Archived: Gloucester Health Access Centre

Updated 7 September 2016

Gloucester GP Consortium Limited is a limited company also known locally as The Gloucester Health Access Centre. The purpose built practice is located in the centre of Gloucester City within Eastgate House which is home to many other businesses including a dental practice. The Gloucester Health Access Centre is located on the ground floor at the rear of the building and is wheelchair accessible.

The practice provides its services to approximately 5,500 patients under an Alternative Provider Medical Services (APMS) contract. (APMS contract is a locally negotiated contract open to both NHS practices and voluntary sector or private providers e.g. walk-in centres.). The practice also has a branch, Matson Lane Surgery which was not visited during this inspection. The practice delivers its services from the following addresses:

Eastgate House,

121-131 Eastgate Street,

Gloucester,

Gloucestershire,

GL1 1PX.

And,

Matson Lane Surgery,

Taylor House,

Matson Lane,

Gloucester,

GL4 6DX.

The practice has four salaried GPs partners making a total complement of approximately two and a half whole time equivalent GPs. There was one male and three female GPs. The nursing staff team include one nurse manager and two practice nurses who were all female; the practice also employed one health care assistant. The practice management and administration team included a practice manager, an assistant practice manager and 28 administration staff and reception staff.

The practice had a higher than average patient population aged between zero and nine years old, and 20 to 34 years old. The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the second most deprived decile. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas). Average male and female life expectancy for the practice is 75 and 82 years, which is lower the national average of 79 and 83 years respectively. The practice population is ethnically diverse; approximately 45% of the population are white British and 40% of the population are Eastern European. The practice has a transient patient population; patients are often outside of the country for long periods. This has an impact on screening and recall programmes

The practice is open from 8am to 8pm, seven days a week. Appointments with a GP are from 8am to 8pm every day.

When the practice is closed, patients can access the out of hours services provided by South Western Ambulance Service NHS Foundation Trust via the NHS 111 service.

This inspection is part of the CQC comprehensive inspection programme and is the first inspection of Gloucester GP Consortium Limited.

Updated 7 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gloucester GP Consortium Limited on 8 June 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.
• 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. However, complaint forms in languages other than English were not readily available for patients who need these. Improvements were made to the quality of care as a result of complaints and concerns.
• 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 a high yearly turnover of patients, typically 50% of the practice patients left the practice and new patients joined each year.
• 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 areas where the provider should make improvement are:

• Ensure complaint forms in languages other than English are readily available for patients who need these.

• Ensure actions are taken to improve the identification of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 September 2016

The practice is rated as good for the care of patients 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 practice achieved 89% of the targets for care of patients with diabetes in 2014/15 which was below the clinical commissioning group average of 95% and similar to the national average of 89%.

• 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.

• The practice offered regular blood testing for patients on blood thinning medicines.

Updated 7 September 2016

The practice is rated as good for the care of families, children and young patients.

• 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.

• 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.

• The practice’s uptake for the cervical screening programme was 79% which was below the clinical commissioning group of 84% and the national average of 82%.

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

• The practice held monthly meetings with health visitors; midwives and school nurses to review children on the child protection and children in need register.

Updated 7 September 2016

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in influenza, pneumococcal and shingles immunisations.

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

• One of the GPs had specialist experience in palliative care and could therefore offer specialist support to patients receiving end of life care.

• The practice supported three care homes and provided fortnightly visits to patients living in the homes.

Updated 7 September 2016

The practice is rated as good for the care of working-age patients (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 was open from 8am to 8pm everyday including weekends and bank holidays.

Updated 7 September 2016

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

• 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was below the clinical commissioning group (CCG) of 86% and national average of 84%.

• The percentage of patients with severe mental health problems who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (04/2014 to 03/2015) was 68% which was below the CCG average of 93% and above the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice carried out advance care planning for patients living with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice hosted bi-weekly clinics ran by the community mental health nurses at its two sites.

• The practice supported a local alcohol rehabilitation unit.

• 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. The practice provided examples of how they had positively supported patients with mental health needs and worked with community teams to promote good outcomes for those patients.

Updated 7 September 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including travellers and those with a learning disability.

• 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. Patients on the vulnerable list were discussed at the practice’s bi-monthly clinical governance meeting.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. There was a benefits advisor available on the premises and the practice could refer patients to social prescribing via the care co-ordinator.

• 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.