Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Concord Medical Centre on Friday 23 January 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing responsive, caring and effective services and for being well led. They were also outstanding for providing services for the all the population groups. They were good for providing safe services.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised and used to enhance services for patients.
• The practice used innovative and proactive methods to improve patient outcomes, working with other providers; locally and within the self-care forum to share best practice.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place which was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

• The practice had invested in a DEXA scanner to aid diagnosis of Osteoporosis and they provide a free assessment for its own patients and a private service for those from other practices. This provided a much faster access to diagnosis for local patients and reduced the need for those patients to attend hospital. In the last year the practice had provided a total of 213 individual patient scans and resulted in improved treatment outcomes for those patients.
• The practice had developed an integrated service provision with the Bristol Oncology Centre hospital staff to provide in house oncology treatment, a branch of medicine which deals with cancer, for their own patients and patients from other practices within the community. The service started in April 2014 and they have the facilities to see up to 20 patients per day. The Oncology unit has provided care to 336 patients since opening and out of these approximately two to four patients from the practice are seen daily.
• The practice employed a full-time mental health nurse consultant who had improved faster patient access for mental health treatment and reduced patient referrals to secondary care by 85%. The practice had employed the mental health consultant in replacement of a GP which had proved successful for reducing GP workload as they saw 40 patients and produced 20 prescriptions per week. This would have otherwise been part of the GPs workload and GPs now report less pressurised surgeries. The mental health nurse consultant also had an important role in working closely with health visitors and GPs to help prevent families from reaching crisis point and needing intervention.
• The practice had been accredited with the Royal College of General Practitioners quality practice award in 2008 and was awaiting reaccreditation in January 2015. This was awarded in recognition of how they improved patient quality care and outcomes, and had demonstrated good practice and organisational and clinical excellence in their practice. Only three other practices in the Bristol and South Gloucestershire area have achieved the award.
• The practice is involved in a programme called ‘Productive General Practice’ supported by the NHS Improving Quality. The practice had been very involved with this scheme and had helped to develop a number of guides to support other practices involved within the scheme. One of the GPs had produced ‘shaping our future practice’ and a number of other staff within the practice helped develop ‘improving todays practice’. One of the GPs led on this and they told us the programme sought to provide better care through a structured whole practice approach. (Both modules are still available on the NHS Institute of Innovation and improvement website). So far the practice had achieved innovation and improvement by empowering members of the administration team in ways such as, dealing with safeguarding correspondence with the GP having the overall responsibility. They had also recruited a mental health nurse consultant following a review of their patient needs. The practice wanted to further develop this and they were planning on reviewing the patient pathway for musculoskeletal conditions and how they could improve a more effective patient focused service.
• Leaders motivated staff to succeed. There was a staff recognition award held twice a year for three staffing areas; nursing, administration and reception. The recognised member of staff would have their picture taken and was celebrated in the patient newsletters. This was one instance of many that contributed to an extremely cohesive and motivated team.
• The practice had recently developed a carers group in September 2014 working with the carers association to ensure patients received the most up to date support and guidance. The practice arranged with the carers association to see carers (may not necessarily be registered patients of the practice) once a week at the practice. The practice made the room freely available as they recognised the benefits of this contact to the carers of their patients. The carers association worked with the practice to deliver a carers awareness evening in September 2014 to provide additional support to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Concord Medical Centre is situated in Little Stoke, South Gloucestershire. The practice serves approximately 14,000 patients. The services provided include, child health care, ante and post natal care, immunisations, sexual health and contraception advice, management of long term conditions and smoking cessation clinics. Additional services included scanning for osteoporosis, ear nose and throat (ENT) procedures including mircosuction specifically for cleaning of the ears and a full time mental health nurse consultant.

During our inspection, we spoke with 12 patients. All of the patients spoken with on the day were very positive about the service provided with a collective view that patients were at the centre of the practices service delivery.

There were systems in place to ensure effective patient care and we heard about a high level of patient satisfaction with the care and treatment provided. Patients were treated with dignity and respect in a purpose built environment which was accessible and ensured their privacy. The appointment system enabled patients to be seen quickly and for the amount of time their needs required. The practice was responsive to the needs of the patient and continuously strived to improve the service it provided through active engagement with the patient group. The practice was well led by the practice manager and their partner GPs. They were supported by a practice nursing and staff team.

The practice must protect patients against the risks associated with the unsafe management of medicines, by making appropriate arrangements for the recording, safe keeping and disposal of medicines.

Patients over the age of 75 had been allocated a dedicated GP to oversee their individual care and treatment requirements delivered in the practice or in the patients own home.

Mothers, babies, children and young people had access to dedicated specialised staff as well as dedicated practice clinics, such as child immunisations.

The practice made provision for the working-age population and those recently retired with some additional early morning and evening appointments and alternate Saturday clinics as well as telephone consultations.

Patients in vulnerable circumstances who may have poor access to primary care were also provided with services by the practice.

Patients experiencing poor mental health had access to a practice mental health nurse consultant who provided additional therapies and support.

We reviewed the information available to us about Concord Medical Centre on 25 April 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.