Severn View Family Practice Also known as Dr P J Burney and Partners

Updated 7 December 2016

The practice is located at Thornbury Health Centre, Eastland Road, in Thornbury, in South Gloucestershire, and supports around 8,900 patients in an approximate 5 mile radius of the town. The practice also provides medical care for the 24 inpatient beds at the local community hospital. The practice shares an older purpose built building with a separate GP practice and additional community services. All patient services are located on the ground floor of the building.

The appointment booking service was open five days a week and offered patient appointments between 8am and 6.30pm Monday to Friday, with extended opening on Tuesday and Thursday evenings until 8pm and on average one Saturday morning clinic per month. There were daily urgent care clinics for patients who had an illness requiring same day medical care. Patients were booked into these clinics at 10.30am and 4pm each day.

The practice operated as a partnership of five GPs and one half time equivalent salaried GP, offering a total of 36 sessions across the week. The practice employed a nurse practitioner, four practice nurses and two health care assistants. There was a practice manager, an assistant practice manager, secretarial, reception and administration teams.

The practice’s patient population has slightly fewer patients between the age of 0 to 18 years and significantly higher number of patients 65+ than the national average. Approximately 28% of the patients are over the age of 65 years compared to a national average of 17%; 12% are over 75 years compared to the national average of 8%, and 3% are over 85 years compared to the national average of 2% which can result in a higher demand for GP and nurse appointments.

Approximately 49% of patients have a long standing health condition compared to a national average of 54%. The patient population was predominantly white British or white other with 2% of patients from minority ethnic groups. The practice supports local residential and nursing care homes.

The Thornbury Health Centre – Foubister, 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 general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the 10th least deprivation decile. (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). Average male and female life expectancy for the area is above the national average at 81 and 86 years respectively and higher than the clinical commissioning group average.

The practice has a Personal Medical Services (PMS) contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

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. This information was also available in the practice brochure and on their website.

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

Updated 7 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Thornbury Health Centre - Foubister on 19 October 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 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 ensure that they retained all of the necessary recruitment information about the locums they employed.
• The practice should ensure that it retained an overview of how the maintenance and health and safety requirements for the premises were met.
• The practice should ensure that they have effective systems in place to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 December 2016

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 percentage of patients with a diagnosis of diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12months (01/04/2014 to 31/03/2015) was 70%, lower than the clinical commissioning group (CCG) average of 77% and the national average of 78%.

• 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.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• 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 7 December 2016

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, and we saw evidence to confirm this.

• National Cancer Intelligence Network data (2014/15) showed that cervical screening programme was 81%, which was higher than the national average of 74%.

• 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 emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 7 December 2016

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.

• The practice identified at an early stage older people who may be approaching the end of life. It involved older people in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

Updated 7 December 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, including an e- consult service as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 7 December 2016

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

• 85% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 85.5%.
• The practice had a system for monitoring repeat prescribing for people receiving medication for mental health needs.

• 95% of patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015). This was comparable to the clinical commissioning group average of 94%, the national average being 84%.

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

• People at risk of dementia were identified and offered an assessment.

• 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.

Updated 7 December 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 was able to offer patients an alcohol and substance misuse support and treatment service.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.