Westbury-on-Trym Primary Care Centre

Updated 8 February 2017

Westbury-on-Trym Primary Care Centre is located in North Bristol. The practice serves a population of approximately 9,700 patients, including those in residential homes and nursing homes. The practice occupies a modern purpose built health centre, completed in 2008, with twenty two clinical rooms on the ground floor and offices and meeting areas on the first floor. The practice is on local bus routes and patients have access from the north and west areas of Bristol, with parking on site including, spaces for those with a disability. The practice has a number of rooms which it makes available to other services, including Carers Trust and community midwives.

This report relates to the regulated activities provided from:

Westbury-on-Trym Primary Care Centre,

Westbury Hill,

Bristol

BS9 3AA

Westbury-on-Trym Primary Care Centre has eleven GPs, five of whom are partners. Between them they provide 41 GP sessions each week and are equivalent to 5.9 whole time employees. GPs Eight are female (with two currently on maternity leave) and three are male. There are five practice nurses, whose working hours are equivalent to 3.4 whole time employees (WTE), including two non-medical prescribers who offer 17 sessions per week. Two health care assistants are also employed by the practice with combined hours of 1.4 WTE. The GPs and nurses are supported by 16 management and administrative staff including a practice manager, assistant manager and an apprentice studying business administration.

The practices patient population is expanding and has more patients aged under 9 years; and between the ages of 35 and 44 years than the national average. Approximately 20% of the patients are over the age of 65 years compared to a national average of 13%.

Approximately 45% of patients have a long standing health condition, which can result in a higher demand for GP and nurse appointments and this is lower than the national average of 51%. Patient satisfaction scores are above average with 91% of patients describing their overall experience at the practice as good compared to a national average of 85% and clinical commissioning group average of 86%.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the 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 82 and 84 years respectively which is above the national and clinical commissioning group averages of 79 and 83 years respectively.

The practice is open between 8am and 6:30pm Monday to Friday. Appointments are available from 8:30am and access is available from 8am for early appointments and emergencies. 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 Wednesday, Thursday and Friday mornings from 7.30am to 8am and Monday, Tuesday, Wednesday and Thursday evenings usually from 6.30pm to 7pm. The practice also offers telephone consultations and now offers an on-line consultation service, available 24 hours a day. GP appointments are 10 minutes each in length and appointment sessions are typically 8:30am to 11am and 3pm to 5.30pm, with variation to meet demand. Each consultation session has 15 appointment slots.

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; influenza and pneumococcal immunisations; and health checks for those with a learning disability.

These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice is a teaching practice and there were two registrar GPs placed with them at the time of our inspection. The practice also hosts placements for medical students. Two of the GPs are GP trainers and this provides training resilience when one of the training partners is away.

The practice has opted out of providing out-of-hours services to their own patients and patients are directed to this service by the practice outside of normal practice hours.

Updated 8 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westbury-on-Trym Primary Care Centre on 3 August 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.
• Feedback from patients about their care was consistently positive. Patients told us that staff went the extra mile.
• 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.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example we saw an appointments system that offered extensive access to patients, including an on-line consultation scheme.
• 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.

We saw one area of outstanding practice:

• The practice offered an online consultation service, available 24 hours a day, 7 days a week, providing a range of outcomes for patients, usually on within one working day, based on clinical needs.

The areas where the provider should make improvement are:

• Review arrangements for staff training to ensure all staff receive appropriate training and records are up to date.
• Review recruitment arrangements to ensure personnel files include a record of all necessary employment checks.
• Review arrangements for storage, issue and audit ensure the security of blank prescription paper.
• Review arrangements for temperature control of vaccine fridges to ensure accuracy of temperature recording.
• Review arrangements for chaperones to ensure consistent practice.
• Review safety of windows where cord operated blinds are fitted.
• Review arrangements for recording patient consent to ensure written record is made.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 February 2017

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

• Nursing staff had lead roles inlong-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was similar to or better than the clinical commissioning group (CCG) and national averages. For example 92% of patients with diabetes, had a blood pressure reading of 140/80 mmHg or less (within the last 12 months), compared with the CCG average of 81% 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.
• The practice 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.

Updated 8 February 2017

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.
• 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.
• The practice provided support for premature babies and their families following discharge from hospital.
• The practice’s uptake for the cervical screening programme was 80%, which was better than the clinical commissioning group (CCG) average of 71% and the national average of 74%.
• 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.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 8 February 2017

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. It involved older people in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. For example, the practice has worked with other local practices to establish targeted schemes to support patients over the age of 75 years. These include designated appointments; a care co-ordinator; and review and follow up of all hospital discharges.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• We saw evidence of the practice participating in innovative pilot schemes including the Retirement in Action study aimed at preventing early onset of frailty in older patients; and theTimeli dementia study offering prompt and early investigation of memory loss.

Updated 8 February 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, for example, on line consultations were available 24 hours a day, 7 days a week providing a range of outcomes for patients, based on clinical needs.
• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group. We saw evidence that the practice was proactively targeting patients aged 40, 45 and 50 years for health checks resulting in 85% uptake in 2015/16.
• The practice was participating in two research studies relevant to working age patients. These included a study of patients with a low mood who were not on antidepressants; and a study offering an herbal remedy for urinary tract infections with the aim of reducing antibiotic prescribing in future.

Updated 8 February 2017

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

• 97% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%. Other performance indicators for mental health were also better than the national average.
• The practice specifically considered the physical health needs of people with poor mental health. For example, a weekly clinic by a Community Psychiatric Nurse provided therapy appointments in the practice.
• The practice had a system for monitoring repeat prescribing for people receiving medication for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example, the practice participated in research studies including one for patients with low mood and another for patients where their medication was not adequately controlling active depression.
• People at risk of dementia were identified and offered an assessment.
• 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 8 February 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. We saw examples of arrangements for homeless patients to remain registered with the practice; work with the Bristol Drugs Project; and issuing of food bank vouchers.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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. For example, the practice offered a monthly carers surgery.
• 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.
• We saw that staff were trained to add alerts to patient records where different arrangements had been agreed. For example, visually impaired patients who would be collected from the waiting area; providing letters instead of phone calls for hearing impaired patients; and specific requests not to phone patients where confidentiality was an issue.