Archived: Riverbank Medical Centre

Updated 18 November 2016

Riverbank Medical Centre is located in the town of Weston Super Mare in North Somerset.

The practice has an NHS England personal medical services (PMS) contract to provide health services to approximately 9700 patients. The practice is open from 8.15am to 6.30pm Monday to Friday. In addition, pre-bookable appointments can be booked on line and up to four weeks in advance. Telephone appointments are also available with additional slots for GPs to see these patients if required. Extended hours appointments are available every Thursday from 6.30pm to 8.30pm.

The practice has opted out of providing out-of-hours services to their own patients and refers them to an out of hour’s provider via the NHS 111 service. This information is displayed on the outside of the practice, on their website, and in the patient information leaflet.

The mix of patient’s gender (male/female) is 49% male and 51% female and 2.3% of the patients are aged over 85 years which is the same as the national average. The practice has a higher percentage of patients aged under 18 years, 23% compared to the national average of 21%. There was no data available to us at this time regarding ethnicity of patients but the practice stated that the majority of their patients were white British. The deprivation score was recorded as eight, on a scale of 1 to 10. One being more deprived and 10 being less deprived.

There are a total of seven GPs working at the practice. This equates to just over 4.5 whole time equivalent GPs. Two of the GPs are partners who hold managerial and financial responsibility for running the business and are supported by five salaried GPs. There are three female GPs and four male GPs in total. The GPs are supported by a practice manager, one nurse practitioner, two practice nurses, three health care assistants, one phlebotomist and additional administration and reception staff.

This report relates to the regulatory activities being carried out at:

Riverbank Medical Centre

Walford Avenue

Weston Super Mare

North Somerset

BS22 7YZ

Updated 18 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Riverbank Medical centre on 17 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, with the exception of governance arrangements for the management of infection control and the absence of a fire risk assessment. The practice notified us with 48 hours that this had been updated, a fire risk assessment and an infection control audit had been completed.
• The practice had safe and effective systems for the management of medicines, which kept patients safe. However prescription pads were not stored securely and vaccines fridges were left unlocked. The practice took immediate steps to improve this by completing a risk assessment and arranging for all doors to be fitted with coded locks.
• 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. However, the training record showed that not all staff had received updated mandatory training in safeguarding, basic life support and the Mental Capacity Act. The practice notified us with 48 hours that this had been updated and all training had been booked in to be completed by June 2016.The practice confirmed they had also arranged for administrative staff to undertake further customer service training including telephone skills and handling difficult situations. This was booked in for July 2016.
• All staff had received an appraisal but we found some had not been completed within the past 12 months. The practice notified us with 48 hours that this had been updated and all staff had a date booked in to be completed by July 2016.
• Recruitment procedures and checks were completed to ensure that staff were suitable and competent. However, some records were not fully complete and had information missing. For example photographic identification and disclosure and barring service checks (DBS). The practice notified us with 48 hours that this had been updated and all files were up to date and DBS checks had been applied for.
• 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, although some found it difficult to get through on the telephone. 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:

• Continue to improve telephone access. The last patient survey showed only 53% of patients said they could get through easily to the practice by phone compared to the national average of 73%.
• Continue with improving services provided to military veterans to ensure they are in line with the military veteran’s covenant.
• Review how audit processes are established to ensure an on-going audit programme is in place to show that continuous improvements have been made to patient care in a range of clinical areas as a result of multi cycle clinical audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 November 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. Longer appointments and home visits were available when needed. Specific clinics were held for particular illnesses such as asthma, and diabetes.
• Enhanced clinics for patients diagnosed with diabetes were held as well as clinics in conjunction with the hospital diabetes specialist nurse when required.
• 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 18 November 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 between April 2015 and March 2016 was 79%, which was comparable with 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, health visitors and school nurses.
• 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.
• The practice had a dedicated midwife who attended the practice weekly.

Updated 18 November 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.
• Systems were in place for avoiding unnecessary admissions of patients aged over 75 years. This included ensuring care plans were in place for patients most at risk of admission, the sharing of common health records with community care teams and acting on hospital discharges within 48 hours.
• The GPs provided a primary medical service to patients who lived in a local care home in the area this included a visit every two weeks to complete a proactive ‘ward round’ of all patients.

Updated 18 November 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.
• Routine appointments were available to book up to four weeks in advance (via the practice or online).
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group, allowing them to book appointments, request repeat prescriptions, or access summaries of their medical records. 

Updated 18 November 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Data from 2014/15 showed:

• 69% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is below the national average of 84%. The practice had responded to this by engaging a Community Care Advisor to review care plans for housebound patients with dementia, as part of a targeting system run by the Dementia Lead.’
• 57% of patients with schizophrenia, bipolar affective disorder and other psychoses had a care plan documented in the last 12 months, which is below the national average of 88%. We spoke to the practice who told us they had changed their approach and a recall system had been put into place to engage patients with their physical and mental health. For example, patients were offered an appointment with the ‘Healthy Heart Advisor’ to have full bloods tests and cardiovascular risk factors checked; followed by a 20 minute appointment with a GP to review their care. We saw evidence of an improvement in the number of patients attending reviews and that another full audit was planned for March 2017.
• 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.
• 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.

Updated 18 November 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. For example, the practice participated in Gemini Refuge, the local delivery of a national scheme to support patients experiencing domestic abuse.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The practice reviewed the health of those patients that were recognised as carer’s. These patients were signposted to other outside agencies for additional support as needed.
• The practice was working to identify military veterans and ensure they received appropriate support. 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. All staff had been booked in for updated training in the principles of the Mental Capacity Act 2005.
• The practice had a hearing aid induction loop for patients with difficulty hearing and were able to provide communication in large print for those who required it.