Archived: Eastville Medical Practice

Updated 9 April 2015

We inspected the location of Eastville Medical Practice, Eastville health centre, East Park, Eastville, Bristol, BS5 6YA, where all registered regulated activities were carried out.

The practice serves approximately 8500 patients and sees patients who live in Easton, Eastville, Stapleton, St Werburghs and Fishponds in the inner city east area of Bristol. The practice is based in a diverse area of Bristol and practice approximate figures say there are approximately 60% of patients registered are from a non-white British ethnicity covering approximately 40 different ethnicities. The highest ethnicity population being Somalian and South East Asian. A high number of patients had a language barrier which was one of the biggest challenges for the practice.

Additional services are provided from the practice premises including a child audiology clinic and a local drug project counsellor visited the practice on a regular basis to provide services to practice patients and others in the community. The practice provides specialist services such as circumcision for boys aged between 1 and 6 months. They also provide 4YP (for young people) a scheme set up by Bristol Clinical Commissioning Group for young patients under the age of 25 years old to provide advice on sexual health matters.

The national general practice profile shows the practice has 23% of patients under the age of 18 years old which is over the England and Bristol Clinical Commissioning Group (CCG) average, particularly between the ages of 0 to 9 years old. They also have above the national and local average numbers of patients in the 25 to 39 year olds category. The practice is significantly under the national and CCG average for patients over 50 years old. The practice is in an area of Bristol which has a higher than average level of deprivation.

Each week the GPs work the full time equivalent to four and half full time GPs. There were three GP partners and three salaried GPS; three male and three female. The practice was a registered GP training practice. They had one GP registrar and a GP retainer. A registrar is a qualified doctor who requires additional experience in a GP practice to qualify as a GP. A retainer is a GP who is working a reduced contract whilst they had child care responsibilities.

The practice employed a clinical pharmacist who leads on auditing and reviewing patient’s medicines. They work an equivalent to 0.75 of a full time worker.

There were seven members of the nursing team, all female. This consisted of two practice nurses who can also independently prescribe medicines, two practice nurses, two health care assistants and a phlebotomist. Each week the nursing team work the equivalent of just over four full time workers.

The practice had a Personal Medical Service (locally agreed) contract with NHS England. The practice referred their patients to Brisdoc for out-of-hours services when the practice was closed.

The practice had previously been inspected under our old methodology in December 2013. We did not have any concerns about this practice prior to our inspection following this inspection. We followed up on some areas which were highlighted on the last report, such as the practice now has a whistle-blowing policy.

Updated 9 April 2015

Letter from the Chief Inspector of General Practice

On Wednesday 3 December 2014 we carried out an announced comprehensive inspection at Eastville Medical Practice. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, members of the patient participation group, interviewed staff of all levels and checked the systems and processes in place.

Overall the practice is rated as good. Specifically, we found the practice to be good for providing well-led, effective, caring, safe and responsive services. They were also good for providing services for patients who circumstances may make them vulnerable, families, children and young patients, older patients, working age and retired patients, patients with long term conditions and patients experiencing poor mental health.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 found it difficult to contact the practice either by phone or visiting the practice. It was often found patients would be queuing outside the practice for appointments or were on hold waiting for a significant time on the phone to make an appointment. The practice had tried to improve this for patients but had a number of challenges making this difficult to achieve.
• 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 practice had good communication with other services to ensure patients received the best care possible.

We saw several areas of outstanding practice including:

• The practice supports a local drug project and a support worker attended the practice once a week to provide support to patients who need help and advice. One of the GPs led on drug and alcohol misuse. We were told the service had been very beneficial to patients. The agencies work closely together and were able to share information about patient’s welfare regularly with each other.

• The practice had a high number of patients who were from Somalia. The practice had a health link worker who spoke Somali visiting the practice once a week to support these patients who may need assistance, such as with interpreting English when visiting the GP.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure all fire safety recommendations were addressed promptly and clearly recorded to ensure risks to patient safety were reduced if there was a fire.
• Ensure nurse practitioners receive regular formal clinical supervision from a GP for their independent prescribing role
• Ensure the recruitment policy reflects current legislation, such as detailing whether health and social care relation references were required depending on the employee’s previous experience and proof of identification for new employees.

• Continually review staffing levels and ensure patients were seen and spoken with promptly when visiting and phoning the practice.
• Ensure staff monitoring refrigerator temperatures where vaccines were kept are aware of current practice protocols in line with this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 April 2015

The practice is rated as good for the care of patients with long-term conditions. There were emergency processes in place and referrals were made for patients whose health deteriorated suddenly. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check their health and medication 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 9 April 2015

The practice is rated as good for the care of families, children and young patients. Information from the Health and Social Care information centre identified that immunisation rates were slightly lower than average for standard childhood immunisations for the local CCG area. The practice were continuing to inform parents of the benefits of the immunisations and ensuring patients were regularly contacted to attend for their child’s immunisations. Patients told us children and young patients 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 heard good examples of joint working with health visitors.

There were a number of children on the child protection register and the child protection lead worked closely with the community teams in the area to ensure information was shared appropriately. The practice held weekly clinical meetings where patients of concern were discussed.

The practice run a scheme set up by Bristol Clinical Commissioning Group called 4YP (for young people) this service provided advice and support for young patients under the age of 25 years old on sexual health matters. This service was available to all young patients in the community not just patients at the practice. Patients using this service were able to drop in during specific times in the practice opening hours without an appointment or could make an appointment to be seen.

Updated 9 April 2015

The practice is rated as good for the care of older patients. Nationally reported data showed outcomes for patients were good for conditions commonly found in older patients. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, in dementia care. They were responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 9 April 2015

The practice is rated as good for the care of working-age patients (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 9 April 2015

The practice is rated as good for the care of patients experiencing poor mental health (including patients with dementia). There were 101 patients registered who had a mental health condition and all were offered an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with a diagnosis of dementia. They had carried out advance care planning for the 15 patients registered at the practice with a diagnosis of dementia.

The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for patients with mental health needs and dementia.

The practice supports a local drug project and a support worker attends the practice once a week to provide support to patients who need help and advice. One of the GPs led on drug and alcohol misuse and told us the service had been very beneficial to patients. Because the agencies work closely they were able to share information about patient concerns easily and the practice had an open door policy for discussions.

Updated 9 April 2015

The practice is rated as good for the care of patients whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability. They had carried out annual health checks for all 43 patients registered at the practice with a learning disability in the last year. They offered home visits and longer appointments for patients with a learning disability. They also worked closely with the community learning disabilities team who were based in the practice.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. They told vulnerable patients about how to access various support groups and voluntary organisations within the local area. 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 high number of patients who were from Somalia. The practice had a health link worker who spoke Somali visiting the practice once a week to support these patients who may need assistance.