7 November 2016
Berkeley Place Surgery is located in Cheltenham, a spa town and borough of Gloucestershire. The current practice has occupied a Grade II-listed, four-storey building since 1963. Rooms for consulting, treatment and phlebotomy services are located throughout the building. Waiting rooms are on the ground and first floors, with a medical records room in the basement. There is one treatment room on the ground floor. The practice does not have a passenger lift, due to restrictions on the modification of listed buildings, but arrangements were in place to see patients with limited mobility on the ground floor.
Berkeley Place Surgery has around 7,789 registered patients, most of whom live within a five mile radius of the practice. The practice has lower than national average patient populations for all age groups from 0 to 14 years, and 40 to 79 years. The patient population from 15 to 19 years, and those aged from 25 to 39 years, are all higher than the national average. Berkeley Place Surgery is one of 85 GP practices in the NHS Gloucestershire Clinical Commissioning Group (CCG) area.
The practice population is 98% white, with the largest minority ethnic population (around 1.6%) being Asian or Asian British. A measure of deprivation in the local area recorded a score of 8, on a scale of 1-10. A higher score indicates a less deprived area. (Note: 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 not all deprived people live in deprived areas).
The practice team consists of four GP partners (three male, one female) and three salaried GPs (all female). In addition there is one lead nurse, one practice nurse, and one health care assistant employed. The clinicians are supported by a practice manager, a deputy practice manager, a pharmacy advisor, a secretary and a team of notes summarisers (administrative staff with some clinical training, who transfer hard copies of patient’s notes onto the practice’s electronic data system) and receptionists. The practice has a General Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice).
Berkeley Place Surgery is open from 8.15am to 6.30pm, Monday to Friday, and GP appointments are available from 8.30am to 6.30pm, Monday to Friday. The practice will take calls from 8.30am. Nursing team appointments were available between 8.30am and 5.30pm, Monday to Friday. All appointments can be pre-booked up to four weeks in advance.
The practice has opted out of providing Out Of Hours services to its own patients. Outside of normal practice hours, to 8.30am, patients can access NHS 111 and an Out Of Hours GP service. Information about the Out Of Hours service was available on the practice website, and as an answerphone message.
Berkeley Place Surgery provides regulated activities from its sole location at 11 High Street, Cheltenham, Gloucestershire GL52 6DA.
7 November 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Berkeley Place Surgery on 8 September 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.
- 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 had good facilities and was well equipped to treat patients and meet their needs.
- The patient participation group (PPG) were well engaged and represented across a diverse range of professional backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services. For example, PPG members suggested rewording questions on the practice’s in-house patient survey, and information displayed on its waiting room screens, to make them easier to understand. The content of both areas has been changed as a result.
- 90% of patients were able to get an appointment to see or speak to someone the last time they tried compared with the Clinical Commissioning Group (CCG) average of 84% and the national average of 76%.
- The practiced worked closely with local services including a homeless shelter and volunteer transport schemes.
- The practice offered to the most appropriate patients the use of information and communication technologies in their homes, to support and self-manage long term conditions such as diabetes, epilepsy and Chronic Obstructive Pulmonary Disease, which causes long term breathing problems.
- The practice is participating in a social prescribing scheme to support people who attend their GP surgery but do not necessarily require medical care. Social prescribing supports people with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that can help improve their wellbeing and meet their wider needs.
- Staff had lead roles that improved outcomes for patients such as a care co-ordinator and a carers champion. Patients had access at the practice to drop-in clinics from outside agencies such as Cruse Bereavement Care.
- The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were visited by the practice nurse, assessed and, if necessary, booked for a same day appointment at the practice.
- 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.
- When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
We found two areas where the provider should make improvement:
- Continue to conduct clinical audits and embed these into its processes so that improvements made are implemented and monitored.
- Review the process through which carers are identified to enable the practice to engage with and support a larger proportion of the patient practice list.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
7 November 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.
- Performance for patients with long-term conditions compared with national averages. For example, 75% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
- 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 routinely offered longer appointments for patients with complex medical needs.
- The practice offered patients the use of information and communication technologies in their homes, to self-manage long term health conditions.
7 November 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. The practice assessed the capability of young patients using Gillick competencies. These competencies are an accepted means to determine whether a child is mature enough to make decisions for themselves.
- The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 77%, comparable to the national average of 82%.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
- We saw positive examples of joint working with midwives, health visitors and school nurses.
- The practice provides medical services for a local independent school. A senior GP partner is the Chief Medical Officer for the school’s health centre and has produced concussion protocol guidelines for the Medical Officers Schools Association. These guidelines have been implemented and used as part of a national assessment tool, from June 2015. GPs answer calls from the school’s staff 24 hours a day, 7 days a week. The practice has also set up an email address for students who may find it difficult to access medical care for personal reasons, particularly relating to sexual and other health issues. We saw evidence that in a recent (2016) survey, 90% of pupils rated the health centre as excellent.
- The practice set up an email address for students from a local school who may find it difficult to access medical care for personal reasons, particularly relating to sexual and mental health issues.
7 November 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.
- Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
- The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
- The practice care-co-ordinator worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
- The practice referred patients to local community health improvement schemes.
- Patients had access at the practice to drop-in clinics from outside agencies such as Cruse Bereavement Care.
7 November 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.
- 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.
- Patients were able to order repeat prescriptions on-line.
- The practice offered text reminders for appointments.
- Patients were able to book and attend appointments throughout the day.
- Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.
7 November 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- 87% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which compared with the clinical commissioning group (CCG) average of 86% and the national average of 84%.
- The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 93%, which compared with the national average of 88%.
- 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.
- A specialist mental health nurse, from a mental health trust, ran a weekly clinic for patients in the practice who needed this service.
7 November 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 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 was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were visited by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.