Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 9 March 2015 and the report was published on 6 August 2015. During this inspection an overall rating of good was made, with the effective, caring and well-led areas all being rated as good. The responsive area was rated as outstanding. However, a breach of Regulation 19 Fit and proper persons employed of The Health and Social Care Act (Regulated Activities) Regulations 2014 was found. This related to the delivery of safe services and this area was rated as requires improvement.

The practice required improvement to protect people who used the services and others against risks associated with recruitment processes. The practice had to provide evidence they employed 'fit and proper' staff who were able to provide care and treatment appropriate to their role and to enable them to provide the regulated activities for which they are registered.

After the comprehensive inspection the practice sent us their action plan and recorded within this what they would do to meet the legal requirements in relation to the Regulation 19 breach.

We visited the practice and undertook a focused inspection on 4 August 2016 to check that the practice had followed their action plan and to confirm that they now met legal requirements.

We found that the practice was meeting the regulation that had previously been breached in relation to safe care and treatment. The practice provided evidence to us that records of identification checks and current DBS checks are included in staff records. The practice had in place a risk assessment to assess the need for criminal record checks for non-clinical staff.

We have amended the rating for this practice to reflect these changes. The practice is now rated as good for the provision of safe services. This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for University of Bristol Students' Health Service on our website at www.cqc.org.uk.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the University of Bristol Students' Health Service on 9th March 2015. Overall the practice is rated as one which provides a good service.

Specifically, we found the practice to require improvement for providing safe services. The practice was good for providing an effective, caring, and well led service and it was outstanding for providing a responsive service. It was good for providing services for four of the population groups. It was outstanding for the population group of people experiencing poor mental health. The older people population group is not applicable to this service.

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

• 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 had actively sought feedback from patients.
• The service had recognised the specialist population group of their patients (Students) and a lot of their information and activity was shared using social media as the preferred medium of communication for their patients. For example they have Facebook and Twitter accounts and produce a regular blog focussing on key aspects of health and wellbeing particularly pertinent to the student population and health issues.
• Patients with long term conditions had open access to their ‘i-cloud’ care plans for long term conditions. The practice held multidisciplinary team meetings to discuss the needs of complex patients, for example vulnerable people.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice introduced a new methotrexate medication monitoring system in 2014, which enabled 100% of patients to be up to date with blood monitoring (patient safety), and resulted in one GP securing a new EMISweb national code for ‘Patient held methotrexate record issued’ EMISNQPA385.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
• The premises and services had been adapted to meet the needs of patient with disabilities, such as providing a space at the end of the reception counter for disabled access.
• Urgent appointments were available on the day they were requested. However some patients said they sometimes found it difficult to make appointments
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Staff told us there was an open and honest culture within the practice and they had the opportunity to raise issues at team meetings.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks for staff.
• Training records for some members of staff were not up to date and no clear induction process for staff members was seen.

We saw five areas of outstanding practice:

• The practice initiated a vaccine programme for the Meningitis B vaccination of 4000 students (2 doses each) in October/November 2014, with a vaccine, which is not yet available through the NHS. The programme targeted the age group most at risk and requiring protection. This was the first place (and so far only) in the UK to provide this specific immunisation to large numbers of the population
• The practice carried out health promotion campaigns such as ‘Love Hurts’ (STI screening) for Valentine’s Day and smoking cessation support for ‘stop smoking day’. The clinicians visited all of the halls of residences at the beginning of the academic year in a road show to educate the new students about their health at university, the risks of meningitis and how to look out for each other.
• We saw the practice had a strong focus on the wellbeing of patients in their care. For example running “Wellbeing Awareness days” for senior medical students and working with STITCH in Bristol to reduce self-harm. The increased access to psychiatric appoints for students in term time.
• Mental health in house services set up as a bespoke service recognising the specialist needs of patient population at this service. It offers ‘in house’ weekly clinics by NHS psychiatrist, a CBT clinic weekly, mindfulness for medical students, self-hypnosis one off session for anxiety and Big White Wall providing 24/7 online support.

• The practice has developed the First Step Eating Disorder service which offers a single point of access where people with an eating disorder can obtain rapid access to assessment and treatment in a familiar environment. This group was offered further support in line with their needs. For example patients followed a pathway where they could see a therapist in the practice who had additional access to specialists without needing re-referral.

The areas where the provider must make improvements are:

• Ensure records of identification checks are included in staff personnel files and use current DBS checks. Ensure risk assessments are in place to assess the need for criminal record checks for non-clinical staff.

In addition the provider should:

• Improve record keeping processes to ensure information is not mislaid; and is recorded and stored appropriately
• Ensure all staff members attend Equality and Diversity training and Mental Capacity Act training.
• Ensure that where poor performance is identified appropriate action is taken and clear records are made and kept to evidence the action taken to address the issue. Ensure learning from complaints includes a record of patient outcomes.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice