Archived: St Georges Surgery

Updated 16 March 2016

St Georges Surgery is located at 135 Pastures Avenue, St Georges, Weston Super Mare, North Somerset. BS22 7SB. The practice serves a local population of approximately 3353 patients from Weston Super Mare and the surrounding area. The practice located to the current premises in 2012,.it has parking on site including spaces for patients with a disability. The practice has a number of rooms which it makes available to other services, these include; the Bristol eye Hospital, a multidisciplinary community team (North Somerset Community Partnership) and a wellness advisor.

St Georges Surgery has three GPs who were shared across two of the providers locations locally. Between them they provide 14 GP sessions each week and are equivalent to 1.125 whole time employees. Two GPs are male and one is female. Two further GPs are expected to commence employment later in January 2016. There are two practice nurses and a clinical pharmacist prescriber whose working hours are equivalent to 1.8 whole time employees, they worked across two of the providers locations locally. There is also a full time health care assistant at the practice. The GPs and nurses are supported by seven management and administrative staff including a practice manager.

The practices patient population is expanding and has slightly more patients between the age of 20 and 39 years than the national average. Approximately 1% of the patients are over the age of 85 years compared to a national average of 2.2%. Approximately 41.9% of patients have a long standing health condition compared to a national average of 54% which can result in a higher demand for GP and nurse appointments. These figures indicate there may well be competing demands for GP appointments.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the third least deprivation decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the area is 80 and 83 years, broadly in line with the national average of 79 and 83 years respectively.

The practice is open between 8am and 6:30pm Monday to Friday. GP appointments are available from 9am with nurse appointments from 8:30am; emergency telephone access is available from 8am and 8:30am. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day. GP appointments are 10 minutes each in length and appointment sessions are typically 8:30am to 10:30am, 11am to 12 midday, 3 pm to 4:30pm and 5pm to 6pm. Later appointments are available until approximately 7:30pm each Tuesday and Wednesday with Saturday morning appointments with a female GP from 9am to 12 midday. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services.

The practice has an Alternative Provider Medical Services (APMS) contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by BrisDoc urgent care, patients are directed to this service by the practice outside of normal practice hours.

A new provider had recently merged with the current provider and was in the process of bringing about changes to how services would be structured and delivered in future. Full details of the new providers plans were unavailable to us as contractual arrangements were still to be finalised.

Updated 16 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Georges Surgery, Weston-Super-Mare on 7 January 2016. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Risks to patients were assessed and managed however, risks associated with GP staffing levels were not robust and left staff such as the health care assistant unsupported or unsupervised at times. The staffing levels also impacted on the continuity of patient care and treatment.
• 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.
• Most 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.
• Most patients said they found it easy to make an appointment. However, they stated appointments with a named GP and continuity of care was often more difficult due to high locum GP use. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff felt supported by the practice management but less so by the provider organisation. The practice sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

• The practice had previously developed a list of frail older patients who lived in vulnerable or isolated circumstances. Each member of staff was allocated a number of these patients and made regular telephone contact with the patients to ensure they were safe. Any concerns identified were passed to the GPs or nurses so further action could be taken. Additionally a health care assistant visited patients at home on a social basis to ensure patient wellbeing; any concerns were highlighted to the GPs so follow up appointments could be made.

The areas where the provider must make improvement are:

• Ensure GP staffing levels are maintained to ensure the nursing team and specifically the health care assistant, have access to clinical support throughout their patient appointments and to ensure clinical advice is available should a medical emergency arise during the practice opening hours.
• Ensure practice governance arrangements consider all aspects of the practice as part of a continuous improvement process. For example, ensuring all staff receive provider identified mandatory training and an annual appraisal, and ensuring risks related to lone working are fully assessed.

The areas where the provider should make improvement are:

• Review how continuity of GP access is provided to patients.
• Review clinical support processes for permanently employed GPs.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 16 March 2016

The practice is rated as requires improvement for the care of patients with long-term conditions. The practice was rated as requires improvement for effective and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for caring and responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Overall the practice diabetes quality and outcomes framework (QOF) performance for 2014-2015 was 79.1% compared to the clinical commissioning group average of 91.5% and the national average of 89.2%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and an 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.

Updated 16 March 2016

The practice is rated as requires improvement for the care of families, children and young patients. The practice was rated as requires improvement for effective and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for caring and responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The percentage of patients with a diagnosis of asthma, on the register, who have had an asthma review in the preceding 12 months that included an assessment of asthma control using the three RCP questions. (01/04/2014 to 31/03/2015) (A screening tool developed by the Royal College of Physicians to prompt a review of treatment) was 71.43% compared to the clinical commissioning group average of 77% and the national average of 75.35%.
• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years (01/04/2014 to 31/03/2015) was 82.7% compared to the Clinical Commissioning Group (CCG) average of 82.2% and the national average of 81.83%.
• 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.

Updated 16 March 2016

The practice is rated as requires improvement for the care of older patients. The practice was rated as requires improvement for effective and well-led as well as overall. The practice was rated as inadequate for safety. The practice was rated as good for caring and responsive and includes this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice offered personalised care to meet the needs of the older patients in its population; however continuity of care was not always available.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice supported patients living in local residential homes with fortnightly visits and the provision of flu vaccinations.
• The practice had previously developed a list of frail older patients who lived in vulnerable or isolated circumstances who staff contacted regularly.

Updated 16 March 2016

The practice is rated as requires improvement for the care of working-age patients (including those recently retired and students). The practice was rated as good for effective, caring and responsive overall and includes this population group. The provider was rated as requires improvement for safety and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 and flexible.
• Weekend appointments were available each Saturday morning and a walk in phlebotomy service was provided by the practice from 8.30am to 10.30am on Tuesday and Thursday mornings.
• 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 16 March 2016

The practice is rated as requires improvement for the care of patients experiencing poor mental health (including patients with dementia). The practice was rated as good for effective, caring and responsive overall and includes this population group. The provider was rated as requires improvement for safety and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015).
• 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.
• The practice carried out advance care planning for patients with a diagnosis of 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.

Updated 16 March 2016

The practice is rated as requires improvement for the care of patients whose circumstances may make them vulnerable. The practice was rated as good for effective, caring and responsive overall and includes this population group. The provider was rated as requires improvement for safety and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless patients and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams 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.