Archived: Emersons Green Medical Centre

Updated 9 July 2015

Dr V H Barry, Dr N C Boelling, Dr J R Eustace and Dr M Gallagher (also known as Emerson Green Medical Centre) provides primary medical services to approximately 10,500 patients living in Emerson Green, a residential area in South Gloucestershire on the northern outskirts of Bristol. The practice is situated next to a nursery school and local shopping centre. Emerson Green NHS Treatment Centre is located close by.

The surgery was purpose built in the 1990’s to serve the new residential area and is leased to the practice by NHS Property Services Ltd. The building is set over two floors with all patient access areas on the ground floor. It has an access ramp to the entrance of the building and a large car park with disabled parking and a bicycle rack. Bus stops are located a short walk from the practice. There is a separate reception area with an automated arrival system and spacious waiting room. There are nine clinical rooms.

Public Health England’s national general practice profile shows the practice has a significantly higher population of female patients aged between 30 and 49 years old and male patients aged between 35 and 44 years old. There are no residential or nursing care homes within the area. The practice describes the population as predominately professionals and young families and this is reflected in the national general practice profile which lists 9.2% of the practice population as over 65 years of age (averages across England is 16.7%). The practice population has low levels of deprivation (8.13) compared with the local CCG average of 11.2 and England average of 22.1.

The practice team includes three GP partners; three salaried GP’s and a GP Registrar (in addition one GP is currently on maternity leave); four registered nurses including a nurse manager and an independent nurse prescriber. Two nurses are currently undertaking advanced nurse training. The nursing team are supported by two experienced health care assistants. A practice manager is supported by an office manager who leads a reception team of seven; administration team of six and a business support coordinator. There is a mix of female and male GP’s plus three female and one male nurse. These staff provide care and treatment for approximately 10,500 patients.

We also had the opportunity to speak to a Locum GP during our inspection. The practice currently uses a regular Locum to cover two sessions a week.

The practice also worked with community staff including Health Visitors who were based at the practice; a Midwife; a District Nursing team; an Emergency Care Practitioner (commissioned by South Gloucestershire CCG to provide urgent home assessments); a Physiotherapist; Dietician and Podiatrist.

The practice is commissioned to provide primary medical services by NHS England under an Alternative Provider Medical Services (APMS) contract. The contract has been in place for seven years and is currently being reviewed in advance of October 2015 when a new contract will be awarded.

The practice has opted out of providing out-of-hours services to their own patients. Patients can access NHS 111 out of hours and Brisdoc provide an out-of-hours GP service.

A new area of housing estate and business park is planned for the area which will result in 3,000 new residents who will register at this and another local GP practice. This had been incorporated within the business continuity plan for the practice.

Updated 9 July 2015

We carried out an announced comprehensive inspection at Emerson Green Medical Centre on 16 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was good for providing services for older patients, patients with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Patients were kept safe because staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice had good facilities and was well equipped to treat patients and meet their needs. There were systems in place to keep patients safe from the risk of infection.
• Information about how to complain was available and easy to understand
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• Not all patients found it easy to book a routine appointment however most patients reported they got an appointment when needed.

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

The provider should:

• Introduce a system for monitoring records of staff training.

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 July 2015

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 that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 9 July 2015

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 were experiencing high risk domestic abuse. Immunisation rates were high than the local average 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 good examples of joint working with health visitors and school nurses.

Updated 9 July 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 proactive, 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 rapid access appointments for those with enhanced needs.

Updated 9 July 2015

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.

Updated 9 July 2015

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 people experiencing poor mental health, including those with dementia.

It carried out advance care planning for patients with dementia and worked with patients and families to ensure any DNACPR (do not attempt cardiopulmonary resuscitation) decisions were appropriate and kept under review.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Staff had received training on how to care for people with mental health needs and dementia.

Updated 9 July 2015

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. It offered longer appointments for people with a learning disability had carried out annual health checks

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and this included attendance at case conferences where a child was at risk of serious harm. It 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.

The practice had engaged with the South Gloucestershire Partnership Against Domestic Abuse (SGPADA) IRIS project (Identification and Referral to Improve Safety for women) to support identification and referral of victims. As domestic abuse impacts health the practice staff had received training in relation to domestic abuse identification and referral pathways for victims and their families. Police incident reports are cascaded daily to GPs and there are care pathways that ensure identification and onward referral and care of victims of domestic abuse.