Harptree Surgery

Updated 18 May 2016

Harptree Surgery is a rural, dispensing practice located about 12 miles south of Bristol. It covers approximately 200 square miles of countryside, and is a 25 minute drive from the centre of Bristol. The practice serves approximately 6,000 patients, across 2 practices in West Harptree and Cameley.

The demographic profile of the practice is mixed with long standing village residents and more recent newcomers. Approximately 3,500 patients are registered at Harptree Surgery and 2,800 at Cameley Surgery, Temple Cloud, although patients can attend the practice of their choice. The practice is part of the Bath and North East Somerset clinical commissioning group. The practice has a higher than average patient population in the over 40 years age group and lower than average in the less than 40 years age group.

The practice is managed by three GP partners, two male and one female and supported by three female salaried GPs as well as three practice nurses, a healthcare assistant and an administrative team led by the practice manager. The practice has four fully trained dispensers who dispense medication for patients under the supervision of the doctors.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available 8.30am to 11.20am every morning and 2.50pm to 5.40pm every afternoon. Extended hours surgeries are offered between 7.30am and 8.30 am Thursday mornings, 6pm and 7.45pm on either a Tuesday, Wednesday or Thursday evening and 9am to 11.40am on alternate Saturday mornings. In addition to pre-bookable appointments that could be booked up to 12 weeks in advance, urgent appointments were available for people that needed them.

When the practice is closed patients are advised, via the practice website and an answerphone message, to ring the NHS 111 service for advice and guidance. 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. This contract acts as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

Harptree Surgery is registered to provide services from the following locations:

Bristol Road, Bristol, Bath and North East Somerset BS40 6HF

and

Cameley Surgery, Temple Cloud, Bristol. BS39 5BW

Updated 18 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harptree Surgery on 15 March 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 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. The practice scored highly on the GP patient survey.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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 practice provided pharmaceutical services to almost all those patients who used the practice.

The areas where the provider should make improvements are:

• The practice should engage more effectively with the patient participation group to improve collaborative working with service users.

• The practice should review procedures for monitoring temperatures within the dispensary where medicines were stored.

• Review the practice of cutting of blister packs and placing them in weekly compliance aids.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 May 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% compared to a national average of 88%.

• The percentage of patients with chronic obstructive disease (COPD) who had a review undertaken in the preceding 12 months (04/2014 to (03/2015) was 94% compared to a national average of 90%.

• Longer appointments and home visits were available when needed.

• A nurse visited housebound patients with a long term condition to carry out an annual review.

• Virtual clinics were held on a regular basis to review diabetic patients with complex needs with the local diabetic specialist nurse.

• 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 18 May 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.

• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control (04/2014 to 03/2015) was 81% compared to a national average of 75%.

• 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 has been performed in the preceding 5 years (04/2014 to 03/2015) was 89% compared to a national average of 82%.

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

Updated 18 May 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. Individualised care plans were in place for older patients who were at risk of admission. Care plans were shared with other services, to ensure patient wishes were adhered to.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs and this was acknowledged positively in feedback from patients.

• Patients who were carers had been identified by the practice and offered annual health checks.

• The practice had no nursing homes within the practice boundary. However the practice continued to provide medical services to patients who had transferred to a nursing home but wished to continue being registered at the practice.

Updated 18 May 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.

• Extended hours surgeries were held, one morning and one evening each week and alternate Saturday mornings.

• Bookable telephone appointments were available, with a preferred GP, for those unable to attend the practice in person.

• The practice offered full sexual health services for those who required them.

• 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.

Updated 18 May 2016

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (04/2014 to 03/2015) was 83% compared to a national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 18 May 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 provided medical services to a local learning disabilities home and worked closely with the local learning disabilities consultant to ensure standards of care remained high.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.