Archived: The Wedmore Practice

Updated 15 May 2017

The Wedmore Practice is located in a residential area of the city of Bristol. They have approximately 8,501 patients registered.

The practice operates from one location:

St John’s Lane Health CentreBristolBS3 5AS

The Wedmore Practice is situated in the St Johns Lane Health Centre, which provides healthcare to patients in the areas of Bedminster, Knowle, Windmill Hill, Headley Park and parts of Totterdown. In addition the practice provides health care to the areas of Withywood, Hartcliffe, Ashton Gate and Knowle West. It previously shared the premises with another GP service and currently hosts other health care services such as podiatry and the midwifery team. The practice premises are not owned by the provider. The practice is all on one level with consulting rooms and treatment rooms situated off corridors from the central waiting and reception area. There is parking for a small number of vehicles at the side of the practice. We were informed that the practice is in the process of having new premises built in the local vicinity with the intention of being completed in December 2017.

The practice is made up of three GP partners and two associate GPs, all female. One GP had additional qualifications in substance abuse. They have a lead nurse, a treatment room nurse, a nurse practitioner and a healthcare assistant. There is an assistant practice manager, and reception and administration team. The practice currently employs a business development manager to support them with their new surgery build.

The practice opening hours are from 8.30am until 12.15pm and reopen 1.15pm until 6.30pm, weekdays. The practice opens Saturday mornings 8:30am to 10.30 for pre-booked appointments only. The practice offered early morning appointments 7.30am until 8am on a Tuesday morning. Three days per week (variable days) evening appointments were available from 6.30pm until 7pm for patients who could not attend during normal opening hours.

The practice has a Personal Medical Services contract with NHS England. The practice is contracted for a number of enhanced services including extended hours access, improving patient’s online access, timely diagnosis and support for patients with dementia and unplanned admission avoidance.

The practice does not provide out of hour’s services to its patients, this is provided by the 111 services and BrisDoc. Contact information for this service is available in the practice and on the practice website.

Patient Age Distribution

0-4 years old: 6.3% (the national average 5.9%)

5-14 years old: 11.5% (the national average 11.4%)

Total under 18 years old: 21% (the national average 20.7%)

65+ years old: 13.7% (the national average 17.1%)

75+ years old: 6.3% (the national average 7.8%)

85+ years old: 1.3% (the national average 2.3%)

Other Population Demographics

% of Patients with a long standing health condition is 48% (the national average 54%)

% of Patients in paid work or full time education is 63% (the national average 61.5%)

Practice List Demographics / Deprivation

Index of Multiple Deprivation 2015 (IMD): is 33.6% (the national average 21.8%)

Income Deprivation Affecting Children (IDACI): is 27.8% (the national average 19.9%)

Income Deprivation Affecting Older People (IDAOPI): is 26.4% (the national average 16.2%)

Patient Gender Distribution

Male 50.7%

Female 49.3%

% of patients from BME populations 7.8%

Patient turnover 2015 9.5%, the national average 8.5%.

Updated 15 May 2017

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of The Wedmore Practice on 20 July 2016 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as Good overall, with the area of Safe rated as requires improvement. The full comprehensive report following the inspection on 20 July 2016 can be found by selecting the ‘all reports’ link for The Wedmore Practice on our website at www.cqc.org.uk.

This inspection was an announced focused follow-up inspection of The Wedmore Practice on 4 April 2017, to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 20 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good, with the area of Safe now rated as Good.

At the inspection 20 July 2016 the areas where the provider must make improvement were:

• The system and policy and procedure for monitoring the temperature of the refrigerators where medicines were stored such as vaccines must be reviewed so that maximum or minimum temperature changes that occurred were monitored to ensure vaccine viability thresholds were not breached.

• Practice staff must ensure there was recorded evidence that the emergency medicines were checked on a regular basis.

• There must be a system to ensure Patient Group Directions for the administration of medicines were signed for and agreed by the responsible GP and nursing staff before implementing.

The areas where the provider should make improvement were:

• Lessons were shared for significant events, but the partners should ensure this information was shared across all of the staff team so that they had awareness and could support any actions taken to improve safety in the practice.

• The practice should ensure that a member of staff was identified and trained to be the named lead for health and safety at the practice.

• The practice should ensure that there was a consistent approach to obtaining and retaining recruitment and employment information held in regard to staff employed at the practice.

• The provider should have a planned approach to ensuring that training or retraining in regard to the Mental Capacity Act 2005 took place.

Our key findings from this inspection, 4 April 2017, were as follows:

• The provider had improved the systems, policy and procedure for monitoring the temperature of the refrigerators where medicines such as vaccines were stored.

• The provider had implemented a system so that there is recorded evidence that the emergency medicines were checked on a regular basis.

• The provider had ensured there was a system to ensure Patient Group Directions for the administration of medicines were signed for and agreed by the responsible GP and nursing staff before implementation.

• Lessons were shared for significant events and information were shared across all of the staff team so that they could have an awareness and could support any actions taken to improve safety in the practice.

• The provider had identified a member of staff to be the named lead for health and safety at the practice. This person attended health and safety updates and sought external advice when required.

• The provider had ensured that there was a consistent approach to obtaining and retaining recruitment and employment information held in regard to staff employed at the practice.

• The provider had a planned approach to ensure that training or retraining in regard to the Mental Capacity Act 2005 was taking place.

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

Importantly, the provider should:

• Continue with the programme of implementing improvements such as electronic monitoring systems for ensuring the safe temperature of the refrigerators where medicines such as vaccines were stored.

• Review the system of the time period between checks on the emergency medicines to ensure that it is in line with current good practice.

• Continue with ensuring that the provider has access to an appropriately trained health and safety representative.

• The provider should continue to ensure that information regarding the training for mandatory and core subjects is obtained for the locums used at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 November 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.

• The clinicians had identified areas to improve the support to patients with type 2 diabetes and had commenced working on a project in the local area, known as ‘HG Wells’ to address how the practice supports patients and how they can develop self-care.

• 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.

Updated 15 November 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 relatively high 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.

• Sexual health and advisory services were available for young people, such as 4YP (For Young People).

• 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 15 November 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 people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• All patients over the age of 75 years of age had a named GP which ensured continuity of care.

• The practice told us they work well with and refer patients to the Rapid Assessment Clinics for Older People for consultation to enable them to quickly target the care and support the individual needs.

• The practice worked with a befriending service to help their patients who were isolated, lonely or housebound.

Updated 15 November 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.

• 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 15 November 2016

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 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.

• 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.

• Patients at risk of or with a diagnosis of dementia have access through the practice from a dementia practitioner (Memory Nurse) and a Dementia Navigator to provide continuity of care and signposting to relevant services.

• The practice provided an in-house counsellor to support patients and provides access to counselling services from other external providers.

Updated 15 November 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 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.

• A GP was a GPwSI (GP with Special Interest) in the treatment of patients with substance abuse issues and was undertaking additional training for the care and treatment of patients who misuse alcohol.