Archived: Dr J Barry-Braunthal & Partners Also known as Lodgeside Surgery

Updated 26 March 2015

As part of the inspection we visited the practice at 22, Lodgeside Avenue, Kingswood, Bristol, BS15 1WW.

Lodgeside Surgery provides primary care services to patients resident in the town of Kingswood on the east side of Bristol. The practice is purpose built with most patient services located on the ground floor of the building with patient lift to access the first floor. The practice has an expanding patient population of approximately 9,550 of which the highest proportion are of working age. The practice trains GP’s, medical students and student nurses.

The practice has four female and one male GP partners. They employ three GPs, three nursing staff, one phlebotomist, a practice manager, and reception/administration staff. Most staff work part-time.

The CQC intelligent monitoring placed the practice in band six. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place.

The practice is open six days of the week. Tuesdays, Thursdays and Friday it is open 8.am - 6.30pm. Mondays 8.00am -7.30pm and Wednesdays 7.30am – 6.30 pm. The practice is open on Saturday mornings from 9am -11am for pre-booked appointments.

The practice has opted out of the Out of Hours primary care provision. This is provided by another provider BRISDOC.

Updated 26 March 2015

Letter from the Chief Inspector of General Practice

We carried out an announced, comprehensive inspection at Lodgeside Surgery on the 11 December 2014. Overall the practice was rated as GOOD. Specifically, we found the practice to be outstanding for providing responsive services. It was good for providing caring, safe, effective, well led services.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Easy read information was provided to help patients with learning disability understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Representative Group (PRG).

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.
• Patients had access to a range of appointments such as same day appointments and booking in advance.
• The practice met nationally recognised quality standards for improving patient care and maintaining quality.

We saw several areas of OUTSTANDING practice including:

• Early Home Visits scheme for older, frail and vulnerable patients.
• Same day patient registration with the practice to enable patients with alcohol and drug misuse to access to accommodation based alcohol and drug services.
• Homeless asylum seekers were able to register and see a GP within 24 Hours and have immediate access to services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 March 2015

The provider was rated as outstanding for responsive overall and this includes this population group. However, the provider was rated good for safety, well-led, caring and effective which led to these ratings applying to everyone using the practice, including this population group. Emergency processes were in place and referrals made for patients who had a sudden deterioration in health. When needed longer appointments and home visits were available. All these patients had a structured annual review to check their health and medication needs were being met. For those patients’ with the most complex needs the named GP worked with relevant health and care professionals to develop patient care plans and a multidisciplinary package of care.

Updated 26 March 2015

The provider was rated as outstanding for responsive overall and this includes this population group. However, the provider was rated good for safety, well-led, caring and effective which led to these ratings apply to everyone using the practice, including this population group. Systems were in place for identifying and following-up children who were at risk. For example, the GP met regularly with health visitors to review children and their families at risk. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us and we saw evidence children and young people were treated in an age appropriate way and recognised as individuals. The premises were suitable for children and babies. GPs offered a range of contraceptive services for patients and chlamydia (a sexually transmitted infection) screening kits for under 25’s.

Updated 26 March 2015

The provider was rated as outstanding for responsive overall and this includes this population group. However, the provider was rated good for safety, well-led, caring and effective which led to these ratings applying to everyone using the practice, including this population group. The practice supported older patients by enabling access to services without patients having to attend the practice for example, ordering repeat prescriptions via the practice website. The practice had a system to triage all visits before 10am and prioritise frail/vulnerable patients for an early home visit to facilitate any hospital admissions within ‘working hours’ and to avoid evening admissions. Patients had a named GP. Nationally reported data showed the practice had positive outcomes for conditions commonly found amongst older patients and had the highest uptake of flu immunisation in the locality. 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, in dementia and end of life care. Frail and vulnerable patients had care plans to enable prompt treatment, reduce hospital admissions and enable patients to be treated at home.

Updated 26 March 2015

The provider was rated as outstanding for responsive overall and this includes this population group. However, the provider was rated good for safety, well-led, caring and effective which led to these ratings applying to everyone using the practice, including this population group. The practice supported the working age population and those recently retired by providing screening for common medical conditions. They offered a flexible appointment system including earlier morning, later evening and Saturday morning appointments. Patients were able access to access health information and practice services via the practice website. Patients were able to monitor their blood pressure by using the self- monitoring machine in the practice.

Updated 26 March 2015

The provider was rated as outstanding for responsive overall and this includes this population group. However, the provider was rated good for safety, well-led, caring and effective which led to these ratings apply to everyone using the practice, including this population group. The practice had started writing care plans for patients who experienced poor mental health. Quality data from the Quality and Outcomes Framework 2013/2014 (QOF is a national performance measurement tool) demonstrated the practice compared favourably with other practices in the assessment of depression. The practice regularly monitored patients for the side effects of certain medicines used in the treatment of mental health conditions. We saw the practice website included links to other information and support services. All patients on the dementia register had completed reviews. We noted nursing staff were aware of the importance of recognising patients in the early stages of dementia and undertook opportunistic, simple tests to aid detection.

Updated 26 March 2015

The provider was rated as outstanding for responsive overall and this includes this population group. However, the provider was rated good for safety, well-led, caring and effective which led to these ratings apply to everyone using the practice, including this population group. The practice held a register of patients with learning disabilities. The practice told us they were highest performing practice in the locality for undertaking health checks for patients with learning disability. Longer appointments for patients with learning disabilities were arranged in recognition of the time needed to involve patients in their care and treatment. There was a named GP who undertook weekly visits to two care homes one supporting patients with learning disabilities and the other caring for patients with head injury and neurological conditions. The practice regularly worked with multi-disciplinary teams and other agencies in the case management of vulnerable patients. For example, the practice had a system to enable homeless patients and patients with drug and alcohol support needs to register quickly to enable them to access the treatment and support they needed. The practice was working with the Red Cross to enhance support and assist in the signposting of patients to support 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 who to contact within the practice.