Streamside Surgery - Thornbury Health Centre Also known as Drs Male Thompson and Higgins

Updated 25 May 2016

The Dr. Male and Partners practice is based at Thornbury Health Centre and is in a semi-rural area providing primary care services to patients resident in Thornbury and those living within a five mile radius.

Thornbury Health Centre

Eastland Road

Thornbury

Bristol

BS35 1DP

The practice shares the purpose built building with another practice. All patient services are located on the ground floor of the building. The practice has a patient population of approximately 5000 of which 20.0% are over 65 years of age.

The practice has four GP partners (male and female), a practice manager, a Nurse Prescriber, two practice nurses, a health care assistant and two phlebotomists. Each GP has a lead role for the practice and nursing staff have specialist interests such as diabetes and infection control.

The practice is open Monday to Friday 8am-6.30pm. GP appointments were available outside core hours twice weekly, starting at 7.30am and later appointments until 7.30pm, with some evening appointments available with a nurse.

The practice had a Personal Medical Services contract (PMS) with NHS England to deliver personal medical services. The practice provided enhanced services which included facilitating timely diagnosis and support for patients with dementia and childhood immunisations.

Dr Male and Partners, in line with other practices in the South Gloucestershire Clinical Commissioning Group, is situated within a significantly less deprived area than the England average.

The practice is a teaching practice and takes medical students from the Severn deanery.

The national GP patient survey (January 2016) reported that patients were more than satisfied with the opening times and making appointments. The results were above local and national averages.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access NHS 111 or BrisDoc provide the out of hours GP service.

Patient Age Distribution

0-4 years old: 4.29%

5-14 years old: 11.1%

15-44 years old: 32.89%

45-64 years old: 29.55%

65-74 years old: 12.71%

75-84 years old: 6.71%

85+ years old: 2.75%

Patient Gender Distribution

Male patients: 50.13 %

Female patients: 49.87 %

Other Population Demographics

% of Patients from BME populations: 1.33 %

Patients at this practice have a higher than average life expectancy for men at 81years and women at 86 years.

We inspected this GP practice in August 2014 as part of our new inspection programme pilot to test our approach going forward.

Updated 25 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Male and Partners – Thornbury Health Centre on 12 April 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. 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 provided minor injuries clinics for cuts, lacerations, minor fractures and injuries.
• The practice leased their accommodation which was managed by their landlord and so had limited opportunity to make changes. However, they had good facilities and were 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:

• All pre-employment checks should be fully recorded.

• The system for checking emergency equipment should be failsafe and monitored.

• The practice should ensure treatment and consulting rooms are locked when unoccupied.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 May 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had specialist training to undertake lead roles in chronic disease management.

• Patients at risk of hospital admission were identified as a priority and had self-management care plans.

• The practice identified and managed patients whose health indicated pre diabetes risk factors. All patients diagnosed with diabetes were offered a Living with Diabetes Education course within six months of diagnosis.

• Longer appointments and home visits were available when needed.

• The practice had home blood pressure monitoring to aid diagnosis and good control of hypertension and a 24hour electrocardiogram (ECG) monitor.

• 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 was involved in research studies such as in the 3D Study which looked at the GP management of care for patients with three or more long term health conditions. This study aimed to develop and test a new approach to how GP practices managed patients with several health problems in a cohesive way in order to improve their overall quality of life. The patients had a planned longer appointment every six months to review their priorities for their health. The practice had the second highest baseline continuity of care measurement with 80% of consultations being with the same doctor.

• The practice used bespoke templates for long term condition reviews based on NICE guidance.

Updated 25 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.

• 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies. For example, a nurse prescriber held minor illness clinics at times which were easily accessible families with young children.

• The practice was part of the ‘No Worries’ scheme which was a sexual health service for young people, that is confidential and free, and included young people who were not registered with the practice.

• We saw positive examples of joint working with midwives, health visitors and school nurses. For example, one GP at the practice provided eight week post-natal mother and baby appointment at the same time as health visitor clinics were held to reduce the number of attendances needed.

Updated 25 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 patients in its population. They used the risk assessment tools to identify those patients who require palliative care input or would benefit from a care planning approach due to the fact that they are found to be at high risk of hospital admission.

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

• The practice had access to a rapid access geriatric service for advice and used it to avoid unnecessary hospital admissions for older patients.

• The practice had applied to work with South Gloucestershire Council and Age concern to be part of a funded scheme to develop a visiting and befriending service for the older patients and to help improve resilience for patients who are high risk of hospital admission.

• They also made use of local “blue beds” (which are used for patients who do not require intensive treatment but may be recovering from illness or require some rehabilitative support through an acute episode of illness) in care homes and community hospitals.

Updated 25 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. For example, GP appointments were available outside core hours on different days; early mornings starting at 7.30am and after work until 7.30pm with some evening appointments available with a nurse.

• 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 contacted young people in their last year at school before going to university, and provided them with details of their immunisation status and offered to retain them as patients to give continuity of care.

Updated 25 May 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 patients experiencing poor mental health, including those with dementia. For example, patients were signposted to the Memory Café in Thornbury and nationally the Alzheimer’s society for information about the condition and what support was available.

• 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.

Updated 25 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 regularly worked with other health care professionals in the case management of vulnerable patients.

• 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 regular training about recognition and reporting of domestic violence and had a system of alerts on the medical records for patients at risk of, or with a history of, domestic violence and for those families who are a cause for concern due to safeguarding children concerns.

• The practice had a volunteer carer worker who came into the practice twice a month to help identify patients who may be carers and to offer support and guidance to them. The patient participation group helped the practice run Coffee Mornings on a quarterly basis for our carers.