Archived: Cheltenham Road Surgery

Updated 15 August 2016

Cheltenham Road Surgery is a long established GP practice located opposite a university campus near Gloucester city centre. The practice is situated in a three storey converted Victorian house which has been extensively modernised and extended to provide 11 consulting rooms. The practice is wheelchair accessible with a lift providing patient access from the ground floor to the first floor.

The practice provides general medical services to approximately 8,100 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice has five GP partners and one salaried GP (four female and two male) which is equivalent to approximately five full time equivalent GPs. The clinical team includes three practice nurses, two health care assistants and three phlebotomists (all female). The practice manager is supported by a team of 12 administrators / receptionists.

Cheltenham Road Surgery is an approved training practice for qualified doctors with hospital experience who wish to become GPs. In addition to specialist GP trainees, the surgery is also a training practice for FY2 doctors who have yet to decide which specialty to follow.

Due to high registration numbers from the local university the practice population has a higher proportion of patients aged between 20 and 24 compared to local and national averages. For example, 11.5% of practice patients are aged between 20 and 24 compared to the local clinical commissioning group (CCG) average of 6% and the national average of 6.5%. The practice has relatively low numbers of patients from different cultural backgrounds with approximately 93.5% of patients being white British.

The practice is located in an area with low social deprivation and is placed in the third least deprived decile by public health England. The prevalence of patients with a long standing health condition is 59.5% compared to the local CCG average of 55% and the national average of 54%. People living in more deprived areas and with long-standing health conditions tend to have greater need for health services.

The practice is open between 8.30am and 7pm on Monday to Wednesday and 8.30am to 6.30pm Thursday to Friday. The practice closes for lunch from 12.45pm to 1.45pm. Between 8am - 8.30am and 12.45pm – 1.45pm every weekday telephone calls are diverted to the practice call handling service (Message Link). They refer urgent matters to the practice that have members of staff on standby to respond to issues if needed.

Out of hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

The practice provided its services from the following address:

16 Cheltenham Road

Gloucester

Gloucestershire

GL2 0LS

This was the first inspection of Cheltenham Road Surgery.

Updated 15 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cheltenham Road Surgery on 12 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.
• 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 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 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 area where the provider should make improvement is:

• Continue to monitor and ensure actions are taken to improve patient satisfaction with telephone access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 August 2016

The practice is rated as good for the care of patients with long-term conditions.

• The practice had specialist nurses for diabetes and respiratory disease who provided both chronic and acute management of these patients within their area of expertise. Support from a GP was available if needed, and patients at risk of hospital admission were identified as a priority.

• Performance for overall diabetes related indicators in 2014/15 was 100% which was above both the clinical commissioning group average of 95% and the national average of 89%.

• Longer appointments and home visits were available when needed.

• 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 participated in a pilot scheme led by Gloucester Doctors (GDoc) to provide identified chronic obstructive pulmonary disease (COPD) sufferers with a dedicated telephone number for rapid response at weekends with the aim of avoiding hospital admission.

• Telehealth care monitoring was utilised at the practice to assist in diagnosis and monitoring patients with long term conditions. It can be used to measure and monitor temperatures, blood pressure and other vital signs parameters.

Updated 15 August 2016

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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Child immunisation clinics were held every Wednesday afternoon.

• 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 practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years in 2014/15 was 93% which was above both the clinical commissioning group average of 84% and the national average of 82%.

• 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. The practice child safeguarding lead had regular meetings with the health visitor.

• The practice participated in the advanced sexual health enhanced service (through Gloucestershire Care Services) and offered dedicated, drop-in clinics on Monday evenings and also daily sexual health appointments with the duty nurse.

• The practice was a C-card (a scheme designed to increase the access and availability to free condoms for young people under 25) centre and advertised sexual health services available at the practice within the local university.

• The practice held monthly multidisciplinary meetings with midwife representation.

Updated 15 August 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example dementia, influenza, shingles and pneumococcal immunisations.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. Practice nurses and health care assistants provided domiciliary visits to housebound patients.

• An office was provided for the district nurses to work from which facilitated good liaison and attendance at multi-disciplinary meetings where palliative care was discussed.

• As a result of practice participation in the clinical commissioning group (CCG) primary care offer enhanced service, frailty scoring (a comprehensive geriatric method for predicting surgery outcomes for elderly patients) has been introduced with the aim of improving patient overall quality of care.

• All these patients had a named GP and all patients aged over 75 were sent a letter to inform them of their GP details.

• The practice submitted a joint business case between seven practices to the CCG to explore collaborative working with six other surgeries for a home visiting service for the combined practices elderly patients. At the time of our inspection the practice were awaiting a decision by the CCG. 

Updated 15 August 2016

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

• Minor surgery and joint injections were performed in the practice for patient convenience.

• The practice regularly reviewed appointment availability and offered extended hours appointments.

• The practice was situated opposite a university campus and had a high number of student registrations. The practice met regularly with the university and attended student registration days to support new students with the registration process at the practice.

Updated 15 August 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was above both the clinical commissioning group average (CCG) of 86% and the national average of 84%.

• Performance for mental health related indicators was 100% which was above both the CCG average of 97% and national average of 82%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• 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.

• A community psychiatric nurse held weekly clinics at the practice.

• 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 15 August 2016

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.

• 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.

• 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 displayed information for carers in the waiting room, on their website, on the health education screen and offered carers health checks.