Hillcrest Surgery

Updated 27 July 2017

Hillcrest Surgery is situated in Peasedown St John, near Bath. The practice supports approximately 6,800 patients from Wellow to the northern edge of Radstock, including the areas of Turley, Camerton and Rockly Ford. The practice is all on one level with consulting rooms and treatment rooms situated off corridors from the central waiting and reception area. There is parking for a small number of vehicles at the front of the practice. The practice has recently completed new build additions to the premises which have included changing the layout internally and creating new consulting rooms, treatment rooms and staff areas.

The practice provides surgeries five days a week and consists of five GP partners, two male, three female. There are two practice nurses and two healthcare assistants, practice manager who is shared with another local practice, deputy practice manager, and secretary, reception and administration team. The practice is a GP training practice.

The practice is open each day from 8am until 6pm and there is extended hour access from 7.30am until 8am on variable mornings during the week.

The practice has a Personal Medical Services contract with NHS England. The practice is contracted for a number of enhanced services including extended hours access, improving patient’s online access, timely diagnosis and support for patients with dementia and unplanned admission avoidance.

When the practice is closed patients are advised, via the practice website and telephone answer machine that all calls will be directed to the NHS 111 service. Out of hours services are provided by Bath and North East Somerset Doctors Urgent Care (BDUC)

The practice is registered to provide services from:

Hillcrest Surgery, Wellow Lane, Peasedown St John, Bath. BA2 8JQ

Prior to the inspection we noted that the provider did not have a Registered Manager in place and the partners listed on the practices registration certificate was different to those within the practice. The provider informed us that they had had problems using the Care Quality Commission provider portal and believed that these issued had been resolved. The provider told us they were taking immediate action to resolve these issues.

Updated 27 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hillcrest Surgery on 3 August 2016. We found that the practice required improvement for the provision of safe services because breaches of regulation were identified. The full comprehensive report on the 3 August 2016 inspection can be found by selecting the ‘all reports’ link for Hillcrest Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 July 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 3 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• The practice had ensured that identified risks relating to infection control and fire safety had been actioned and managed.
• Systems and processes for the safe management of medicines had been reviewed and improved.
• Policies relating to the maintenance of patient confidentiality had been implemented.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 November 2016

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

• The provider must ensure that there is a safe medicines management system in place to ensure that patient’s wellbeing is not put at risk.

• The provider must ensure that safe systems are in place for handling confidential waste and ‘Smart cards’ used for accessing patient records.

• 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 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 15 November 2016

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

• The provider must ensure that there is a safe medicines management system in place to ensure that patient’s wellbeing is not put at risk.

• The provider must ensure that safe systems are in place for handling confidential waste and ‘Smart cards’ used for accessing patient records.

• 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.

• Family planning services were available in the practice including hormone implants and contraceptive device fitting.
• Same day appointments were available for children.
• Each week a childhood immunisation clinic was held ensuring that patients were able to have their immunisations in a timely way.
• Post-natal and six to eight week baby checks were held together reducing the need for patients to attend for two appointments.

• One of the GP registrars had set up a regular children’s clinic to provide support to parents and carers.

• 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 15 November 2016

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

• The provider must ensure that there is a safe medicines management system in place to ensure that patient’s wellbeing is not put at risk.

• The provider must ensure that safe systems are in place for handling confidential waste and ‘Smart cards’ used for accessing patient records.

• 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.

Updated 15 November 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The provider must ensure that there is a safe medicines management system in place to ensure that patient’s wellbeing is not put at risk.

• The provider must ensure that safe systems are in place for handling confidential waste and ‘Smart cards’ used for accessing patient records.

• 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 early morning appointments from 7.30am on variable days of the week for working patients and those patients who could not attend during normal opening hours. These appointments included chronic disease management and NHS health checks.

• The practice offers an online service for patients to book appointments and order repeat medicines which was accessible 24 hours per day.

• Text reminders are set up if requested to remind patients of their appointments.

• The practice was proactive in offering online health information as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 15 November 2016

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

• The provider must ensure that there is a safe medicines management system in place to ensure that patient’s wellbeing is not put at risk.

• The provider must ensure that safe systems are in place for handling confidential waste and ‘Smart cards’ used for accessing patient records. 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.

• Counselling services were provided by the practice in the practice premises each week.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 15 November 2016

• The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The provider must ensure that safe systems are in place for handling confidential waste and ‘Smart cards’ used for accessing patient records.

• 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.