Archived: Grosvenor Place Surgery

Updated 27 March 2017

Grosvenor Place Surgery is located close to the city centre of Bath with good transport links. The practice has a slightly higher than average patient population in the age groups 25 to 55 years and 65 to 70 years. The practice is part of the Bath and North East Somerset Clinical Commissioning Group and has approximately 3,000 registered patients. The area the practice serves has relatively low numbers of patients from different cultural backgrounds and is in the lowest range for deprivation nationally.

The practice is managed by two female GP partners and supported by one female salaried GP, as well as two practice nurses, a nurse who is seconded from the community team to provide one clinic a week and an administrative team led by the practice manager.

The practice is open between 8am and 6.30pm Monday to Friday. Telephone lines are open between 8am and 6pm and the doors are open from 8.30am to 6.30pm. Appointments are available from 9am to 12pm every morning and from 3pm to 6pm every afternoon. Extended surgery hours were offered on variable days on Monday to Thursdays from 6.30pm to 7.30pm. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also available for patients that needed them.

When the practice is closed patients are advised, via the practice website and an answerphone message, to ring the NHS on 111 for advice and guidance. Out of hours services are provided by Bath and North East Somerset Doctors urgent care (BDUC).

The practice has a Primary Medical Services contract to deliver health care services; the contract includes enhanced services such as minor surgery and childhood vaccines. This contract acts as the basis for arrangements between NHS England and providers of general medical services in England.

Grosvenor Place Surgery is registered to provide services from the following location:

26 Grosvenor Place, Bath, BA1 6BA

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grosvenor Place Surgery on 28 July 2016. The practice was rated as requires improvement for providing safe services. The overall rating for the practice was good. The full comprehensive report on the 28 July 2016 inspection can be found by selecting the ‘all reports’ link for Grosvenor Place Surgery on our website at www.cqc.org.uk.

This inspection was a desk-based review which was carried out on 23 February 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 28 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 now rated as good.

Our key findings were as follows:

• A fire risk assessment had been completed and a log of routine checks was being maintained.
• We saw evidence that water temperatures are being checked in line with their legionella risk assessment.
• Policies to maintain confidentiality of personal information had been implemented.
• The practice had improved the identification of carers. In July 2016 the practice had identified 0.7% of registered patients and this had increased to 2.4%. Reminders had also been added to the patient records of others, who may be appropriate for identification, to encourage clinicians to discuss with the patient. This meant that more patients were getting the appropriate care and support.
• Significant events were shared with the practice team providing opportunities for learning.

We have changed the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 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 percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (04/2014 to 03/2015) was 96% which was higher than the local average of 92% and the national average of 88%.

• Longer appointments and home visits were available when needed.

• All patients with a long term condition 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 had a robust system for patient recall in place for patients who required regular blood monitoring or review of a long term condition.

• The practice offered additional appointments for respiratory patients during the winter months when cold weather could have adverse effect on this cohort of patients

Updated 8 September 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.
• The practice’s uptake for the cervical screening programme was 79%, compared to the local to the CCG average of 84% and the national average of 82%. The practice had followed up patients, to ensure they understood the benefits of the screening and immunisation programmes and that patients had made their choices through informed decision making. Notice boards within the practice, practice newsletters and the practice website had all been utilised to encourage patients to attend for screening.
• 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.
• Liaison with the local schools ensured young people were aware of and how to access advice and care in relation to sexual health.The practice was a member of The Young Persons Health association. This enabled the practice to access the most up to date information leaflets and advice for communicating effectively with young people.
• The practice delivered training to reception staff in appropriate management of young patients who were requesting sexual health advice

Updated 8 September 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.
• The practice encouraged elderly frail patients to involve their family/carers in their consultations to enable them to hear the clinical discussions and understand the choices available which would help them to support their loved ones.
• The practice were proactive in ensuring patients had appropriate knowledge that would facilitate shared decision making regarding their health. Care plans were agreed in discussion with patients and relatives.
• The practice held multi-disciplinary team every three weeks to review the care of the frailest patients.

Updated 8 September 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.

• Extended hours surgeries and telephone consultations were offered by the practice in order to optimised access to health care advice by the working population.

Updated 8 September 2016

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

• The percentage of patients with a serious mental illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 94% compared to a local average of 93% and a national average of 90%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example, a patient with mental health issues had been inappropriately utilising emergency and urgent care services. The practice ensured all agencies were aware of the patient’s problems and met to discuss ways in which the patient could be best supported. As a result of this collaborative approach, attendances at urgent care had been reduced from 8 for the year 2015-2106 to three for the first six months of 2016.
• 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 hosted talking therapists in the practice twice weekly.
• 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 8 September 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.