Weston House Practice Also known as Weston House Practice

Updated 12 August 2016

The Portland Practice is a GP partnership close to Cheltenham town centre. The practice is located on the first floor within St Paul’s Medical Centre which is a modern purpose built building and is wheelchair accessible with automatic doors and a lift. The practice has seven consulting rooms and three treatment rooms. The practice also has a branch surgery which is located approximately three miles away. We did not visit the branch surgery as part of this inspection.

The practice provides its services to approximately 13,800 patients under a General Medical Services (GMS) contract. (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 delivers its services from the following two locations:

St Pauls Medical Centre,

121 Swindon Road,

Cheltenham,

Gloucestershire,

GL50 4DP

And,

Hatherley Surgery,

Glebe Farm Court Road,

Up Hatherley,

Cheltenham,

Gloucestershire,

GL51 3EB.

The practice partnership has nine GP partners making a total of approximately six and three-quarters whole time equivalent GPs. There are five male and four female GPs. The clinical team includes a nurse practitioner (who is also a partner), five practice nurses and five health care assistants, all of which are female. The nursing team are directly supported by a senior nurses’ receptionist and a nurse receptionist. The practice management and administration team includes a practice manager, a finance manager, a data quality co-ordinator, a medical records summariser, a medical secretary, a reception manager and eight receptionists. The practice is approved for training qualified doctors who wish to become GPs and for teaching medical students and second and third year nursing students.

The practice population demographic is in line with local and national averages. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in 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 practice is 81 and 85 years, which is above the national average of 79 and 83 years respectively.

The practice is open from 8.30am to 6.30pm Monday to Friday and 8.15am to 11am every other Saturday. Appointments are from 9am to 5.10pm Monday to Friday. Extended hours are available from 8.15am to 11am every other Saturday. The practice is closed on Fridays between 1pm and 2pm. When the practice is closed between 8am and 8.30am Monday to Friday and 1pm and 2pm on Fridays, call are diverted to a call handling service (Message Link), who will divert any urgent calls to a designated member of staff at the practice.

The practice has opted out of providing out of hours services to its patients. Patients can access the out of hours services provided by South Western Ambulance Service NHS Foundation Trust via the NHS 111 service.

This is the first inspection of The Portland Practice.

Updated 12 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Portland Practice on 19 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 areas where the provider should make improvement are:

• Ensure actions are taken to improve the identification and increase the number of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 August 2016

The practice is rated as good for the care of patients 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 practice achieved 100% of the targets for care of patients with diabetes in 2014/15 which was above the clinical commissioning group average of 95% and 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 operated a system where patients could be reviewed for all their long-term conditions in a single appointment. This was undertaken in the month of the patient’s birth, making it easier to remember.

• One of the GPs was trained in initiating insulin therapy for patients diagnosed with diabetes.

• The practice participated in the winter resilience program. They provided additional appointments between January and March primarily for patients diagnosed with chronic obstructive pulmonary disease to avoid unnecessary hospital admissions.

Updated 12 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.

• 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 the cervical screening programme was 84% which was comparable to the clinical commissioning group average of 84% and national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice held monthly child safeguarding meetings with health visitors, school nurses and community midwives.

• Children with serious illness could be seen immediately without prior appointment.

• The practice held weekly sexual health clinics and had received a “You’re Welcome” award in recognition of the service they provided to young patients. (A Department of Health initiative to encourage young people friendly health service and has a set of criteria that health services must to meet to be accredited)

Updated 12 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.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. One of the health care assistants visited housebound patients who were at risk of unplanned hospital admission. She worked with the GPs to develop care plans for those patients and ensured these were updated regularly. She would also visit patients on this register within 48 hours of being discharged from hospital.

• The practice supported three nursing homes and provided weekly “ward rounds” to the larger homes and fortnightly visits to the smaller homes.

• The practice held monthly multi-disciplinary meetings with the district nurses to review the care of older housebound patients and those receiving palliative care.

Updated 12 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.

• The practice offered extended hours every other Saturday between 8.15am and 11am.

Updated 12 August 2016

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

• 88% 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 the clinical commissioning group (CCG) average of 86% and the national average of 84%.

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 99% compared to the CCG average of 93% and national average of 88%.

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

• The practice carried out advance care planning for patients living 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.

Updated 12 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 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. There was a notice board advising patients of the service available through social prescribing. There was a dedicated member of staff who gathered information on social prescribing and updated all staff accordingly at monthly practice meetings.

• 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.