Background to this inspection
Updated
18 March 2019
The Old School Surgery is registered with the CQC as the provider of regulated activities, carried out from the registered location at Manor Road, Fishponds, Bristol, BS16 2JD. Website: and also from a branch surgery within the campus of the University of the West of England (UWE) at:
The Health Centre, 23 Carroll Court, Frenchay Campus, Coldharbour Lane, Bristol BS16 1QY website: www1.uwe.ac.uk/students/healthandwellbeing/universityhealthcentre
We visited both the location and branch sites during the inspection.
The practice supports approximately 19,700 patients within Fishponds and the surrounding areas in the inner city east area of Bristol. Over 50% of patients are students and there is significant change to the registered patient list each year. For example, over 5,000 new patients, mostly students, were registered with the practice in the last year. This means the practice has a significantly higher than average patient population aged 15 to 44 years; and lower than average patient populations aged under 18 years or over 65 years old. Approximately 19% of patients are from black and minority ethnic (BME) groups. The practice catchment area scores in the fifth decile of the general Index of Multiple Deprivation (IMD). The most deprived score is the first decile and the least deprived score is the tenth decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas).
The provider is registered to carry out the following regulated activities:
Diagnostic and screening procedures
Family planning services
Surgical procedures and
Treatment of disease, disorder or injury.
There are six partners (three female GPs, two male GPs and a clinical pharmacist) and eight salaried GPs (seven female and one male). The GPs work alongside a clinical team including nurse practitioners, practice nurses, a mental health nurse, clinical pharmacists and health care assistants. Two of the nurse practitioners and one practice nurse form a frail and elderly nursing team supporting older patients. The clinicians are supported by practice management, reception and business support staff. The practice has been a registered GP teaching practice since April 2013, with two qualified GP trainers; and they also provide training for students at UWE. A range of other services are hosted by the practice including: hearing aid clinics, substance misuse and alcohol services, carer’s clinics, Age Concern and Marie Curie.
The practice has a General Medical Service contract with NHS England. The practice does not provide out of hour’s services to its patients. This is provided via NHS 111 by BrisDoc when the practice is closed. Contact information is available in the practice and on the website.
Updated
18 March 2019
This practice is rated as Good overall. The well led domain was rated as outstanding.(Previous inspection December 2014 - Good)
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Outstanding
We carried out an announced comprehensive inspection at The Old School Surgery on 10 May 2018 as part of our inspection programme.
At this inspection we found:
- The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. However, arrangements for medicines management did not always ensure the security of blank prescription stationery.
- The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
- Staff involved and treated patients with compassion, kindness, dignity and respect.
- Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
- There was a strong focus on continuous learning and improvement at all levels of the organisation.
We rated well-led as outstanding because:
- We saw evidence of effective leadership with a strong focus on innovation and improvement. For example, improvements to the services delivered to patients diagnosed with dementia, a true engagement of patients and staff to seek contributions and feedback to make improvements.
- The practice took a leadership role in its local health system to identify and proactively address challenges and meet the needs of the population. For example, taking a lead within the local transformation programme to improve access to patients and integrate care and improving student healthcare locally and nationally.
We saw some areas of outstanding practice:
- The practice was using innovative and proactive methods to improve patient outcomes, with services tailored to the needs of students including a dedicated mental health nurse employed by the practice; sexual health services for young people and through the Catheter Care pathway.
- A dedicated nursing team supported frail and older patients, including through urgent and routine home visits; management of long-term conditions; and care for patients with a diagnosis of dementia and their carers.
- The practice had continued to develop its practice based, prescribing clinical pharmacist role; and close working with the attached pharmacy, to enhance patient care. Both schemes had won national recognition from NHS England as case studies for innovation in primary care.
The areas where the provider should make improvements:
- Review and implement arrangements for the security of blank prescription stationery.
- Continue to monitor and improve the uptake of cervical screening, childhood immunisations and lower exception reporting for long term conditions and improve patient outcomes.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice