Archived: Clarence Park Surgery

Updated 15 October 2015

We inspected the location of Clarence Park Surgery, 13 Clarence Road East, Weston Super Mare, North Somerset, BS23 4BP where all registered regulated activities were carried out. This focused inspection was undertaken to follow up on the breach of regulation found at our previous comprehensive inspection undertaken on 11 February 2015.

Clarence Park Surgery has approximately 5,000 patients registered with the practice within a catchment area which includes an area within Weston-Super-Mare. There are three GPs employed by the practice; two partners and a salaried GP. Two of the GPs are female and one is male and the hours contracted by GPs are equal to approximately 2.1 whole time equivalent employees. Additionally there are five practice nurses including an advanced nurse practitioner and a health care assistant employed.

Since the previous inspection the practice manager had left the practice and the assistant manager was acting as practice manager with the support from a manager who had been employed by the practice a number of years previously.

The practice population is predominantly white British with an age distribution of male and female patients predominantly in the 45 and above age categories. The average male and female life expectancy for the practice is 80 and 84 years respectively, slightly above the national average. The practice has the highest number of older patients over the age of 85 years in the South West with many of them living in nursing and residential homes. The patients come from a range of income categories with an average for the practice being in the fourth most deprived category. One being the most deprived and ten being the least deprived. About 15% of patients are over the age of 75 years and about 12% under the age of 15 years.

The practice has a Personal Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice). The practice is contracted for a number of enhanced services including facilitating timely diagnosis and support for patients with dementia, learning disabilities, patient participation, immunisations and remote care monitoring.

The practice has core opening hours from 8am to 6:30pm to enable patients to contact the practice. The practice has opted out of providing out-of-hours services to their own patients. Patients can access NHS 111 and if necessary patients are directed to BrisDoc the Out of Hours doctor service.

Updated 15 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clarence Park Surgery on 11 February 2015. Overall the practice is rated as Good.

Specifically, we found the practice was good for providing an effective, responsive, caring and well led service. They required improvement for providing safe services in relation to their medicines management. Overall they were good for providing services for all of the population groups.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was not always recorded, monitored, appropriately reviewed and addressed. For example, infection control audits did not always identify areas for improvement and significant events were discussed but had not always been recorded.
• Risks to patients were often assessed and well managed. However, there were some aspects that required improvements and review including medical emergencies, security arrangements.
• 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 said they found it easy 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.

We saw one area of outstanding practice:

• One of the nurses had achieved the Queens Nursing Institute in 2014. This award recognises a nurses commitment to the values of community nursing, to excellent patient care, and to a continuous process of learning and leadership. Locally, they were leading improvement projects and redesigning services to improve care for patients. The award was for the nurses development, teaching and examination of students undertaking a post graduate diploma/MSC at the university of Cardiff medical school. They also had an honorary contract as a Senior Lecturer at a Hospital in the Isle of Man where they facilitated and supported pre-registration learning and non-medical prescribing course. Additionally they were mentoring a nurse who had been a newly qualified in minor illness. The nurse was well established within the area and when they had moved to this practice other patients had joined this practice due to the quality of care received. They ensured patients were consistently seen to complete treatment and necessary tests in a timely manner.

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

Importantly the provider must:

• The practice must risk assess medical emergency equipment and medicines in reflection of current guidelines and review security of all medicines including vaccine refrigerators and where emergency medicines were kept.

Additionally the provider should:

• Review procedure for recording significant events to ensure these are recorded when they happen and any action to address the event.
• Review access to the front entrance of practice to improve accessibility for all patients.
• Review how consent was recorded for joint injections including any advice and guidance provided during consultations.
• Review and risk assess security of consultation rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 June 2015

The practice is rated as good for the care of patients 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 that 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 25 June 2015

The practice is rated as good for the care of families, children and young patients.

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 heard about examples of joint working with midwives, health visitors and school nurses.

Updated 25 June 2015

The practice is rated as good for the care of older people.

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

Updated 25 June 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 offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 25 June 2015

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

We saw 100% of patients experiencing poor mental health had received 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 dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND. They 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.

Updated 25 June 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 people, travellers and those with a learning disability. They had carried out annual health checks for patients with a learning disability and all of these patients had received a follow-up appointment where indicated. They offered longer appointments for patients with a learning disability where the need was identified.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. They had told 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.