West View Surgery

Updated 19 December 2016

West View Surgery is located in Keynsham, a small town six miles south of Bristol, in the south west of England. The practice has a higher than average patient population in the over 45 year’s age group and lower than average in the 25 to 40 years age group. The practice is part of the Bath and North East Somerset Clinical Commissioning Group and has approximately 7,000 registered patients. The area the practice serves is Keynsham and surrounding villages and has relatively low numbers of patients from different cultural backgrounds. The practice has a branch surgery, The Severn Surgery, Keynsham.

The practice is managed by four GP partners (two female and two male). The practice is supported by; three practice nurses, one health care assistant and an administrative team led by the practice manager. West View Surgery is a training and teaching practice providing placements for GP registrars and medical students.

The practice is open between 8am and 6pm Monday to Friday. Appointments are available between 9am and 11am every morning and 3pm to 5pm every afternoon. Extended hours appointments are offered between 6.30pm and 8pm on a Monday evening and an additional two varying evenings each month and 8.30am to 12.30pm on two Saturdays a month. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are available for patients that need them.

When the practice is closed patients are advised, via the practice website and an answer machine message, that all calls will be directed to the out of hours service. Out of hours services are provided by Bath and North East Somerset Doctors Urgent Care.The practice has a Primary Medical Services (PMS) contract to deliver health care services. A PMS contract is a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract.

West View Surgery is registered to provide services from the following locations:

9 Park Road, Keynsham, Bristol. BS31 1BX

The Surgery, Severn Way, Keynsham Bristol BS31 1NU

Updated 19 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at West View Surgery on 15 September 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.
• We saw evidence that audits were driving improvements to patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Collaborative working with the midwife and health visitor for travellers and boat people, had improved integrated working and had built trust and rapport between the families and health services.
• 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.
• The practice had developed and utilised information in pictorial formats to assist patients with low literacy levels and learning disabilities to be more involved in their own care.
• 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.
• Allied health professionals were mentored within the practice, for example, a physiotherapist undertaking prescribing qualifications and paramedics. Plans to train nursing students and apprentices from the local further education college had been approved.
• 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.

We saw areas of outstanding of outstanding practice:

• The practice had double the prevalence expected, of patients with learning disabilities. . The service that the practice delivered these patients, had recently been redesigned to improve the quality of care provided and to ensure it offered flexibility and continuity of care that met the needs of each individual patient. Patients attended their annual review with their key worker and were seen, for 50 minutes, by the learning disabilities nurse and GP. This had ensured patients received a comprehensive holistic annual review. In the year 2015-2016 all patients with learning disabilities had received a full health check.
• There was a proactive approach to understanding the needs of different groups of people and ensuring care was delivered in a way that met those needs and promoted equality. The practice provided medical services to patients living within the traveller community. Collaborative working with the midwife and health visitor for travellers and boat people had improved integrated working and had built trust and rapport with the families and improved their engagement with health services.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 December 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.
• Nurses reviewing patients with long-term conditions had undertaken appropriate qualifications in diabetes and asthma and attended regular updates. The diabetes nurses worked closely with the local diabetic specialist nurse to gain the support and skills to manage complex cases.
• The practice was proactive in identifying and supporting patients who were at risk of developing a long term condition. For example, the practice recognised that patients who had developed diabetes in pregnancy were at a higher risk of developing lifelong diabetes and were invited for an annual blood test and lifestyle review.
• Performance for diabetes related indicators was better than local and national averages. The percentage of patients with diabetes, on the register, in whom the last blood test was within target range in the preceding 12 months (2014 to 2015) was 84% compared to a local average of 81% and a national average of 78%.
• 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 19 December 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• The practices most recent newsletter had focussed on the importance of breast, and cervical cancer screening. It include health promotion advice to prevent cancer and the screening programmes available to patients.
• 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.
• 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 19 December 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 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.
• The practice worked closely with the health visitor for the elderly to ensure older patients were getting the care and support they needed.
• The practice worked closely with pharmacists to identify issues and optimise medicines management for older patients on multiple medicines.

Updated 19 December 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.
• The practice promoted the use of email and text messaging and on-line services to improve access for working age patients.
• The practice offered extended hours on a Monday until 8.30pm and two Saturday mornings a month for working patients who could not attend during normal opening hours.

Updated 19 December 2016

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

• 84% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, compared to the local average of 88% and the national average of 84%.
• 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.
• 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.

Updated 19 December 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.
• Collaborative working with the midwife and health visitor for travellers and boat people had improved integrated working and had built trust and rapport between the families and health services .
• The practice supported patients from the traveller community to access services that would be of benefit. For example, nursery provision for the children and literacy classes for those who required them. Awareness was raised with practice staff about additional support that would be needed for patients with low literacy levels, regarding registering with the practice, using automated booking in facilities and making use of information leaflets.
• 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. For example, the practice had engaged with a clinical commissioning group pilot scheme to develop an earlier home visiting service. The purpose of which, was to ensure that patients could be assessed and a management plan commenced early in the day to help prevent unnecessary hospital admission.
• 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.
• The practice had double the prevalence expected, of patients with learning disabilities. Patients attended their annual review with their key worker and were seen, for 50 minutes, by the learning disabilities nurse and GP. This had ensured patients received a comprehensive holistic annual review. In the year 2015-2016 all patients with learning disabilities had received a full health check.
• Prior to reviews learning disability patients completed a questionnaire that had been developed in pictorial format to ensure patients were given optimal opportunity to be involved in their own care.