Archived: Partners in Health

Updated 20 April 2016

Partners in Health, also known as Pavilion Family Doctors, is located close to the city centre of Gloucester with good transport links. The practice also has a branch surgery, St James Family Doctors, at the Quedgeley Health Campus. During our inspection we visited Pavilion Family Doctors and did not visit the branch surgery at Quedgeley Health Campus.

The practice population is comprised of a mixture of inner city and suburban and has a slightly lower than average patient population in the over 65 years age group. The practice is part of the Gloucester Clinical Commissioning Group and has approximately 14,000 patients. The area the practice serves has a relatively low numbers of patients from different cultural backgrounds. A significant proportion of the practice area is in the bottom 20% of deprivation scales nationally.

The practice is managed by five GP partners, two male and three female, one female nurse partner and supported by two female salaried GPs. The practice has eight practice nurses three being nurse prescribers, two female healthcare assistants and an administrative team led by the practice business manager and practice manager.

The practice is open between 8.15am and 6.15pm Monday to Friday. Appointments are available 9am to 12pm every morning and 3pm to 6pm every afternoon. Extended hours surgeries are offered between 7am and 8 am on Tuesdays. The surgery phone lines are open between 8am and 6.30pm. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also 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 Gloucester out of hour’s service.

The practice has a General Medical Services (GMS) contract to deliver health care services; the contract includes enhanced services such as extended opening hours, online access and patient participation. This contract acts as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

Partners in Health is registered to provide services from the following locations:

Pavilion Family Doctors, 153A Stroud Road, Gloucester, Gloucestershire GL1 5JJ

And at the Branch surgery

St James Family Doctors, Quedgeley Health Campus, Quedgeley, Gloucester GL2 4WD

Updated 20 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Partners in Health on 28 January 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 which demonstrated a culture of continuous learning for all staff.
• 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.
• 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
• Information about services and how to complain was available and easy to understand.
• 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 we spoke to during the inspection said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment however the patient survey results were not in line with these responses.
• Urgent appointments were available on the day they were requested but patients said they did not find it easy to make an appointment with a named GP.

We saw areas of outstanding practice including:

• Respiratory hospital admissions were recalled for review by the nurses following hospital discharge; care plans were updated and shared with the patient to prevent further admissions and deterioration in their health.
• The practice had developed their own in house training course for nurse triage, developing it into a research project to assess outcomes and its suitability to share with other practices.
• In addition the provider should:
• Improve processes for making appointments.
• Review and update procedures and guidance with regard to chaperone duties.
• Ensure an up to date risk assessment is undertaken and fire risk policies and procedures are updated.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 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, for example all respiratory hospital admissions were recalled for review by the nurses within ten days of discharge.

• Longer appointments and home visits were available when needed. For example the practice conducted home visits for housebound patients with chronic obstructive pulmonary disease to carry out their annual reviews.

• The practice minimised the number of times patients had to visit the practice by reviewing a number of long term conditions during an extended appointment.

• 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. We spoke with district nurses attached to the practice who confirmed that team working with the practice was effective and that GPs responded to requests by the district nursing team on the same day.

Updated 20 April 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 comparable for all standard childhood immunisations.

• 73% of patients diagnosed with asthma, on the register had an asthma review in the last 12 months which was comparable to the national average of 74%.

• 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.

• 85% of women aged 25-64 had had a cervical screening test in the preceding five years and comparable to the national average of 82%.

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

Updated 20 April 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice worked closely with a community agent (community agents are employed by Gloucester county council and work with the over 50s in Gloucestershire, providing easy access to a wide range of information that will enable them to make informed choices about their present and future needs).

Updated 20 April 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, for example early morning and evening commuter surgeries were available on Tuesdays until 8pm.

• 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 provided full sexual health services to young people and also information in the waiting room was available to signpost young people to sexual health services they could access elsewhere. Two nurses had completed additional sexual health training which meant patients could access these services more easily within the practice.

Updated 20 April 2016

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

• 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 20 April 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 those with a learning disability.

• The practice had no homeless patients. All staff were aware of a local service that offered medical care to the homeless and signposted people appropriately. There were no policies to allow people with no fixed address to register or be seen at the practice, however they told us they would not refuse to register a homeless patient, but they always advised patients to register at the specialist service.

• 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 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.