Archived: Bridge Practice

Updated 24 May 2017

The Bridge Practice is situated in the Stepgates area of Chertsey. The practice is located in the Chertsey Family Health Centre which is a purpose built property. The building is owned by NHS Estates and there are three providers sharing the property. This practice is not the major tenant. At the time of our inspection there were approximately 7,900 patients on the practice list.

Since our last visit the practice had undergone a period of change following the retirement of two long standing partners.

The practice has three GP partners and two salaried GPs (two male and three female), three nurses, a practice manager, a deputy practice manager, reception and administration staff. The practice is a training practice, training practices have GP trainees and Foundation Year Two junior doctors and at the time of our inspection had one GP registrar.

The practice is open between 8am and 6.30pm Monday to Friday. Extended hours surgeries are offered 7.30am to 8am Tuesday and Thursday mornings and 6:30pm to 7.30pm Tuesday, Wednesday and Thursday evenings. Patients requiring a GP outside of normal hours are advised to call NHS 111 where they will be directed to the most appropriate out of hours service. The practice has a Personal Medical Services (PMS) contract and offers enhanced services for example; various immunisation and learning disabilities health check schemes.

The service is provided at the following location:-

The Bridge Practice

Chertsey Family Health Centre

Stepgates

Chertsey

Surrey

KT16 8HZ

The practice has a below average number of patients aged 0-29, and an above average number of patients aged 40-54 and male patients aged 65-69. There are a slightly higher than average percentage of patients with long standing health conditions. The practice has a lower number of children and older people affected by deprivation than the national average although it is slightly higher than the clinical commissioning group average.

Updated 24 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge Practice on 17 November 2015. The overall rating was good. During the inspection we found breaches of legal requirements and the provider was rated as requires improvement under the effective key question. Following this inspection the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that training for staff is completed as appropriate and training records kept up to date.

We carried out a focused follow up inspection on 28 February 2017, this inspection was to verify if the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we had identified in our previous inspection on 17 November 2015. We found that they had not completed their action plan. We found staff training had not been completed and training was not being monitored appropriately by the practice. The overall rating was good but remained rated as requires improvement under the effective domain. As the provider had not completed their action plan to meet the legal requirements following this inspection we issued a warning notice that the practice must comply with the legal requirements in relation to the following:-

• Ensuring that training for GP partners, clinical and non-clinical staff is completed as appropriate to their job role and that training is monitored by the practice.

This report covers our findings in relation to the concerns regarding training. The full comprehensive report on the 17 November 2015 and the focused follow up report on the 28 February 2017 inspection outcomes can be found by selecting the ‘all reports’ link for Bridge Practice on our website at www.cqc.org.uk.

At this inspection, on 24 April 2017 we found that training appropriate to job roles had been completed and training was being monitored by the practice.

The practice is now rated as good for providing effective services.

Our key findings at this inspection, 24 April 2017 were as follows:

• All GP partners, clinical and non-clinical staff had completed training at a level appropriate to their job role and in accordance with the practice training schedule.
• The practice had implemented a central record of staff training and was using this to monitor training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 March 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.
• QoF indicators for diabetes were comparable with other practices.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• There were systems in place to proactively screen patients for pre-diabetes and review patients with pre-diabetes annually. The practice gave a talk about diabetes to their patient participation group (PPG).

Updated 3 March 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 has been performed in the preceding 5 years is comparable with CCG and national averages.
• 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 and health visitors.

Updated 3 March 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.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice arranged a talk by a charity to increase awareness of staff about dementia.
• The practice is participating in an admissions avoidance programme where they have identified the 3% of their patients at highest risk of admission and developed personal care plans for them which were shared with the ambulance service.

Updated 3 March 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 and electronic prescription service (EPS) as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered a Health Check clinic for adults aged 40-74.
• Extended hours appointments were available.

Updated 3 March 2016

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

• 79.7% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (national average 83.8%).
• 97% 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 (national average 86%).
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It 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.
• It 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 people with mental health needs and dementia.

Updated 3 March 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.
• It offered longer appointments for people with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It 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.