Archived: Drs Kessler, McRobert, Weil, Blythe, Goodger and Platt Also known as Gaywood House Surgery

Updated 24 December 2015

Gaywood House Surgery is located in an urban area of Bristol. They have approximately 7700 patients registered.

The practice operates from one location:

Gaywood House,

North Street,

Bedminster,

Bristol BS3 3AZ

It is sited on the ground floor of a residential block of flats owned by Bristol City Council. The practice has five consulting rooms, one for each GP partner and one allocated for any trainee GPs on placement. There are two treatment rooms (for use by nurses, health care assistants and phlebotomists); reception and records room; and a waiting room area. There is limited patient parking immediately outside the practice with spaces reserved for those with disabilities.

The practice is made up of six GP partners, one salaried GP and the practice manager, working alongside three qualified nurses and one health care assistant and two phlebotomists. The practice is supported by an administrative team made of medical secretaries, receptionists and administrators. The practice is open from Monday to Friday for urgent and routine appointments between 9am-6pm and extended hours are available on Monday evenings.The reception is open Monday to Friday 8.30am-6.30pm for appointment booking and enquiries. The practice has a Saturday surgery each month, on the second Saturday of the month in the morning for pre-booked appointments. The practice provides 36 GP sessions each week. It is a training practice and regularly has a registrar (who will be in their final year of GP training) who works under the supervision of another GP.

The practice has a General Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice). The practice is contracted for a number of enhanced services including extended hours access, facilitating timely diagnosis and support for patients with dementia, patient participation, immunisations and unplanned admission avoidance.

The practice also manages the GP Tackling Violence Service. Patients are enrolled in the GP Tackling Violence Service, following immediate removal from their own regular GP practice for violent or verbally abusive behaviour; they can be seen in a weekly clinic. The aim is to provide the same standard of GP care available to all patients, working with patients to have a productive relationship with the GP and support staff. The clinic is held in a safe facility located within Bristol Royal Infirmary. The practice staff provide the GP cover and undertake all the administrative tasks such as appointment booking and making referrals. Patients accessing the service outside of the clinic times do so by phone, normally being booked in for a phone consultation with the practice duty GP.

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

Patient Age Distribution

0-4 years old: 6.2%

5-14 years old: 8.24% (lower than the national average)

15-44 years old: 46.39%

45-64 years old: 22.49%

65-74 years old: 7.83% (higher than the national average)

75-84 years old: 5.97%

85+ years old: 2.87% (higher than the national average)

Patient Gender Distribution

Male patients: 51.17 %

Female patients: 48.83 %

Other Population Demographics

% of Patients in a Residential Home: 0.79 % (higher than the national average)

% of Patients on Disability Living Allowance: 4.58 %

% of Patients from BME populations: 7.15 %

The area has a higher than average unemployment rate and has a higher than average crime deprivation index.

All GP practices across Bristol CCG are engaged in contract reviews with NHS England. There is a wide disparity across practices in funding terms of income per patient, and this exercise will put in place a process over the next five years to equalise the per patient rate across the 55 Practices.

Gaywood House offers a consultation rate of 6.3 per weighted patient per year against a national average of 5.5, delivering 6,435 appointments above the national average. The data from Health and Social Care Information Centre (HSCIC) indicates this demand is due to higher than predicted disease prevalence rates.

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Drs Kessler, McRobert, Weil, Blythe, Goodger and Platt at Gaywood House Surgery on 17 November 2015. 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 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.
• Patients said they were able to make an appointment with a named GP which provided continuity of care; urgent appointments were available the same day.
• The practice had purpose built 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 actively sought feedback from 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:

• Produce a written vision for the practice which encompasses the planned changes to service provision.
• Develop wider use of formal consultation and surveys for staff so they are able to contribute to the vision and values of the practice.
• Review risk assessments for the service to ensure they cover all the areas of the building and functions which the practice has responsibility for such as risk assessment of the individual rooms to ensure they are fit for purpose.
• Further develop the internal audit processes so as to be able to demonstrate the quality of the service such as timely response to telephone calls.
• Relocate the emergency equipment and medicines to a more accessible place.
• Review the infection control audit to ensure it reflects the latest best practice guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 December 2015

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

• Nursing staff had specialist training for management of chronic disease, such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).
• The practice offered winter rescue packs to patients with COPD and encouraged patients to self-manage.
• The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 September to 31 March (01/04/2013 to 31/03/2014) which was comparable to other Clinical Commissioning Group practices at 95.46% but higher than the national average of 93.46%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that 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 24 December 2015

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 in comparison to other practices in the clinical commissioning group area.
• 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 percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years (01/04/2013 to 31/03/2014) was comparable to other practices.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had introduced a child friendly health advice leaflet.
• We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 24 December 2015

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 patients in its population such as holding weekly clinics at care homes for older people.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. For example, patients who may have additional communication needs.
• The practice could access a community based nurse specifically overseeing the care of older patients.
• The practice accessed the Rapid Assessment Clinic for Older people based at the local community hospital and assigned a GP to attend sessions in which to observe the consultant and then take the learning to the practice to share with colleagues.
• The practice hosted the Age UK foot care clinic.

Updated 24 December 2015

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 reflected the needs for this age group.
• The practice hosted a councillor for patients with substance misuse one day a week.

Updated 24 December 2015

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

• 87.69% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• The percentage of patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2013 to 31/03/2014) was 91.63% higher than the national average of 86.04%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including patients living with dementia.
• The practice carried out advance care planning with patients living with dementia and involved their families.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• They 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 those living with dementia.

Updated 24 December 2015

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 patients and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. They maintained lists of the vulnerable patients which were regularly reviewed.
• The practice had told 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.