Archived: Hotwells Surgery

Updated 26 October 2016

The provider is Dr Nicholas Ring, who provides a service at Hotwells Surgery; this is located in the Hotwells area of Bristol. There are approximately 3103 patients registered at the practice who live within the Hotwells area of Bristol.

The practice operates from one location:

2 Charles Place

Hotwells

Bristol

BS8 4QW

The Hotwells Surgery is situated in an adapted building close to the residential areas of Hotwells and one of the main routes into the city of Bristol. There are two consulting rooms, a treatment room, reception and waiting room on the ground floor. On the first floor there are offices, staff kitchen and areas for storing records. There is no patient parking, although there is a free public car park a short distance away.

The practice is provided by an individual GP (male) who employs a small team of staff including regular locums. The practices core team of employed staff include one salaried GP (female), a practice nurse, three receptionists, a secretary and a clerk. Two male locum GPs and one locum practice nurse (female) supplemented the clinical team.

Hotwells Surgery is open from 8.30am until 1pm, Monday to Friday, with the exception of Thursday when it closes at 12noon. In the afternoons Monday, Tuesday and Wednesday the surgery reopens at 3pm until 6.30pm, and on Friday it is open from 3pm until 5pm. Appointments are available from 9am to 11am and 4pm to 6pm every day. The exception is Friday which is 3pm to 5pm. Patients are directed to the out of hour’s service during the day when the practice is closed. Since the last inspection undertaken on 18 May 2016 we have been informed by the provider their contractual arrangements have been reviewed by NHS England. This was in regard to the information provided by the practice to patients about the opening hours. At the time of this report we did not have access to the outcome of this review.

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 extended hours access, immunisations and unplanned hospital admission avoidance.

The practice does not provide out of hour’s services to its patients, this is provided by BrisDoc. Contact information for this service is available in the practice and on the practice website. Patients can call the practice and speak to a receptionist or dial directly the GPs mobile during the day when the practice is closed.

Patient Age Distribution

0-4 years old: 5% (the national average 5.9%)

5-14 years old: 7.6% (the national average 11.4%)

Under 18 years old: 14.4% (the national average 20.7%)

65-74 years old: 11.2% (the national average 17.1%)

75-84 years old: 4.5% (the national average 5.9%)

85+ years old: 1.1% (the national average 2.3%)

Other Population Demographics

% of patients with a long standing health condition is 46.6% (the national average 54%)

% of patients in paid work or full time education is 75.7% (the national average 61.5%)

7.2% of the practice population was from a Black and Minority Ethnic background.

Practice List Demographics / Deprivation

Index of Multiple Deprivation 2015 (IMD): is 14.7 (the national average 21.8). The lower the number the more affluent the general population in the area, is.

Income Deprivation Affecting Children (IDACI): is 10.2% (the national average 19.9%)

Income Deprivation Affecting Older People (IDAOPI): is 13.7% (the national average 16.2%)

Updated 26 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Hotwells Surgery on 7 September 2016. This was to check compliance to the serious concerns we found during a comprehensive inspection of Hotwells Surgery on 18 May 2016 which resulted in the Commission issuing a Warning Notice in regard to Regulation 12, Safe Care and Treatment. Other areas of non compliance found during the inspection undertaken on 18 May 2016 will be checked by us for compliance at a later date.

Following our inspection undertaken on 18 May 2016 we rated the practice overall as requires improvement. The domain of caring was assessed as being one that provided good services. The domain of safe was rated as inadequate and the domains of effective, responsive and well led required improvement. These ratings will remain in place until we have been assured these concerns have been rectified and a further inspection to check compliance will be undertaken .

Our key findings across all the areas we inspected at the previous inspection 18 May 2016 were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.

• Improvements are required in respect of practice management. The practice had a limited number of policies and procedures to govern activity. Key policies and procedures were not in place to direct and guide staff and to further ensure that all staff were aware of their role and responsibilities. Risks to patients care and treatment were assessed and well managed with the exception of those relating to recruitment checks.

• Data showed patient outcomes were similar to the national average.

• Patients said they were treated with compassion, dignity and respect. Patients told us they felt cared for, supported and listened to and 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 there was continuity of care, with urgent appointments available the same day.

• The practice had appropriate facilities and was equipped to treat patients and meet their current 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.

