Archived: Graham Road Surgery

Updated 22 March 2016

Graham Road Surgery, 22 Graham Road, Weston Super Mare, BS23 1YA provides support for approximately 9592 patients in a central residential area of the town.

The building is accessible to patients with restricted mobility, wheelchair users and those using pushchairs.

There are eight consulting rooms, two treatment rooms and a treatment suite. There are waiting rooms on the ground and first floors which are accessible. There are administrative offices, meeting and staff rooms on the first floor. Car parking is on street parking.

There are two partners and one salaried GP, and two regular locums. There are two Advanced Nurse Practitioners, an Emergency Care Practitioner and three Practice Nurses and three Health Care Assistants. The clinical staff are supported by a practice business manager and an administration team.

The surgery is open from 8.30 am to 6.30 pm, Monday to Friday. Appointments can be made via the telephone between 8.00am and 6.30 pm and most appointments are provided on a book on the day system. Although the surgery is open during these core hours the time between 12:30pm and 3:00pm is reserved for home visits and telephone consultations and the administrative duties. A small number of pre-booked appointments are available. Patients who find it difficult to access or attend the practice can book a telephone consultation with a GP.

The practice has a Personal Medical Services contract with NHS England. The practice is contracted for a number of enhanced services including facilitating timely diagnosis and support for patients with dementia, remote care monitoring, patient participation and childhood vaccination and immunisation scheme. The practice was a training practice for medical and nursing students, newly qualified doctors and GP registrars. There is an onsite pharmacy.

The practice does not provide Out Of Hour’s services to its patients, this is provided by BrisDoc. Contact information for this service is available in the practice and on the website.

Patient Age Distribution

0-4 years old: 5% (similar to the national average of 5.5%)

5-14 years old: 8.5% (below the national average of 11.1%)

The practice had 12% of the practice population aged 75 years and above (above the national average 7.8%)

The practiced had 68.8%(2014- 2015) of patients with a long standing health condition, above the Clinical Commissioning Group(CCG) average of 56.8% and national average of 54%.

Other Population Demographics

% of Patients in a Residential Home: 2.9 % (above the national average of 0.5%)

% of Patients in paid work or full time education: 51.8 % (the national average 61.5%)

Practice List Demographics / Deprivation

Index of Multiple Deprivation 2015 (IMD): 34.4 (above the national average 21.8)

Income Deprivation Affecting Children (IDACI): 27% (above the national average 19.9%)

Income Deprivation Affecting Older People (IDAOPI): 21.4% (above the national average 16.2%)

Updated 22 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Graham Road Surgery on 17 February 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 the skills, knowledge and experience to deliver effective care and treatment.
• The practice partnership was actively addressing issues with recruitment of clinical staff to ensure that patients had their needs met.
• 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.
• Patients said they had found the appointment system had improved and it was easier to make an appointment with a named GP and that 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.

The areas where the provider must make improvement are:

• The provider must ensure the systems for the management of prescription paper management are implemented.

The areas where the provider should make improvement are:

• The improvements implemented to the systems for management of infection control should be maintained

• The improvements implemented to the systems for management the recruitment of staff should be maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 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.

Updated 22 March 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 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’s uptake for the cervical screening programme was 78.6%, which was comparable to the Clinical Commissioning Group (CCG), and the national average of 81.8%.

• 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 22 March 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 patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 22 March 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.

Updated 22 March 2016

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

• Performance for mental health related indicators were better than the CCG and national average. For example, the percentage of patients(99.2%) diagnosed with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive agreed care plan documented in the record, in the preceding 12 months(01/04/2014 to 31/03/2015). This was in comparison with the national average of 88.4%.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 engaged through the One Care Consortium a full time Community Psychiatric Nurse to lead support for their patients.

• 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 22 March 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, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams 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.

• The practice had a dedicated member of administration to monitor and manage any safeguarding information received or any correspondence sent out. They ensured information was kept up to date and that GPs were alerted to issues which arose and patient’s electronic information was maintained and up to date.