Grange Road Surgery

Updated 5 October 2016

Grange Road Surgery is located in a suburban area of Bristol. They have approximately 10378 patients registered. Grange Road Surgery is located on a main road in a residential area,.

The practice operates from one location:

Grange Road,

Bristol,

BS13 8LD

It is sited in a purpose built two storey building. The consulting and treatment rooms for the practice are situated on the both floors; there was no lift access to the second floor. The practice has eight consulting rooms, one for each GP partner and one allocated for any trainee GPs on placement. There are three treatment rooms (for use by nurses, health care assistants) and a phlebotomy room, reception and a waiting room area on the ground floor. There is a further consulting/counselling room on the first floor along with the offices for administrative staff, kitchen facilities and a meeting room. There is limited patient parking immediately outside the practice with spaces reserved for those with disabilities.

The practice is made up of seven GP partners, three salaried GPs and the practice manager, working alongside a nurse practitioner, five qualified nurses and two health care assistant and two phlebotomists. The practice is supported by an administrative team made of medical secretaries, receptionists and administrators.

The practice is open for urgent and routine appointments between 8.30am – 6.30pm with extended hours appointments every Monday evening until 9pm, and in the morning on the second Saturday of the month. In addition to this there are pre-bookable appointments that can be booked up to two weeks in advance with the GP and nurse practitioner appointments; nurse and health care assistant’s appointments are available up to 6 weeks in advance. The service also offered ‘same day’ phlebotomy appointments.

The practice has a Personal Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice). The practice is contracted for a number of enhanced services including extended hours access, facilitating timely diagnosis and support for patients with dementia, patient participation, immunisations and unplanned admission avoidance.

The practice is a training practice and also offers placements to medical students and trainee GPs.

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 website.

Patient Age Distribution

% aged 0 to 4 years: 8% - higher than the national England average.

% aged 5 to 14 years: 12.6% - higher than the national England average.

% aged under 18 years: 16.1% - higher than the national England average.

% aged 65+ years: 13.6%

% aged 75+ years: 7.1%

85+ years old: 2.1%

Patient Gender Distribution

Male patients: 49.57 %

Female patients: 50.43 %

Other Population Demographics

% of Patients in a nursing Home: 0.4 %

% of Patients from BME populations: 4.08 %

All GP practices across Bristol Clinical Commissioning Group (CCG) are engaged in contract reviews with NHS England. There is a wide disparity across practices in funding terms of income per patient, and this exercise will put in place a process over the next five years to equalise the per patient rate across the 55 Practices in the Bristol CCC area.

The practice is in South Bristol which has the highest number of people with a long term health problem or disability in each age category in Bristol and the highest % of long term conditions.

Updated 5 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grange Road Surgery

on 24 November 2015. Following our comprehensive inspection overall the practice was rated as good with requires improvement for the safe domain. Following the inspection we issued a requirement notice. The notice was issued due to a breach of Regulation 12 of The Health and Social Care Act (Regulated Activity) Regulations 2014, Safe care and treatment. The requirement notice was for the practice to implement the necessary changes to ensure patients who used the service were protected against any risks associated with the safe management of the medicines, checking of emergency equipment and the safe management of blank prescriptions. A copy of the report detailing our findings can be found at www.cqc.org.uk.

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

• The areas where the provider must make improvement are:

• The practice must implement policy and procedures which reflect current best practice to ensure the safe management of the medicines, checking of emergency equipment and the management of blank prescriptions. The processes for the safety of prescriptions must be sufficiently implemented to provide a clear audit trail in the event of any security incident.

• The areas where the provider should make improvement are:

• The provider should review the layout and staffing of the reception area so that conversations between patients and the receptionist could not be overheard and reduce the wait for reception so patients did not have to queue so long.

• The practice should always involve a GP in the 6 month review of the significant events and the learning and action taken.

• The practice should identify a date for completion of actions or training in the staff had personal development plans.

• The policies and procedures should always cite the latest best practice or guidance.

We undertook this focused inspection on 25 August 2016 to follow up the requirement to assess if the practice had implemented the changes needed to ensure patients who used the service were safe.

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

• The practice had reviewed and rewritten their medicine management protocols, processes for prescription security and checking emergency equipment; these had been fully implemented by the practice.

• The front desk staffing had been reviewed and dedicated reception staff were available to focus on patients who arrived at the reception desk.

• The process for review of significant events now involved the GP team.

• We found the policies and procedure which had been compiled since our last visit made reference to best practice guidance.

• Personal development plans had been updated to include completion dates for any training or action.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 January 2016

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

• Nursing staff had specialist training for the management of chronic disease management and patients at risk of hospital admission were identified as a priority.
• There was a holistic approach to patients with multiple chronic disease diagnoses and multiple conditions were reviewed in a single chronic disease clinic appointment.
• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2013 to 31/03/2014), was 80.71%, this was above the national average of 77.72%.
• Longer appointments and home visits were available when needed.
• All patients from this group 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 21 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.
• The practice were working toward the ‘for young people (4YP)’ accreditation for sexual health advice.
• The practice’s performance for their cervical screening programme for 2014/15 was 80.0% , 3.3% above Clinical Commissioning Group average and 0.9% above England average.
• 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.

Updated 21 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 and had a range of enhanced services, for example, in dementia, influenza and pneumococcal Immunisations.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice was part of a scheme working with the charity RSVP (Retired and Senior Volunteer Programme) in the area to help to provide social support to their patients who were living in vulnerable or isolated circumstances.
• The practice accessed the Rapid Assessment Clinic for Older people based at the local community hospital and assigned a GP to attend sessions in which to observe the consultant and then take the learning to the practice to share with colleagues.
• Flu vaccination rates for the over 65s was 79%, compared to the national average of 73%.

Updated 21 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 reflected the needs for this age group.
• The practice was part of the pilot for eConsult (formally Web GP) which provided access to online consultations.

Updated 21 January 2016

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2013 to 31/03/2014) was 88.71%, this was above the national average of 83.82%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2013 to 31/03/2014) was 92.21%, this was above the national average of 86.04%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients living with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• There was 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 and worked in partnership with the Bristol Dementia Project.

Updated 21 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 homeless patients, travellers and those with a learning disability.
• They offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients such as, hosting a counsellor for patients with substance misuse three days per week.
• They 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.