Horfield Health Centre

Updated 14 September 2016

Horfield Health Centre is located in a residential area of the city of Bristol. They have approximately 15,461 patients registered.

The practice operates from one location:

Horfield Health CentreLockleaze RoadBristolBS7 9RR

Horfield Health Centre is situated in an adapted building in a central area of Horfield in Bristol. It serves patients from Horfield, Lockleaze, Northville, Gloucester Road, Manor Farm and Ashley Down areas of Bristol. The main patient areas of the practice are situated on the ground floor of the main building and it hosts health visitors speech and language, midwifery, podiatry and counselling service on the first floor. There is a lift to the first floor. There is parking at the side and rear of the practice. There is an independent pharmacy on site in the adjacent building, which the partnership has recently purchased and developed to accommodate the local community nursing team and an independent optician.

The practice is made up of eight GP partners, one currently waiting to be registered with the CQC and six salaried GPs. Ten female and four male. They have one nurse prescriber, five practice nurses and three healthcare assistants. They are supported by a practice business manager, who also is a partner and shares the role of registered manager. There is a deputy practice manager, secretaries, reception and administration team. The practice employs staff for maintenance and managing the car park. The practice is a teaching practice for medical students. There were no medical students at the time of this inspection. The practice has been a training practice for over 30 years and there was an F2 doctor and ST3 doctor present on the day of inspection.

The practice opening hours are from 8am until 6.30pm, Monday to Friday. Saturdays 8.30am to 12noon. Doctor’s surgeries are from 8.40am to 11.20am and then from 3:30pm to 6.30pm. The practice also offers some appointments in the early afternoon between 1:30pm and 3:00pm. Practice Nurse, Health Care Assistant and Phlebotomy (blood taking) appointments are available between 8.40am and 6.10pm, Monday to Friday.

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, patient participation, immunisations, supporting patient with a learning disability and unplanned admission avoidance.

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 practice website.

Patient Age Distribution

0-4 years old: 6.8% (the national average 5.9%)

5-14 years old: 11% (the national average 11.4%)

Under 18 years old: 21.3% (the national average 20.7%)

65-74 years old: 11% (the national average 17.1%)

75-84 years old: 4.6% (the national average 7.8%)

85+ years old: 1.6% (the national average 2.3%)

Other Population Demographics

The percentage of Patients with a long standing health condition is 50.1% (the national average 54%).

The percentage of Patients in paid work or full time education is 71% (the national average 61.5%).

Practice List Demographics / Deprivation

Index of Multiple Deprivation 2015 (IMD): is 27.5% (the national average 21.8%)

Income Deprivation Affecting Children (IDACI): is 25% (the national average 19.9%)

Income Deprivation Affecting Older People (IDAOPI): is 23.6% (the national average 16.2%)

There is a black and minority ethnic group population of around 15.5%, including a large number of people of Somali origin. There is a changing population, including those whose first language is Polish.

Patient turnover 2015 13%.

Updated 14 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Horfield Health Centre on 4 May 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice had trained both male and female reception staff and healthcare assistants to act as chaperones, supplementing the male and female clinical practice nursing team.

• 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.

• 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 several areas of outstanding practice:

• The practice had jointly employed, with three other practices, a Care Coordinator from April 2015. The Care Coordinator contacted all patients post hospital discharge, not just those aged over 65 years, to see if they needed help to manage at home. For example, support such as instigating contact for changing of dressings, catheters or medicines.

• The practice led on providing a Community Resources Lead across the area with sourcing information about support and local groups for patients and both supporting and directing.

• The practice had a very long history of providing community support to patients, not just carers. A volunteer driving service enabled patients to attend the practice for appointments and treatment and a befriending service enabled volunteers to visit housebound patients once a week.

• There was a holistic approach to patients with multiple long term conditions who had their reviews of care carried out at the same time reducing the number of appointments patients were required to attend for their ongoing care.

• The GPs carried out one ante-natal check, and also saw their expectant mothers in the third trimester, to discuss post-natal contraception.

• The percentage of respondents to the GP patient survey who described the overall experience of their GP surgery as fairly good or very good was 95% compared to the clinical commissioning group average of 86% and national average of 85%.

The areas where the provider should make improvement are:

• The practice should ensure the new audit check, policies and procedures for the security of prescription paper is sustained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 September 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 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 14 September 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.

• 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 provided ‘teen’ checks to all 14 year olds that included immunisation, advice on general well-being, drugs and alcohol and mental health.
• The GPs carried out one ante-natal check, and also saw their expectant mothers in the third trimester, to discuss post-natal contraception.

Updated 14 September 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 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 14 September 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 had been participating in a trial since May 2015 for Web GP e-consult which offered patients 24 hour access to health advice and the option to request an online consultation.

Updated 14 September 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 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.

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

• The practice was involved with a project for a mental health nurse to be based and work in conjunction with the clinical staff at the practice to improve care at a local level.

Updated 14 September 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 had recognised that many of their vulnerable patients were temporarily homeless and although they may be living outside of their catchment area, kept them on their patient list until settled at a permanent address.

• 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.