Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Christchurch Family Medical Centre on 9 August 2016. We had inspected this GP practice in August 2014 as part of our inspection programme pilot to test our approach going forward.

Areas identified for improvement in August 2014 were:

• The practice should ensure all staff understand what to do if they are concerned or worried about a vulnerable adult or child.

• The practice should ensure that actions resulting from clinical audits are reviewed to complete the audit cycle.

• The practice should ensure all staff are aware of translation or signing services for patients.

• The practice should ensure their whistle blowing policy contains contact details for external organisations.

From this inspection 9 August 2016 our findings were:

Overall the practice is rated as good.

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

• 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 could make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. The practice managed its more vulnerable patients well and made specific support available to them to facilitate them to access health care.
• 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.
• 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 team had regular away days in order to review and plan the practice developments.
• There was a governance framework for the delivery of the strategy and good quality care, and the practice had a number of policies and procedures to govern activity.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events, but we found the practice relied on their established verbal communication systems and informal meetings to share and cascade information.

We saw areas of outstanding practice:

• A clinical coordinator was employed by the practice to support vulnerable patients with learning disabilities. They offered the annual health checks for patients which had allowed them to develop a secure and trusting relationship and continuity of care. They also liaised with the care homes for people with learning disabilities and provided a point-of-contact for those patients living independently in the community by providing support, care, chaperoning and interpretation. They had been involved in developing a DVD to support training in other primary care organisations to raise awareness of learning disabilities. Patients could contact the clinical coordinator directly for support making appointments.

• The practice offered support to carers and held monthly meetings which provided social and health care opportunities to carers. These patients could also contact the clinical coordinator directly for support making appointments.

The areas where the provider should make improvement are:

• The practice should update their fire safety risk assessment.

• The practice should maintain clear records of clinical and other meetings where decisions are taken which impact on the work of the practice.

• The practice should monitor the cleanliness of the practice environment.

• The practice should monitor their patient group direction to ensure they are up to date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Christchurch Family Medical Centre is located in North Street, Downend, Bristol, BS16 5SG and provides primary medical services to approximately 12,500 NHS patients. The practice is situated in a purpose-built building and is fully accessible for patients with mobility issues.

There were examples of practice that Christchurch Family Medical Centre had developed to meet the needs of its patients, which could be shared with other services. These included the substance misuse, learning disability and diabetes services and the accessibility of the practice.

We found the practice had systems that ensured their service was safe effective and caring for patients and staff. During our visit we spoke with six patients and reviewed 26 comments cards from patients who had visited the practice in the previous two weeks. Patients were complimentary of the staff and the care and treatment they received. Patients told us that they were not rushed and staff explained their treatment options clearly. They said all the staff at the practice were helpful, caring and supportive.

The practice proactively sought and responded to patient feedback to improve the service. The practice opened a variety of times throughout the week between 7:30 am and 6:30 pm, offered evening surgery twice a week until 8 pm and opened on Saturday mornings. This resulted in patients being able to access the practice at times that were convenient to them, including early mornings, evenings and at the weekend. There was also a system in place to ensure that patients who had an urgent need could be seen on the same day.

There were arrangements in place to ensure patients received urgent medical assistance when the practice was closed. The Out Of Hours service was delivered by another provider.

The practice was well led by a practice manager and the GPs. The staff team were engaged in the service and told us they were excited by the future direction of the practice.   

We talked with most of the staff employed in the practice who worked on the day of our inspection. This included five GPs, two practice nurses and a nurse practitioner, a health care assistant and the practice manager and five administrative staff.

We spoke with the staff team about patient groups as defined by the NHS and used as part of the Care Quality Commissions new methodology. The patient groups were;

•           Older People

•           People with long-term conditions

•           Mothers, babies, children and young people

•           The working-age population and those recently retired

•           People in vulnerable circumstances who may have poor access to primary care

•           People experiencing a mental health problem

We found that they provided services to all these groups of patients and the practice provided us with examples. These included employing a clinical co-ordinator to manage the health and social care needs of older patients, providing specialist clinics to meet the needs of patients with long-term conditions, offering extended hours to suit the working population, a specialist substance misuse service for vulnerable patients to improve access to services for patients experiencing a mental health problem.