Background to this inspection
Updated
8 April 2020
The Cedars Surgery, 87 New Bristol Road, Worle, Weston Super Mare, Avon, BS22 6AJ is located within the North Somerset local authority and is one of 81 practices serving the NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (CCG) area.
The Cedars Surgery took over the running of Worle Medical Practice, which is now a branch surgery, in April 2016. The Cedars Surgery is in a converted domestic dwelling and Worle Medical Practice (which we did not visit as part of this inspection) operates from a purpose-built facility.
During this inspection, we visited the Cedars Surgery where there are 6 consulting rooms, 4 treatment rooms, one administrative room, a reception and waiting area on the ground floor. There is also a further administrative room on the first floor. We did not visit the branch surgery as part of this inspection.
The Cedars Surgery is part of a Primary Care Network (PCN) called Weston, Worle and Villages Hub.
The Cedars Surgery provides general medical services to approximately 15,400 patients and has a lower proportion of registered patients (56.5%) who are of working age when compared to the CCG average of 63.2% and the national average of 62%. It has a higher percentage (23.9%) of elderly patients over 65 years of age when compared to the local average of 16.5% and national average of 17.4%.
Information published by Public Health England rates the level of deprivation within the practice population group as seventh on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.
The practice is led by two male GP partners who are contracted to provide general medical services under a personal medical services (PMS) contract. PMS contracts offer local flexibility compared to the nationally negotiated general medical services (GMS) contracts by offering variation in the range of services which may be provided by the practice, the financial arrangements for those services and the provider structure. They are also registered with the CQC for the following regulated activities: diagnostic and screening procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury. The practice did not perform minor surgery.
The partners are supported by three salaried GPs, three advanced nurse practitioners, one paramedic practitioner, five practice nurses and four healthcare assistants (HCAs). The practice patients also benefited from the work provided by a clinical pharmacist and a social prescriber.
For non-clinical activities, the partners are supported by a Managing Partner, a Practice Manager, Two team leaders, and twenty-five additional administrative, secretarial and reception staff.
The practice has opted out of providing out-of-hours services to their own patients and this is provided by BrisDoc. Patients are directed to this service outside of normal practice hours, via the telephone system, and by information provided on the practice website. They can also access it via NHS 111 whose contact details are available in the practice and on the website.
Updated
8 April 2020
We carried out an announced comprehensive inspection at The Cedars Surgery on 20 February 2020 as part of our inspection programme.
We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change (either deterioration or improvement) to the quality of care provided since the last inspection in July 2017.
This inspection focused on the following key questions:
- Are services effective?
- Are services responsive?
- Are services well led?
Because of the assurance received from our review of information, we carried forward the ratings for the following key questions:
- Are services safe? (Good)
- Are services caring? (Good)
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We provided the practice with Care Quality Commission feedback cards prior to the inspection and we received 19 completed cards. Patients were generally positive about the practice staff, their experiences, and the care and treatment they received.
We have rated this practice as good overall; good for providing effective, responsive and well led services; Requires Improvement for the population group which includes working age people (including those recently retired and students) and good for the remaining population groups because:
- Patients’ needs were assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools.
- The practice had a comprehensive programme of quality improvement activity and routinely reviewed the effectiveness and appropriateness of the care provided.
- Staff had the skills, knowledge and experience to deliver effective care, support and treatment.
- Staff worked together and with other organisations to deliver effective care and treatment.
- There was compassionate, inclusive and effective leadership at all levels. This included working with and supporting the practice Patient Participation group (PPG).
- The practice had a clear vision and set of values that prioritised quality and sustainability.
- The practice had a culture that drove high quality sustainable care.
- There were clear responsibilities, roles and systems of accountability to support good governance and management.
- There were clear and effective processes for managing risks, issues and performance.
Although we did not find any beaches of regulation on this inspection, we did see one area where the provider should make improvements. This was to:
- Monitor arrangements for recording consent to include the administration of joint injections.
- Continue monitoring the uptake of cervical screening in line with national guidance.
- Continue monitoring the effectiveness and need for two week wait referrals.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care