Archived: The College Yard Surgery

Updated 30 July 2015

As part of the inspection we visited the College Yard Surgery, Mount Street, Westgate, Gloucester GL1 2RE.

The College Yard Surgery is a small inner city practice which provides primary care services to residents in the city of Gloucester. The provider has another practice in Gloucester and most staff work across both sites. Although patients are able to access services from either site they are encouraged to utilise appointments at the practice they are registered with.

The practice has all patient services located on the ground floor of the building. The practice has a population of 1800 of which many are older adults. The Westgate ward is one of the most deprived within the county and has high levels of unemployment.

The practice has one female and two male GP partners. One of the partners has been acting in a part-time practice manager role due to a staff vacancy. However, a new appointee started in January 2015. They employ four nurses, two dispensary staff, a practice manager and reception/administration staff. Most staff work part-time.

The practice is open five days of the week. Monday to Wednesday it is open 8.30am to 6.00pm and Thursday and Friday 8.30 to 1pm. The practice is closed for lunch on Monday to Wednesday between 1pm and 2pm. Patients from College Yard Surgery are able to access later evening appointments from 6.30 pm to 7pm at the other practice location. The practice has opted out of the Out of Hours primary care provision. This is provided by another provider, South West Ambulance Service NHS Trust.

Updated 30 July 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The College Yard Surgery on 7 January 2015. Overall the practice is rated as Good.

We found the practice to be good for providing safe, effective, caring, responsive and well led services for older adults, families and children, patients with long term conditions, vulnerable patients, patients with mental health issues and patients who worked.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about patient safety was recorded, monitored, appropriately reviewed and addressed.
• Overall risks to patients were assessed and well managed
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about services and how to complain was available and easy to understand.
• Overall patients said they found it easy to make an appointment with a named GP and that there was continuity of care. There were arrangements to enable patients with urgent same day needs to see a GP on the same day. However, patients told us there could be long waits after their appointment time for a same day appointment.
• Staff felt supported by management.
• The practice met nationally recognised quality standards for improving patient care and maintaining quality.

The provider SHOULD:

• Ensure the urgent appointments system is reviewed to improve patient waiting times.
• Implement the plan to proactively seek feedback from patients
• Review governance arrangements to ensure policies and procedures are maintained to clinical governance standards.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 July 2015

The provider was rated as good for this population group. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. Patients were offered a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs including end of life care, the named GP worked with relevant health care professionals to deliver a multidisciplinary package of care based on a person centred care plan.

Updated 30 July 2015

The provider was rated as good for this population group. 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. We were given examples to demonstrate staff understood issues regarding consent and confidentiality when supporting young adults and children with mental capacity. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered contraceptive services for women and sexual health self-test screening kits and advice for young people.

Updated 30 July 2015

The provider was rated as good for this population group. Care and treatment of older people reflected national guidance. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice provided proactive personalised care to meet the needs of the older people in its population and offered home visits. The practice delivered a range of enhanced services, for example, end of life care and avoiding unplanned admissions to hospital.

Updated 30 July 2015

The provider was rated as good for this population group. The needs of the working age population, those recently retired and students had been identified and the practice had adjusted some of 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.

Updated 30 July 2015

The provider was rated as good for this population group. The GPs regularly worked with health and social care professionals to promote the wellbeing of people experiencing poor mental health,

The practice had information for patients experiencing poor mental health about how to access various support groups and voluntary organisations including recovery orientated alcohol and drugs services. Staff knew their patients and had strategies to support patients with dementia.

Updated 30 July 2015

The provider was rated as good for this population group. The practice held a register of patients with a learning disability and had carried out annual health checks for these patients. There was information on the website and in the practice for 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. However, formal working arrangements with relevant health and social care professionals to protect children at risk were not evident.