Archived: Dr Vera Austin Also known as Monmouth Surgery

Updated 9 June 2016

Dr Vera Austin is known locally as Monmouth Surgery. The practice has a registered population of approximately 3,300 patients. The practice is close to the centre of the city of Bath, its proximity to the centre of the city means good transports links but very limited parking. The practice moved in to its current building in 2011. The practice was originally (approximately 30 years ago) formed when a GP from the west of Bath moved to work in the city centre and a cohort of patients followed the GP and registered with the new practice.

The practice works hard to retain a family friendly personalised service.

The practice has some areas of higher than average social deprivation. The practice population reflects the local and national average in demographics except for a higher than average number of patients between the ages of 25 to 35 and slightly lower than average number of under 20 year olds.

The practice has two GPs both female; one full time and one part time (two thirds of a whole time equivalent). The practice has a current long term male locum. The practice has tried to ensure access to a male GP is available.

The GPs are supported by two part time practice nurses who provide a nursing service over the five days, and a management, administration and reception team of six part time staff, providing the equivalent of four whole time equivalents. Due to the size of the team the reception and administration team provide a dual role for cover and resilience.

The practice is open between 8am and 6pm Monday to Friday, although open until 7 pm when extended hours are available. Appointments are available from 8.30am to 12pm every morning and 15:30 to 5.10pm daily although this varied slightly per day. Extended hours appointments are offered from 6pm to 7pm for 3 Tuesdays a month and from 6pm to 7pm every Thursday. In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments are also available for patients that need them.

The Bath and North East Somerset area have a local agreement for the out of hours cover to commence at 6pm.

When the practice is closed the out of hours care is provided by Bath Doctors Urgent Care accessed via NHS 111.

The regulated activities the practice provides are located at;

8 Monmouth place,

Bath.

BA1 2AU

Updated 9 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Vera Austin on 27 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 a very caring personalised service, with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• There was a clear leadership structure and staff felt supported by management. The practice had been through some uncertainty as negotiations had been held relating to mergers. These discussions were ongoing which had impacted on the practice over the previous year. The practice valued the personalised service they delivered and were working to maintain this ethos and sustain this while meeting the changes required to continue to provide a primary care service.
• 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 all staff have regular appraisals.

• The practice should seek to improve the support of patients with mental health related conditions.

• The practice should seek to improve the number of patients having health screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 June 2016

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

• GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with high blood pressure whose blood pressure was in the target range (2014/15) was 76% which was below the national average of 84%.

• The percentage of patients with COPD (a range of chronic lung conditions) who had a review of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (2014/15) was 93% which was higher than the national average of 90%.

• Performance for diabetes related indicators were mixed compared to the national average. The practice was aware of this and working with the diabetic specialist nurse to ensure these patients were reviewed this year.

• The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (2014 /15) was 100% which was higher than the national average of 94%.

• The percentage of patients with diabetes, on the register, in whom the blood test was in the target range in the preceding 12 months (2014/15) was 74% which was lower than the national average of 78%

• 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.

Updated 9 June 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 patients who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations for the under 2 year olds, but lower than the local average for the under 5s. The practice had appropriate measures in place to address this.

• 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 88%, which was higher than 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 and health visitors.

Updated 9 June 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.

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

• The practice offered a personalised caring service.

• We saw care plans were in place and shared as appropriate with the relevant agencies to ensure continuity of care.

Updated 9 June 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 offered telephone consultations and telephone automated appointment bookings. The practice offered extended hours appointments.

• 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 9 June 2016

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

• Performance for mental health related indicators were mixed in comparison to the national averages:

• The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan documented in their record in the preceding 12 months (2014/15) was 82% which was lower than the national average of 88%.

• The percentage of patients with physical and/or mental health conditions whose notes record smoking status in the preceding 12 months (2014/15) was 98% which was higher than the national average of 94%.

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

• The practice carried out advance care planning for patients with dementia. 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.

• 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.

• The practice had a good individual knowledge of their patients and those that did not attend for an appointment were followed up with a phone call.

Updated 9 June 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 complex needs and those 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