Archived: Hope House Surgery

Updated 1 December 2016

Hope House Surgery is situated in the town of Radstock in Bath and North East Somerset. The practice serves a population of approximately 6,400 patients, covering a semi-rural ex mining area.

Although the population has relatively low areas of social deprivation the practice population does cover areas of deprivation and in the Bath and North East Somerset area the practice has the third highest areas of deprivation. People living in more deprived areas tend to have greater need for health services. The practice population mix is similar to the national average, except for lower than average numbers of females between the ages of 20 to 40, and males between the ages of 30 to 40.

The practice has four GP partners (two male and two female) and one nurse practitioner partner. There are three practice nurses, one health care assistant and the clinical team are supported by a practice manager, a deputy practice manager and a team of administration and reception staff.

The practice is a teaching and training practice and is currently supporting one GP Registrar (Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine) and one student nurse.

The practice is open between 8am and 6pm Monday to Friday. Appointments are available from 8:30am to 11:40am every morning and 2:50pm to 5:40pm every afternoon although these are variable. Extended hours appointments were available from 7:30am to 8am on Wednesday and Friday mornings. Between 6pm and 6:30 pm the Bath and North East Somerset area has a local agreement for the Out of Ours cover to commence at 6pm.

When the practice is closed overnight and at weekends the Out of Ours care is provided by Bath Doctors Urgent Care accessed via NHS 111.

The practice has a Personal Medical Services contract to provide NHS services for the population.

The practice’s regulated activities are accessible from:

Hope House Surgery,

The Street,

Radstock,

Bath,

BA3 3PL.

This was our first inspection of Hope House Surgery.

Updated 1 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hope House Surgery on 5 October 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Significant events were reviewed every quarter to identify any themes or areas for learning. Any lessons learnt were shared effectively across all the staff teams.
• Risks to patients were assessed and well managed.
• 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.
• The practice had introduced a wide range of recall checks into their clinical system to ensure that patients with any long term conditions or at risk of developing a long term conditions had regular care reviews.
• 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 a triage system to manage the demand on appointments, all patients had a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had a local agreement with a neighbouring practice to support each other in any times of staff shortage. We saw examples of GPs, nurses and administration and reception staff supporting each other in times of unexpected absences.

• The practice had a clear vision to deliver high quality care and facilitate improvement in the health of their patients by providing easily accessible high quality care and health education. The practice valued the whole team input and had a supportive ethos towards the whole team.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 December 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.

• Performance for diabetes related indicators were higher than the local and national averages:

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months)was in the target range was 86% which was higher than the clinical commissioning group (CCG) average of 81% and the national average of 78%.

• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (2014/15) was 95% which was higher than the CCG average of 92% and the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had introduced a wide range of recall checks into their clinical system to ensure that patients with any long term conditions or at risk of developing a long term conditions had regular care reviews. Examples seen included:patient with arthritis, coil checks, pre diabetes, patients needing home visits for long term conditions reviews and kidney disease monitoring.

• The practice held regular clinics with input from a consultant for those with diabetes, including educational sessions. The practice also offered phone access to the nursing team for support and had set up regular virtual multidisciplinary clinics. Data from 2015 demonstrated that 91% of diabetic patients had received all eight care processes, which was the highest in the local area.

Updated 1 December 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 practice offered easy access for sexual health advice and support for young patients whether they were registered at the practice or not.

• The practice referred all young pregnant women under the age of 20 to a local family nurse support service.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The GPs had introduced a system to follow up all children under 12 who had any involvement with the health services out of hours to ensure they had the correct follow up care or review in place.

• We saw positive examples of joint working with midwives and health visitors

Updated 1 December 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.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice nurses or GPs undertook health reviews for housebound patients with complex conditions every six to 12 months where appropriate, to ensure their care plans were updated and care needs reviewed.

• The practice follows up all those on a care plan after any hospital admission within 48 hours to ensure they have the correct care in place.

Updated 1 December 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice offered prebookable telephone consultations, morning and afternoon triage and early morning access two mornings a week.

Updated 1 December 2016

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (2014/15) was 93% which was higher than the clinical commissioning group (CCG) average of 86% and the national average of 84%.

• Performance for mental health related indicators were higher than the local and national averages, for example:

• The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (2014/15) was 100% which was higher than the CCG average of 92% and the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice 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.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Any patients with mental health needs who became pregnant were reviewed to ensure a patient specific care plan was in place.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 1 December 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 and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. The practice delivered an annual review for patients with a nurse appointment followed by a GP review. In 2015/16 28 out of 29 patients on the learning disability register had had their annual health care review. The practice offered tailored literature and/or picture materials to aid communication and understanding if required.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice offered drug and alcohol support with the GPs and support services jointly at the practice and also offered two weekly reviews.

• 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.