Background to this inspection
Updated
8 November 2016
Trinity and Bowthorpe Medical Practice, provides general medical services to around 10,257 patients divided between the two sites and living in Bowthorpe, Norwich and the surrounding area. The practice provides general medical services from Trinity Street Surgery, Trinity Street, Norwich and from the branch surgery at Bowthorpe Health Centre, Bowthorpe, Norwich. We visited both surgeries as part of our inspection. The Trinity Street premises has been a GP surgery for approximately 100 years and the Bowthorpe Health Centre premises are purpose built and have recently undergone some extensive redesign and decorating. All treatment and consultation rooms are situated at ground level at both sites. Parking is available at Bowthorpe Medical Practice with level access and automatic doors. However parking is limited at Trinity surgery, with one disabled parking bay at the front of the building and ramp access to the front door. Entrance doors at Trinity were not automatic, however we saw an external doorbell was available for patients to call for assistance should they need support accessing the building and we saw the practice worked closely with the patient participation group to continually review improvements to access and facilities at these premises.
The practice has a team of seven GPs meeting patients’ needs. Six GPs are partners, meaning they hold managerial and financial responsibility for the practice. We were told the practice were was also in the process of recruiting a GP. There is a team of two advanced nurse practitioners, three practice nurses, a health care assistant and a receptionist/phlebotomist who run a variety of appointments for long term conditions, minor illness and family health.
There is a practice manager, two surgery managers, a personal assistant to the practice manager, a nurse administrator, an IT lead and a team of non-clinical administrative, secretarial and reception staff who share a range of roles, some of whom are employed on flexible working arrangements. Community midwives run sessions weekly at the practice.
The practice provides a range of clinics and services, which are detailed in this report, and operates generally between the hours of 8.30am and 6.00pm, Monday to Friday. Appointments are from 8.30am to 11.30am at Bowthorpe Health Centre and 8.30am to 12am at Trinity surgery every morning. Weekly afternoon appointments are available from 3pm to 5.30pm at both Bowthorpe Health Centre and Trinity Surgery daily. Saturday morning 15 minute appointments are available with GPs at Bowthorpe Health Centre from 8am to 11am, with pre-booked telephone consultations from 11am to 1pm. The practices are both open between 8.00am and 6pm Monday to Friday. Both surgeries have an early closing day with each surgery providing cover for emergencies. Trinity surgery closes Thursday afternoons from 1pm and Bowthorpe Health Centre closes Wednesday afternoons from 1pm. In addition to pre-bookable appointments which can be booked up to four weeks in advance, urgent appointments are also available for people that needed them.
Outside of these hours, medical care is provided by Integrated Care 24 Limited (IC24). Primary medical services are accessed through the NHS 111 service.
Updated
8 November 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Trinity and Bowthorpe Surgery on 11 September 2015. Overall the practice is rated as good.We found the practice to be safe, effective, caring, responsive to people’s needs and well-led. The quality of care experienced by older people, by people with long term conditions and by families, children and young people is good. Working age people, those in vulnerable circumstances and people experiencing poor mental health also receive good quality care.Our key findings were as follows:
- The practice had a good understanding of the needs of the practice population and services were offered to meet these.
- Patients were satisfied with the service and felt they were treated with dignity, care and respect and involved in their care.
- There were systems in place to provide a safe, effective, caring and well run service. Practice staff were kind and caring and treated patients with dignity and respect.
- The practice was safe for both patients and staff. Robust procedures helped to identify risks and where improvements could be made.
- The clinical staff at the practice provided effective consultations, care and treatment in line with recommended guidance.
- The practice had strong visible leadership and staff felt supported by the management and were involved in the vision of providing high quality care and treatment. The practice proactively sought feedback from staff and patients, which it acted on.
We saw areas of outstanding practice:
- All GP partners at the practice undertook sessions with the local out of hours service to ensure continuity of care for the practice patient population.
- The practice continued to provide an unfunded acupuncture service to patients where required.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
8 November 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 home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to co-ordinate and deliver a multidisciplinary package of care.
Families, children and young people
Updated
8 November 2016
The practice is rated as good for the population group of families, children and young people. Staff were effective in identifying potential child abuse and the computerised alert system identified individual patient’s risk to enable clinicians to consider issues for consultations with children who were known to be at risk of harm. There was a strong relationship with the Health Visiting service to manage and review risks to vulnerable children. There was a dedicated section on the practice web-site providing detailed information about family health. The community midwife also held ante-natal clinics at the practice. The practice provided a full family planning service including the fitting of contraceptive devices. The practice also provided chlamydia screening. Nationally reported data showed the immunisation rates were comparable to local and national averages for all standard childhood immunisations.
Updated
8 November 2016
The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.
Working age people (including those recently retired and students)
Updated
8 November 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 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 opening hours on Saturdays between 8am and 11am as well as daily telephone consultations. This benefitted people who were unable to attend the practice during working hours.
People experiencing poor mental health (including people with dementia)
Updated
8 November 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 people experiencing poor mental health, including those with dementia. The practice proactively identified patients who may be at risk of developing dementia. The practice were aware of the number of patients they had registered who were suffering from dementia and additional support was offered. This included those with caring responsibilities. A register of dementia patients was being maintained and their condition regularly reviewed through the use of care plans. Patients were referred to specialists and on-going monitoring of their condition took place when they were discharged back to their GP. Annual health checks took place with extended appointment times if required. Patients were signposted to support organisations such as Improving Access to Psychological Therapies and the community psychiatric nurse for provision of counselling and support. Staff had a clear understanding of the 2005 Mental Capacity Act and their role in implementing the Act. The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they might have been experiencing poor mental health. It carried out advance care planning for patients with dementia.
People whose circumstances may make them vulnerable
Updated
8 November 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 homeless people and those with a learning disability. Of those patients with a learning disability 10.61% had either declined a health check or we were told by the practice were too young for an annual health check. Of those remaining patients on the register we were told 9.9% had received a health check since January 2015. The practice offered longer appointments for people with a learning disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.