St. Mary Street Surgery is a semi-rural practice which provides primary care services to patients living in Thornbury, South Gloucestershire, Monday to Friday during working hours. In addition, there are a range of clinics for all age groups, specialist nursing treatment and support.
As part of our inspection we spoke with other organisations, such as: the South Gloucestershire Clinical Commissioning group; the local Healthwatch; and other healthcare providers, to share what they knew. We also talked with patients and staff. We looked at the practice facilities which with the exception of the treatment room had not had the decoration updated.
The practice used a range of information to identify risks and improve quality regarding patient safety. They had a system for reporting, recording and monitoring significant events. The practice had systems which recognised and supported patients who were at risk of abuse. The practice had written guidance to support staff with the recruitment and selection process of new staff. Patients were treated by sufficient, suitably qualified staff. Patients were cared for in a safe environment. The practice had the equipment, medicines and procedures to manage foreseeable patient emergencies. Patients were protected from the risks of unsafe medicine management procedures. Patients were cared for in an environment which was clean and reflected good infection control practices.
Patients’ care and treatment was delivered in line with recognised best practice standards and guidelines. The practice met nationally recognised quality standards (the Quality and Outcomes Framework - QOF) for improving patient care and maintaining quality. For example, the management of patients with long term conditions and compared favourably with other practices in the area. Patient care was improved by the effective monitoring of treatment. Patients’ rights were protected with regards to the consent process. Patients' care was co-ordinated and managed by the practice to enable appropriate referrals to other healthcare providers. Patients had access to a range of health promotion information.
Patients were generally positive about their care and treatment. This was supported by results from the 2014 GP National Patient Survey, which demonstrated 95% of respondents from the practice had confidence and trust in their GP. Patient privacy and confidentiality was not easily maintained in the practice waiting area. The practice was aware of the situation and had started to address the issue, for example: relocating a telephone and work station to a room away from patient areas. Patients were involved in treatment choices.
Patients were generally able to get an appointment when they needed it. Of the respondents who completed the 2014 GP National Patient Survey 98% said their last appointment was convenient for them. However, there were areas requiring change, for example: contacting the practice by telephone during peak periods involved long waiting times. Patients with mobility needs could not gain access to the practice without assistance. The main door was not automated and there was no doorbell to summon assistance. Patients with communication difficulties had access to help. Patients had access to the practice complaints procedure via the practice leaflet and in the practice waiting area.
Patients were cared for by staff who were aware of their roles and responsibilities for managing risk and improving quality. Patients’ views on the service were listened to. The practice demonstrated a focus on learning. GPs and nurses were encouraged to update and develop their clinical knowledge and skills. The practice monitored significant events and used the learning to improve practice.
The practice supported older patients and patients with long term conditions by offering advice and support through specialist clinics, screening and evidence based information. The practice supported mothers, children and young people by working with other healthcare providers. The practice supported the working age population and those recently retired by offering a flexible appointment system. The practice supported patients in vulnerable circumstances by the early identification and protection of patients at risk. The practice supported patients experiencing poor mental health by regular monitoring of their treatment and support needs.
Please note that when referring to information throughout this report, this relates to the most recent information available to the Care quality Commission (CQC) at that time