Archived: The Medical Centre, Ridingleaze

Updated 25 June 2015

The Medical Centre in Ridingleaze at Lawrence Weston provides a service to over 6,500 patients and has been at its current site since the 1980’s. Lawrence Weston is a post-war housing estate with over half of its 2,700 dwellings owned either by Bristol City Council or other social landlords.

The area has significant levels of deprivation being ranked in the ten most deprived areas in the city because of its Health Deprivation and Disability score. Those who live in Lawrence Weston were almost twice as likely to be disability benefits claimants when compared to the city average.

The practice team is made up of four GP partners and two salaried GPs making a total of 3.85 full time equivalent GPs. Five of the GPs were female. There were four practice nurses along with a phlebotomist, reception and administrative staff.

The practice shares a practice manager with another practice in the area working approximately half time in each. We were told the practice was looking towards a future of greater interactive and collaborative working between the practices. The practice had appointed an operations manager who was to commence employment shortly.

The practice has opted out of providing out-of-hours services to its patients. This service contracts with Brisdoc to provide out of hours services and patients are advised to contact them through the NHS 111 service.

Updated 25 June 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Medical Centre, Ridingleaze on 9 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for older patients, those with long term conditions, people of working age, the recently retired and students. In addition it was good for

providing services for families children and young patients, patients whose circumstances make them vulnerable and patients with poor mental health including those with dementia.

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

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff were receiving training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice was well equipped to treat patients and meet their needs. It had identified that the premises were too small and had worked with other services and shared information with patients about plans to move to a more suitable building in the future.
• 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 practice manager had identified the need to motivate the patient participation group to be more active.

We saw an area of outstanding practice

• One of the GPs told us they carried out their own out of hours visits for patients receiving palliative care. They gave the patient or their carer their personal telephone number so they could contact the GP directly for support.

However, the practice should:

• Maintain a record of refrigerator temperatures to evidence that medicines were stored safely.
• Update the health and safety policy and keep it under review.
• Consider and disseminate relevant health and care guidance.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 25 June 2015

The practice is rated as good for the care of people with long-term conditions. GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medication needs were being met.

There was close working with the practice pharmacist to ensure audit and implementation of up to date prescribing guidance was carried out. Similarly there was close working with the community matron and district nurses for patients who were housebound.

Updated 25 June 2015

The practice is rated as good for the care of families, children and young patients. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice had a policy for ensuring all patients under the age of five years were seen on the same day at the request of their parent.

There was joint working with midwives, health visitors and school nurses. The practice was a 4YP practice (Wherever the 4YP logo is displayed patients can be sure that the services on offer are young people friendly) and had achieved standards to ensure it met the needs of young patients.

Updated 25 June 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

There were weekly multi-disciplinary team meetings to discuss the most vulnerable patient and those with complex health needs. In addition there were monthly meetings to discuss those with palliative care needs. All patients over the age of 75 years had a named GP.

Updated 25 June 2015

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 reflected the needs for this age group.

The practice offered appointments before and after normal surgery hours for these patients and telephone consultations for those who did not require a face to face consultation.

Updated 25 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). People experiencing poor mental health had regular and opportunistic reviews and the mental health team saw patients in the practice. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. Staff had received training on how to care for people with dementia.

Updated 25 June 2015

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 and those with a learning disability. It carried out annual health checks for people with a learning disability and offered longer appointments for these patients.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. 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.

The practice recognised the difficulties some patients had making appointments and offered same day access. There were identified lead GPs for domestic violence, safeguarding vulnerable adults and substance misuse.