Stoke Gifford Medical Centre

Updated 28 September 2016

Stoke Gifford Medical Centre is a suburban providing primary care services to patients resident in the Stoke Gifford and Conygre Road areas of South Gloucestershire.

The service operates from two locations:

Stoke Gifford Medical Centre,

Ratcliffe Drive,

Stoke Gifford,

South Gloucestershire

BS34 8UE

And

Conygre Medical Centre

3 Conygre Road,

Filton,

South Gloucestershire,

BS34 7DA

The practice has six GP partners (male and female), three associate GPs, a strategic manager, two nurse practitioners, five practice nurses, two health care assistants and three phlebotomists. This staff team worked across the two sites. The site at Stoke Gifford had six consulting rooms, two clinic rooms, two treatment rooms and one interview room available for patients. We saw there was a large waiting room and a smaller waiting area for patient with nurse appointments. Each GP has a lead role for the practice and nursing staff have specialist interests such as diabetes and infection control. The practice is open Monday to Friday 8am-6.30pm. GP appointments were available outside core hours on different days, starting at 7.30am. The practice also has a branch surgery based at Conygre Road.

The practice had a Personal Medical Services contract (GMS) with NHS England to deliver general medical services. The practice provided enhanced services which included facilitating timely diagnosis, support for patients with dementia and childhood immunisations.

Stoke Gifford Medical Centre, in line with other practices in the South Gloucestershire Clinical Commissioning Group, is situated within a significantly less deprived area than the England average.

The practice is a teaching practice and takes medical students from the Severn deanery. No registrars or students were present during our visit.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access NHS 111 or BrisDoc provide the out of hours GP service.

Patient Age Distribution

0-4 years old: 6.8%

5-14 years old: 11.9%

15-44 years old: 43.2%

45-64 years old: 24.9%

65-74 years old: 7%

75-84 years old: 4.1%

85+ years old: 2.1%

Patient Gender Distribution

Male patients: 49.8 %

Female patients: 50.2 %

Other Population Demographics

% of Patients from BME populations: 13.53 %

Patients at this practice have a higher than average life expectancy for men at 81 years and women at 85 years.

The practice had made an application to the commission to add the newest partner to the registration.

Updated 28 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stoke Gifford Medical Centre

on 5 July 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, however, where the partners had delegated authority to staff to undertake areas of work within the practice, processes were needed to ensure there was continuous clinical oversight of these areas. 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.
• 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 there were 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.

The areas where the provider should make improvement are:

• The partners had delegated authority to staff to undertake areas of work within the practice, such as dissemination of patient safety alerts, patient medicines changes and exception reporting, however, the processes to ensure there was continuous clinical oversight of these areas should be further developed.

• Where a patient’s mental capacity to consent to care or treatment was assessed the outcome of the assessment should always be recorded on the patient record.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 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.

• 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 nurse or GP followed up patients who have experienced chronic obstructive pulmonary disease or asthma exacerbation episodes leading to intervention from secondary of out of hours services.

• The practice employed a pharmacist who carried out medication reviews and planned to deliver face to face consultations.

• The practice used a recall system for patients with a range chronic diseases (including those not on the quality and outcomes framework, for example, coeliac disease) and had a dedicated member of the administration team co-ordinating recall appointments. There were text reminders 24 hours ahead of the appointment and telephone prompts from an administrator for specific vulnerable patients.

Updated 28 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 good for all standard childhood immunisations.

• New parents were invited to education sessions based on ‘When Should I Worry Guidance ‘on common childhood illness.

• The threshold for seeing unwell children or responding to parental concern was low and embedded within the telephone triage system. The practice had nurse led minor illness sessions which were supported by the duty GP. These offered flexible and easy access which was particularly useful for families with young children.

• The practice was part of a research programme ‘Action Plans for Children with Eczema (APACHE) study’ to improve outcomes for children with eczema.

• Sexual health, contraception advice and treatment were provided for young people including opportunistic chlamydia screening.

• They had a system of alerts on the medical records for patients at risk of, or with a history of, domestic violence and for those families who are a cause for concern due to safeguarding children concerns. Families were allocated to a named GP.

• The practice operated a minor injuries walk in service.

• Appointments were available outside of school hours and the premises were suitable for children and babies; the triage system prioritised sick children.

• We saw positive examples of joint working with midwives, health visitors and school nurses. Written invitations were sent for eight week post-natal checks and immunisations with active recall for non-attenders using specific ‘Did Not Attend Immunisation’ protocol.

Updated 28 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 patients in its population. They used the risk assessment tools to identify those patients who require palliative care input or would benefit from a care planning approach due to the fact that they were found to be at high risk of hospital admission.

• The practice held weekly clinics in three care homes for older people and a monthly ‘virtual ward’ with the multidisciplinary health care team in order to have proactive care planning for hospital admission avoidance and end of life care.

• The practice policy was for patients over trhe age of 75 to have appointment with their usual GP to promote continuity of care.

• The practice held a palliative care register, for all those patients in the last year of life to promote a “good death”, in line with patient choice and wishes.

• Use of triage for appointments had enabled GPs to prioritise care of unwell older patients and ensuring timely home visits. The practice used emergency care practitioners from the local community healthcare services to undertake some home visits.

• The practice held a carers register and signposted patients to services who offered carers assessment.

• The practice had successfully applied to work with South Gloucestershire Council and Age Concern to be part of a funded scheme to develop a visiting and befriending service for the older patients and to help improve resilience for patients who were high risk of hospital admission. The practice held regular meetings with the health visitor for the elderly and reviewed all patients 80 -85 years.

Updated 28 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. Examples of this were increased provision of telephone appointments, both in-hours and extended hours; web based GP consultation service; evening and early morning appointments; 65% of appointments were available to book on- line or in advance. There were four Saturday morning surgeries in the winter when pressure for appointments is greater.

• The practice was proactive in offering on-line services as well as a full range of health promotion and screening that reflects the needs for this age group such as on-line prescription ordering and Electronic prescribing service, referral to weight management; exercise programme; cervical screening; flu immunisations; Chlamydia screening; support to stop smoking.

• The practice offered NHS health checks and a new patient’s check to those identified as higher risk.

• The practice publicised team specific e-mail addresses for patients to access on their website for non-urgent queries.

Updated 28 September 2016

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

• The practice regularly carried out screening for dementia and were engaged in the local dementia pilot scheme to develop appropriate services.

• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia, to develop registers and formalise shared management plan with a usual GP.

• 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 and had awareness of the Mental Capacity Act (2005); the practice had alerts on the records of patients who had a Deprivation of Liberty authorisation in place.

Updated 28 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 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.

• Patients with a cancer diagnosis and those on the palliative care register had a named GP.

• 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; adult safeguarding concerns were discussed at the multidisciplinary ‘virtual’ ward round.

• The practice hosted a substance misuse worker providing a fortnightly clinic

• Text reminders were sent prior to pre-booked appointments.

• Patients with hearing impairments were able to text the practice mobile to arrange appointments.