We also identified the areas where the provider must make improvements were:

• The provider must ensure there are documented key policies and procedures, such as medicines management, Patient Group Directions and business continuity plans, to ensure all staff were aware of their role and responsibilities and were working effectively and safely to deliver the service.

• The provider must implement recruitment practices and ensure they are carried out effectively in order that safe recruitment processes being followed.

• The provider must implement a robust process to ensure that staff have the necessary training, supervision and appraisal to carry out their roles.

• The provider must ensure there is an overarching recorded approach to meeting health and safety at the practice including meeting legislative requirements relating to Control of Substances Hazardous to Health (COSHH), fire safety, and risk assessments in regard to the safety of people and the environment of the building.

The areas where the provider should make improvements are:

• The provider should implement an effective system of recording minutes of meetings so that discussions and decisions can be effectively shared, other than by verbal handover.

• The provider should implement an effective system of identifying carers in order to provide the most appropriate support they require.

• The provider should have an effective system in place for regularly seeking patient’s opinions about the service.

• The provider should have an effective system of ensuring that practice opening hours in line with what the expected NHS England contracting agreements for core hours between 8am and 18:30pm Monday to Friday, the exception being Bank Holidays, Saturdays and Sundays.

At this inspection we checked the progress the provider had made to meet the outstanding significant areas of concern as outlined in the Warning Notice, for a breach of Regulation 12 (safe care and treatment). This Warning Notice was issued by us on 24 June 2016. We gave the provider until 30 August 2016 to rectify concerns . This Warning Notice had been issued because we found there were inadequate systems, processes and practices to keep patients and visitors safe. The other key lines of enquiry in this area will be reassessed by us at a later date when the provider has had sufficient time to meet the outstanding issues.

The outstanding issues are:

• A lack of safeguarding training for staff.

• Poor medicines and prescription management

• Insufficient recruitment and employment processes

• Poor systems for the monitoring of risks to patients and staffs safety

• Gaps in the arrangements for responding to emergencies did not fully ensure patient safety.

We found at this inspection that the provider had made adequate initial steps towards implementing improvements in regard to the significant concerns identified in the Warning Notice, for a breach of Regulation 12(safe care and treatment). We will check that these steps have been sustained at the next inspection process when we will assess that the other outstanding issues have been met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 October 2016

This inspection was conducted in order to further review issues that were found at the comprehensive inspection carried out on 18 May 2016. Overall the practice was rated as requires improvement. The domain of caring was assessed at being good. The domain of safe was rated as inadequate and the domains of effective, responsive and well led required improvement. These ratings will remain in place until we have been assured these concerns have been rectified.

Updated 26 October 2016

This inspection was conducted in order to further review issues that were found at the comprehensive inspection carried out on 18 May 2016. Overall the practice was rated as requires improvement. The domain of caring was assessed at being good. The domain of safe was rated as inadequate and the domains of effective, responsive and well led required improvement. These ratings will remain in place until we have been assured these concerns have been rectified.

Updated 26 October 2016

This inspection was conducted in order to further review issues that were found at the comprehensive inspection carried out on 18 May 2016. Overall the practice was rated as requires improvement. The domain of caring was assessed at being good. The domain of safe was rated as inadequate and the domains of effective, responsive and well led required improvement. These ratings will remain in place until we have been assured these concerns have been rectified.

Updated 26 October 2016

This inspection was conducted in order to further review issues that were found at the comprehensive inspection carried out on 18 May 2016. Overall the practice was rated as requires improvement. The domain of caring was assessed at being good. The domain of safe was rated as inadequate and the domains of effective, responsive and well led required improvement. These ratings will remain in place until we have been assured these concerns have been rectified.

Updated 26 October 2016

This inspection was conducted in order to further review issues that were found at the comprehensive inspection carried out on 18 May 2016. Overall the practice was rated as requires improvement. The domain of caring was assessed at being good. The domain of safe was rated as inadequate and the domains of effective, responsive and well led required improvement. These ratings will remain in place until we have been assured these concerns have been rectified.

Updated 26 October 2016

This inspection was conducted in order to further review issues that were found at the comprehensive inspection carried out on 18 May 2016. Overall the practice was rated as requires improvement. The domain of caring was assessed at being good. The domain of safe was rated as inadequate and the domains of effective, responsive and well led required improvement. These ratings will remain in place until we have been assured these concerns have been rectified.