Temple House Practice

Updated 11 July 2016

Temple House Practice is located in Keynsham, a small town six miles south of Bristol, in the south west of England. The practice has a higher than average patient population in the over 65 year’s age group and lower than average in the under 35 years age group. The practice is part of the Bath and North East Somerset Clinical Commissioning Group and has approximately 7,000 patients. The area the practice serves is Keynsham and surrounding villages and has relatively low numbers of patients from different cultural backgrounds. The practice area is in the low range for deprivation nationally. The practice has 63% of patients with a long standing health condition which is higher than the both local average of 52% and the national average of 54%.

The practice is managed by five GP partners (four female and one male). The practice is supported by a female salaried GP, four practice nurses, one healthcare assistant and an administrative team led by the practice manager. Temple House Practice is a teaching practice providing placements for medical and nursing students.

The practice is open between 8am and 6pm Monday to Friday. Appointments are available between 8.30am and 11am every morning and 2pm to 5.50pm every afternoon. Extended hours appointments are offered between 6.30pm and 7.30pm on one evening a week, on either a Monday, Tuesday, Wednesday or Thursday and 8.30am to 11am on alternate Saturday mornings. In addition to pre-bookable appointments that can be booked up to six weeks in advance, urgent appointments are available for patients that need them.

When the practice is closed patients are advised, via the practice website that all calls will be directed to the out of hours service. Out of hours services are provided by Bath Doctors Urgent Care.

The practice has a Primary Medical Services (PMS) contract to deliver health care services. This contract acts as the basis for arrangements between NHS England and providers of general medical services in England.

Temple House Practice is registered to provide services from the following location:

St Clements Road

Keynsham

Bristol

BS31 1AF

Updated 11 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Temple House Practice on 26 May 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. However we found that the process in place for the review of some high risk medicines were not always consistent.
• 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 improvements are:

• To ensure the practice has a robust system for monitoring patients on high risk medicines.
• To ensure patient care plans are comprehensive and fully completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 July 2016

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.

• Performance for diabetes related indicators was similar to local and national averages. The percentage of patients with diabetes, on the register, in whom the last blood test was within target range in the preceding 12 months (2014 to 2015) was 77% compared to a local average of 82% and a national average of 76%.

• The practice identified patients who were at risk of developing diabetes. Patients were invited for a lifestyle review with a member of the nursing team. Blood tests were repeated and reviewed at appropriate intervals to maintain monitoring.

• A practice nurse with training in a number of chronic diseases visited housebound patients to carry out reviews of their conditions.

• 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 11 July 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 practice’s uptake for the cervical screening programme was 81%, compared to the local CCG average of 83% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice telephoned new parents to congratulate them to congratulate them and book babies 6 week check, On the day of the appointment, parents were telephoned to remind them. A letter was sent if the baby did not attend for immunisations.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 11 July 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 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 proactively worked with a local social prescribing scheme to support patients who were socially isolated or lonely.

• Patients had been discharged from hospital were flagged by the administration team to prompt a GP review of the patient and their care plans.

• The practice worked collaboratively with a health visitor for older patients to ensure patients were receiving appropriate services, the right level of care and benefits.

Updated 11 July 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. A 24 hour automated appointment booking system was also available.

• Extended hours surgery were offered one evening each week and alternate Saturday mornings for working patients who could not attend during normal opening hours. Bookable telephone appointments were also available.

Updated 11 July 2016

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

• The percentage of patients with a serious mental illness who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014 to 2015) was 95% compared to a local average of 92% and a national average of 88%.

• 74% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which was below the local average of 88% and the national average of 84%.

• 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. However we found that patient care plans were not always comprehensive. In addition the care plans we looked at had not been fully completed and were not dated.

• 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 11 July 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.