to follow the gold standard framework for end of life care, using their standardised medicine prescribing charts to ensure patients had appropriate pain relief.

• 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.