Fishponds Family Practice

Updated 6 January 2017

Fishponds Family Practice is located in Fishponds, a conurbation of Bristol. The practice has occupied its current, purpose-built facility since 2006, and shares it with another GP practice and teams of health visitors, district nurses and a community midwife. Fishponds Family Practice has 11 GP consulting rooms on the ground floor, along with three treatment rooms and a room for minor operations. A general office area is located behind the reception desk. An administration office is located on the first floor, which can be accessed by a lift or stairs.

Fishponds Family Practice is one of 48 GP practices in the NHS Bristol Clinical Commissioning Group (CCG) area. The practice has around 12,673 registered patients, most of whom live within a two to three mile radius of the practice. The practice patient populations broadly mirror the England average for most age groups, thereby providing an indication of the area’s demographic profile. There are slight deviations for the 15 to 19, and 45 to 49 age groups, which are slightly below the England average, and the 30 to 34 age group, which is slightly above the England average.

69% of the practice population describes itself as white British, and 26% as having a Black, Asian and Minority Ethnic background. A measure of deprivation in the local area recorded a score of 5, on a scale of 1-10. A higher score indicates a less deprived area. (Note: 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 not all deprived people live in deprived areas).

The practice team consists of six GP partners (three male, three female) and two salaried GPs (both female). A nurse manager leads a team of three practice nurses and there are two phlebotomists who also combine the role with that of health care assistant. The clinicians are supported by a practice manager, a deputy practice manager, and a team of administrators and secretaries. The practice has a Personal Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice).

Fishponds Family Practice will take calls from 8am to 6.30pm, Monday to Friday. Doors are open from 7.30am to 7.30pm, Monday to Thursday, and from 7.30am to 6.30pm on Friday.

Routine GP appointments are available from 8am to 10.30am and 3pm to 6pm, Monday to Thursday; and from 8.30am to 11.30am and 3pm to 6pm on Friday. The practice provides extended hours morning appointments with a GP from 7.30am to 8am and extended hours evening appointments from 6.30pm to 7pm, from Monday to Thursday. Appointments can be pre-booked up to four weeks in advance.

Fishponds Family Practice is a teaching and training practice for junior doctors and nursing students and currently has one trainee in their final year of a postgraduate medical training programme.

The practice has opted out of providing Out Of Hours services to its own patients. Outside of normal practice hours, patients can access NHS 111, and an Out Of Hours GP service is available. Information about the Out Of Hours service was available on the practice website, on the front door, in the patient registration pack, and as an answerphone message.

Fishponds Family Practice provides regulated activities from its sole location at Beechwood Road, Fishponds, Bristol. BS16 3TD.

Updated 6 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fishponds Family Practice on 4 October 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.
• 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. 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.
• Fishponds Family Practice received the Customer Service Excellence Award, for demonstrating a high level of commitment to patient care. The practice’s customer care policy is one of several component parts to the award. The care policy focuses on how the practice delivers access to patient services and offers choice wherever possible. The customer care policy is available for patients to read in the practice and on its website.
• The patient participation group (PPG) were well engaged and represented across a diverse range of ages and backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness to patients about the practice’ services.
• The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary booked for a same day appointment at the practice.
• The practice worked closely with local organisations including a hospice, a dementia charity and a homeless charity.
• The practice participated in a social prescribing scheme to support people who attend their GP surgery but did not necessarily require medical care. Social prescribing supported patients with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs.
• Staff had lead roles that improved outcomes for patients such as a carer’s lead.
• The practice was one of seven GP practices that had helped to develop a medical student psychotherapy scheme, for patients who did not have access to specialist mental health services.
• The practice helped to establish an additional psychotherapy service for patients to be initially assessed before referral to the private or voluntary sector, where they were provided with opportunities for work and art therapies.
• Patients were able to access a specialist dementia memory nurse. The nurse assessed patients in their own homes, advised on tests and medications and once diagnosed, referred patients to a dementia navigator to help them and their carer access available community support.
• 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.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
• The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.

We saw two areas of outstanding practice:

• There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. Fishponds Family Practice received the Customer Service Excellence Award in 2010. This government-backed scheme was open to all health sector organisations and awarded where there was a demonstrably high level of commitment to patient care. Fishponds Family Practice was the third GP practice in the country to attain the award since its’ inception in 1991. Following a reassessment in 2015, the practice was re-accredited for this Excellence Award until 2018.
• The leadership, governance and culture of Fishponds Family Practice are used to drive and improve the delivery of high-quality person-centred care. For the last three years, practice GPs have had fortnightly supervision sessions with a consultant psychotherapist. The sessions were self-funded by the GPs, and focussed on patient empathy and interaction, staff relations, and identifying and working to meet the demands of a GP’s role. The practice produced a paper about the GPs’ experiences of counselling that was published in the British Medical Journal in 2014. When we spoke to the practice, we saw that informal feedback highlighted GPs found the sessions highly beneficial to their professional practice.

We saw one area where the practice should make improvement:

• The provider should continue to make efforts to identify a greater proportion of carers from its patient list, to better support the population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 January 2017

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.
• Performance for patients with long-term conditions compared with national averages. For example, 72% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 76%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
• 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.
• The practice routinely offered longer appointments for patients with complex medical needs.

Updated 6 January 2017

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 assessed the capability of young patients using Gillick competencies. These competencies are an accepted means to determine whether a child is mature enough to make decisions for themselves.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 81%, which was comparable to the national average of 82%.
• 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 worked to provide inclusive services for younger patients, such as hosting the 4YP (for young people) initiative which enabled teenagers to access sexual health care.

Updated 6 January 2017

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.
• Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• A carer’s lead worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
• The practice referred patients to local community health improvement schemes.

Updated 6 January 2017

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 hours appointments with a GP, nurse or phlebotomist on five mornings a week and four evenings a week.
• Patients were able to book appointments and order repeat prescriptions online.
• The practice offered text reminders for appointments.
• Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

Updated 6 January 2017

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

• 77% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which compared with both the clinical commissioning group (CCG) average of 81% and national average of 78%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 92%, which compared with the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 provided injections of slow-release antipsychotic medication for patients at risk of missing their medication, and a phlebotomy service for those patients on medications needing regular blood test reviews.
• The practice provided a medical student psychotherapy scheme for patients who were not normally able to access specialist mental health services.

• The practice was proactive in helping patients to access mental health services. The practice helped to develop a further psychotherapy scheme and referred patients to private or voluntary sector psychotherapy services. Patients were able to access individual face-to-face assessment with an appropriate follow-up package then being arranged for them. This could be anything from group art therapy work to individual counselling lasting up to six months. The scheme was funded by the local CCG and had engaged around 133 patients.

• Patients were able to access a specialist dementia memory nurse.

• The practice referred 49 patients into a social prescribing scheme in the last 12 months, and we saw evidence that this had benefitted them in their lives.
• The practice worked closely with local charities including a dementia charity and we saw evidence that patients benefitted by being referred more quickly into those services. The practice also invited local charities to attend its monthly palliative care meetings, to discuss the patients on their caseload.

Updated 6 January 2017

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 those with a learning disability.
• 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.
• The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.