Archived: The Green Practice at Whitchurch Health Centre Also known as The Green Practice

Updated 28 January 2016

The Green Practice at Whitchurch Health Centre is located in a suburban area of Bristol. They have approximately 3863 patients registered.

The practice operates from one location:

Whitchurch Health Centre

Armada Road

Whitchurch

Bristol

BS14 0SU

It is sited in a leased purpose built health centre which is shared with other healthcare providers. The consulting and treatment rooms for the practice are situated on the ground floor. The practice has two consulting rooms. There are treatment rooms (for use by nurses, health care assistants and phlebotomists), reception and records room, and a waiting room area. There is patient parking immediately outside the practice with spaces reserved for those with disabilities.

The practice is made up of four GP partners, two salaried GP and a Physician Associate (Physician Associates support doctors in the diagnosis and management of patients). They commission through the Whitchurch Health Centre organisation the practice manager, two nurse practitioners, seven registered nurses, two healthcare assistants and a phlebotomist. The practice is supported by an administrative team consisting of medical secretaries, receptionists and administrators also commissioned through the Whitchurch Health Centre organisation. The practice is open from 8.30am until 6.30pm Monday to Friday for on the day urgent and pre-booked routine GP and nurse appointments. Patients with a new & urgent medical problem were seen by a doctor or the Physician’s Assistant. Emergencies were dealt with as priority. Patients were also added to the end of the day’s list in order to be seen as soon as possible.

The practice has a Personal Medical Services contract with NHS England (a nationally agreed contract negotiated between NHS England and the practice). The practice is contracted for a number of enhanced services including extended hours access, patient participation, and immunisations.

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.

Patient Age Distribution

• 0-4 years old
• 0-4 years old: 4.4%
• 5-14 years old: 10.25%
• 15-44 years old: 36.68%
• 45-64 years old: 26.69% (higher than the national average)
• 65-74 years old: 12.88% (higher than the national average)
• 75-84 years old: 7.65% (higher than the national average)
• 85+ years old: 1.46%

Patient Gender Distribution

• Male patients: 48.88 %
• Female patients: 51.12 %

Other Population Demographics

• % of Patients in a Residential Home: 0.16 %
• % of Patients on Disability Living Allowance: 5%
• % of Patients from BME populations: 5 %

Practice List Demographics / Deprivation

• Index of Multiple Deprivation 2010 (IMD): 18.72.
• Income Deprivation Affecting Children (IDACI): 0.18
• Income Deprivation Affecting Older People (IDAOPI): 0.18vation Affecting Children (IDACI): 0.18
• Income Deprivation Affecting Older People (IDAOPI): 0.18

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.

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Green Practice at Whitchurch Health Centre on the 3 November 2015. Overall the practice is rated as good but the safe domain was rated as requires improvement.

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

• There were gaps in the processes for recruitment of staff to ensure they were appropriate qualifications, skills and training.
• The assessment of patient’s capacity to make an informed choice about their care and treatment was not always recorded in their records.
• 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 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.
• Patients said there were urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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:

• Identify a clinical lead to liaise with the local infection prevention teams in order to keep up to date with best practice.

• Review the system for policies and procedures in order that relevant information is available and easily accessible for staff.

• Establish an overall management lead for the nursing team.

The areas where the provider must make improvement are:

• Make sure personnel employed to carry on the regulated activity have the appropriate checks through the Disclosure and Barring Service and they hold the required specified information in respect of persons employed by the practice as listed in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Ensure that where patient’s mental capacity is assessed as to their ability to make decisions about their care and treatment is recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

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

• Nursing staff had specialist training for management of chronic disease, such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).

• The practice offered winter rescue packs to patients with Chronic Obstructive Pulmonary Disease and encouraged patient to self-manage.

• The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 September to 31 March (01/04/2013 to 31/03/2014) which was comparable to other Clinical Commissioning Group practices at 97.3% but higher than the national average of 93.46%.

• Longer appointments and home visits were available when needed.

• Patients with long term conditions had a named GP and a structured annual review to check that 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 28 January 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 people who had a high number of 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.

• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding year, based on data from the practice, was 85.02% which was comparable to other practices.

• 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. All vulnerable families had a named GP which provided continuity of care to the whole family.

Updated 28 January 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.

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

• The practice could access a community based nurse specifically overseeing the care of older patients.

• The practice used the Rapid Assessment Clinic for Older people based at the local community hospital.

Updated 28 January 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice was a member of the One Care Consortium and able to offer patients weekend reviews.

• The practice had a daily ‘drop in’ phlebotomy service for patients.

• The practice hosted councillors for substance misuse three days a week which included appointments later in the day for patients who worked.

Updated 28 January 2016

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

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

• 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 which included younger patients.

• 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 who had been diagnosed with mental health needs and dementia.

Updated 28 January 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 those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• The practice 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.