Archived: Locality Health Centre

Updated 20 February 2018

The Locality Health Centre is located at 68 Lonsdale Avenue, Weston-Super-Mare, North Somerset, BS23 3SJ. The service had approximately 5296 patients registered from around the local and surrounding areas. Patients can access information about the service at www.localityhealthcentre.org.uk

The service is located within the For All Healthy Living Centre, a multi agency building incorporating a café, library, church, nursery, community rooms, meeting rooms and offices. There is a car park and disabled parking bays outside the centre. Locality Health Centre is a Community Interest Company (CIC) and is responsible for the provision of some but not all the services available in the For All Healthy Living Centre, which hosts a broad spectrum of community services such as social services, community midwife, food bank, and childrens centre.

The provider has informed us that they have taken over the NHS England contracts to provide GP services from two other locations in Weston-Super-Mare from October 2016 and April 2017. They have also recently accepted a contract for a twelve month pilot to provide a Primary Care Service led by Advance Nurse Practitioners based within the emergency department at the local hospital. Applications to add these locations to the providers registration are in the process of being completed, or have recently been received into the Care Quality Commission(CQC), and are awaiting to be processed. All these services are managed by the Registered Manager and the management team for Locality Health Centre CIC.

The practice employs six salaried GPs, three male and three female. The practice employed five Advance Nurse Practitioners, three practice nurses and one health care assistant. The practice has a practice manager who is supported by a team of management staff, reception staff, administrators and secretaries. The provider told us as part of the acquisition of other services they had reviewed their clinical cover and leadership. New clinicians had been employed across the service and new roles developed such as a clinical medical lead had been created but had not embedded into the service.

The practice is open from 8.00am, Tuesday to Friday until 6.30pm each evening. On Mondays the practice is open 8.am until 6.30 pm but is closed between the hours of 12.30 to 14.00. Extended hours for pre-booked appointments are: 9.00 am to 11.00 am on the second Saturday of each month.

The practice has an Alternative Provider Medical Services (APMS) contract with NHS England (a locally agreed contract negotiated between NHS England and the practice). The practice is contracted to deliver for a number of enhanced services including; extended hours access for patients, childhood immunisations, enhanced services for the assessment and provision of services for patients living with dementia, and the practice were involved in the unplanned hospital admission avoidance scheme.

The practice does not provide out of hour’s services to its patients, this is provided by BrisDoc. Contact information for this service is available in the practice and on the practice website.

Demographic data from 2015/2016 that is available to the CQC shows:

The age of the patient population was above the national averages for patients under the age of 18 years at 31%, the national average being 20%. For patients over 65 years the practice has 10% with the national average being 23%.

Other Population Demographics included 60% of the practice population had a long standing health condition, which was above the national average of 53%. Also 48% of patients were in paid work or full time education which was below the national average of 62%. Information from the

Index of Multiple Deprivation 2015 (IMD): showed the practice population is at 57 (the national average 21). The lower the number the more affluent the general population in the area, is.

Income Deprivation Affecting Children (IDACI): is 51% (the national average 20%)

Income Deprivation Affecting Older People (IDAOPI): is 40% (the national average 17%).

Updated 20 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an unannounced comprehensive inspection at Locality Health Centre on 12th December 2017 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients did not always find the appointment system easy to use; the practice was looking a system to improve this.

• There was a focus on continuous learning and improvement at all levels of the organisation.

• They were knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges involved and were addressing them.

• The practice was sited within the For All Health Living Centre which was part of the central hub of the community and worked with other organisations to improve the outcomes for patients in that area.

The areas where the provider should make improvements are to:

• Review how patients with long term conditions or those prescribed with at risk medicines receive their reviews in a timely way in accordance with guidance.

• Review systems to ensure there is a cross practice system for sharing information and learning from incidents.

• Review systems to ensure changes are made to the policies and procedures currently in use so that they reflect the appropriate organisation ownership and offer clarity to staff.

• Review processes for recruitment documentation to ensure it is held together in one place and includes detail of the immunisation status of clinical staff.

• Review systems of how patients were to gain access to the practice by phone as 55% stated they could get easily get through in comparision to the CCG – 70%; national average - 71%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 June 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 11 June 2015

The practice is rated as outstanding for the care of families, children and young people. Families and young patients were the highest proportion of the practice population with approximately 30% of patients being under 16 years. Immunisation rates for all standard childhood immunisations were above average for the CCG and up to 100% for many common illnesses such as polio and diphtheria and measles, mumps and rubella.

Many of the families arriving into the area arrived with existing difficulties and lack of resources. Urgent nurse clinics supported these patients; the practice was able to offer 15 minutes appointments giving more time for patient education and support. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. The practice had a close working relationship with the local midwife service which provided six clinics a week. The midwives were viewed as an active member of the practices clinical team taking part in significant event audits and other meetings. The practice also had strong relationships with the Health Visiting team, Children’s Social Care and Children’s Centre which had a nursery provision on the premises.

One of the practice nurses had achieved the Queens Nursing award earlier this year for her work related to sexual health. They ran a specific clinic about sexual health each Wednesday for young people under the age of 21 years. To help address concerns about pregnancy in young people the nurse, who is the ‘No Worries’ advisor, visited a local school to advise on contraception and pregnancy avoidance. We saw evidence of signposting young people towards sexual health clinics and contraception advice in information around the practice. The practice also signposted younger patients to the ‘No Worries’ service which provided confidential, young people friendly services and advice on all aspects of growing up, relationships and health.

The co-location with the children’s family service, ‘Troubled Family’ team, family nurse practitioners, health trainers and being part of the new Bournville One Police initiative ensured the practice had close links and information sharing with very local services. The Centre also operated a food bank to which the practice referred their most vulnerable families.

The midwives we spoke with told us about multidisciplinary team work involving practice staff and other organisations. Mother and baby and post natal clinics were provided each Tuesday afternoon with an immunisation clinic also available that afternoon. The mothers we spoke with spoke positively about the clinics and the support of the nurses and GPs involved in their maternity and post maternity care. The South Weston children's centre was based on the premises and the practice referred patients to the service.

Updated 11 June 2015

The practice is rated as outstanding for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The healthy living centre ran a daily lunch club for older people, the practice referred patients with poor nutrition to the club and the lunch club brought patients to the practices attention if they had identified concerns. We saw practice staff visiting the lunch club to check those attending were well. The practice kept a register of older patients who were identified as being at high risk of admission to hospital or who were nearing the end of their life. All had up to date care plans and these were shared with other providers such as the out of hour’s service. All older patients discharged from hospital had a follow-up consultation where this was clinically advised.

Updated 11 June 2015

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.

Updated 11 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The majority of patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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 including MIND and other local organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 11 June 2015

The practice is rated as outstanding 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. It had considered the needs of these patients and 100% of people with a learning disability were seen by clinical staff for a review. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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 adopted the use of summary care records for their most vulnerable patients in this category. We saw the lead nurse had been proactive in promoting healthy lifestyles with patients. Information boards were maintained in prominent areas of the waiting areas, leaflets were available in the consulting rooms and advice offered was recorded in the patient’s notes.

The practice was able to identify patients who may be living in vulnerable circumstances and had a system for flagging vulnerability in individual records. People were easily able to register with the practice, including those with “no fixed abode” care of the practice’s address. People not registered at the practice are able to access appointments as temporary residents at the sit and wait clinic provided each day.