Archived: Northville Family Practice

Updated 24 March 2017

Northville Family Practice is part of BrisDoc Healthcare Services Limited. BrisDoc is a limited company whose shareholders are the current employees. The provider BrisDoc has an Alternative Provider Medical Services (APMS) contract to deliver primary health care services which it took on at short notice from 15th January 2016 for a two year period when the previous GP contract holders resigned.

It operates from one site:

521 Filton Avenue,

Bristol

BS7 0LS

The practice is sited in a converted house. All patient services are located on the ground floor of the building. The practice has a patient population of approximately 5200.

The contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor injury services. An influenza and pneumococcal immunisations enhanced service is also provided.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8.30am and emergency telephone access is available from 8am. The practice operates a mixed appointments system with some appointments available to pre-book and others available to book on the day. The practice also offers telephone consultations. GP appointments are 15 minutes each in length and appointment sessions are typically 8.30am until 11.30am and 3pm until 6pm. The practice offers online booking facilities for non-urgent appointments and an online repeat prescription service. Patients need to contact the practice first to arrange for access to these services.

The practice has six salaried GPs (male and female), a practice manager, two practice nurses who were prescribers, two treatment room nurses and two health care assistants.The practice also has an Operations Manager, one practice secretary, prescriptions clerk and seven receptionists. Each GP has a lead role for the practice and nursing staff have specialist interests such as diabetes and infection control.

The practice is not a teaching practice.

The practices patient population is stable but has slightly more patients between the age of 20 and 29 years than the national average. They have a lower than national average number of patients over the age of 65 years at 16.7% compared to a national average of 27.2%.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is that the practice is in one of the most deprived areas of South Gloucestershire. (An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score. It is important to remember that not everyone living in a deprived area is deprived and that not all deprived people live in deprived areas).

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

Patient Age Distribution

0-4 years old: 5.21%

5-14 years old: 9.55%

15-44 years old: 49.1%

45-64 years old: 19.35%

65-74 years old: 9.06%

75-84 years old: 5.41%

85+ years old: 2.31%

Patient Gender Distribution

Male patients: 50.96 %

Female patients: 49.04 %

Other Population Demographics

% of Patients from BME populations: 15.53 %

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

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northville Family Practice on 2 February 2017.

Overall the practice is rated as good.

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

• 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.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Risks to patients were assessed and well managed; further attention was needed to ensure all vulnerable patients records were coded correctly. However, we found the practice was proactive with identifying risks to patients and had reviewed the notes of all female patients aged over 65 who had not had contact with the surgery in the last year and planned to do the same for the comparable males. The register was reviewed quarterly at multidisciplinary practice meetings and patients who had no contact with the practice in the previous quarter were telephoned and services offered.

• 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 could make an appointment with a named GP; 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.

• 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:

• The practice should further develop processes and systems and embed them with the staff team, for example, medicine monitoring processes, a protocol for hospital discharge medicine changes and timely viewing of results.

• The practice should ensure that the information accessible by the public on the website is kept up to date.

• The practice should address the coding issues to ensure all vulnerable patients are identified.

• The practice should obtain an electrical installation certificate for the premises.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 March 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The practice proactively identified patients at risk of developing long-term conditions and took action to monitor their health and help them improve their lifestyle. For example, the percentage of patients with diabetes, in whom the last blood test (HbA1c) to look at diabetes control was 64 mmol/mol or less was 57% compared to the clinical commissioning group average of 74%. The practice had employed a nurse practitioner with specialist knowledge to address this issue.

• Patients identified with raised blood glucose levels were phoned by the GP and advised that they were pre-diabetic. Patients were then asked to make an appointment with the practice nurse to discuss their lifestyle factors. 31 patients with prediabetes were seen this year and given advice.

• 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.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health. The respiratory nurse reviewed the records of housebound patients looking at which chronic obstructive pulmonary disease (COPD) patients may require home visits.

• The respiratory nurse was part of a pilot scheme with a specialist nurse to look at step down care in patients with milder disease and infrequent or no exacerbations. For patients this meant a reduction in use of triple inhalation therapy and maximal achievable bronchodilation supported by exercise and pulmonary rehabilitation, as this improved lung function, aiding daily activity and enhancing quality of life.

• The practice had a plan in progress to follow up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs. For example, patients with a hospital admission for asthma or COPD are highlighted to the respiratory nurse who will contact the patient.

• All appointments were for 15 minutes however, longer appointments and home visits were available when needed.

• The practice undertook monthly record searches for patients needing a repeat blood test and contacted those who had not attended.

Updated 24 March 2017

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

• There were systems 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 accident and emergency (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.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 88% compared to the local average of 84%.

• 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 had a list of all patients who were pregnant with their expected delivery date and monitored patients to ensure the babies are registered with the practice and attend for their immunisations. The practice followed up non-attendance and highlighted to the GP any patients who failed to attend.

• Minor illness clinics were offered twice weekly.

• There was a minor injury drop in service.

Updated 24 March 2017

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

• Staff were able to recognise the signs of abuse in older people and knew how to escalate any concerns.

• 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.

• Where older patients had complex needs, the practice shared summary care records with local care services; the practice had a fortnightly meeting with the multi-disciplinary team including hospice care, district nurses and health visitor for older people.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

• Two staff members were booked to attend ‘Frailty Friday’ training which would provide training and guidance for identifying and addressing frailty in older patients.

Updated 24 March 2017

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. For example, staff had attended NHS Health Checks training in January 2017 and will be sending out invitations to the target patient group. There was a protocol in place to act on findings.

• There was a risk register developed for patients who had limited or no interaction with the practice; they were contacted directly by the practice as a monitoring exercise.

Updated 24 March 2017

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

• 72% of patients diagnosed with dementia had been reviewed in a face-to-face review in the preceding 12 months.

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

• Patients at risk of developing a dementia were identified and offered an assessment.

• The practice specifically considered the physical health needs of people with poor mental health; for example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record was 73%.

• The practice had a system for monitoring repeat prescribing for patients receiving medication for mental health needs. For example, there was a system to identify patients who requested prescriptions early and they planned to monitor patients so that those who fail to renew their prescription for medicines are identified.

• 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 24 March 2017

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 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 a system in place for sharing child protection information and responded to MARAC) requests was shared. The practice sent a list monthly to the Bristol and South Gloucestershire team of health visitors that covered the practice advising them of any newly registered patients under the age of five.