The Orchard Medical Centre

Updated 27 February 2017

The Orchard Medical Centre is an urban practice providing primary care services to patients who reside in the Kingswood area. The practice has areas of high deprivation and a high level of patients with long term conditions.

The practice operates from one location:

MacDonald Walk,

Kingswood,

South Gloucestershire

BS15 8NJ

The practice owned the purpose built building which has other healthcare practitioners co-located there. Patient services are located on the ground floor and first floor of the building which is accessible using a lift. There were 26 consulting rooms including seven treatment rooms. The practice has a patient population of approximately 12,900.

The practice has a six GP partnership registered with the CQC (3 male and 3 female), four associate GPs, a full-time pharmacist, a practice manager, four practice nurses including a nurse prescriber, three treatment room nurses, one health care assistant and a health care practitioner. The clinical staff provided 52 sessions each week. Each GP has a lead role for the practice and the nursing staff have an area of expertise, such as diabetes or infection control.

The practice is open Monday to Friday 8am – 6:30pm and Saturdays from 8am – 1pm.

The practice had a Personal Medical Services contract (PMS) with NHS England to deliver general medical services. The practice provided enhanced services which included facilitating timely diagnosis for patients with dementia and childhood immunisations. The practice is a teaching practice with two GP trainers and takes medical students from the Severn deanery.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access out of hours service via the NHS 111 who work with BrisDoc to provide the out of hours GP service for the area.

Updated 27 February 2017

Letter from the Chief Inspector of General Practice

We had previously inspected this GP practice in August 2014 as part of our new inspection programme pilot to test our approach going forward.

The outcome from inspection Aug 2014 was that the provider should:

• Identify a lead for infection prevention and control.

• Review their appointment process to improve patient’s access to appointments with GPs.

• Review their systems to ensure timely referral to other services.

• Introduce a patient participation group (PPG) to seek feedback from patients about the way the practice runs.

We carried out an announced comprehensive inspection at The Orchard Medical Centre 10 May 2016. Overall the practice is rated as good, however, we found some areas of concern within the safe domain which is rated as requires improvement.

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

• Risks to patients were assessed and well managed.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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.
• 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 was proactive in assessing patient access to the service and sourcing innovative solutions such as the employment of a practice pharmacist.
• Some patients said they were able to make an appointment with a named GP; there were urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure with robust underpinning systems which supported the day to day activity of the practice.
• Staff felt supported by management and there was a positive learning culture for staff development.
• The practice proactively sought feedback from staff and patients through the patient participation group and patient surveys, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• The practice must ensure procedures are fully embedded bychecking their implementation, specifically in relation to the system for ensuring the safe storage of medicines which required refrigeration, prescription management,the process of audit of infection control measures and emergency equipment checking records.

The areas where the provider should make improvement are:

• All practice staff should follow best practice guidance for updating training for the insertion of intrauterine devices.

• The practice should ensure that clinical results are reviewed in a timely way following receipt by the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 July 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.

• 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.

• Longer appointments and home visits were available when needed.

• The practice undertook the Admissions Avoidance Enhanced service which identified those patients most at risk and ensured they had a care plan in place to support them to remain out of hospital.

• The practice had appointed a pharmacist to undertake long term condition medicines reviews and to follow up patients’ post-hospital discharge.

Updated 5 July 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.

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

• We saw joint working with midwives, health visitors who were co-located at the practice.

• The practice provided sexual health support and advice under the ‘No Worries’ scheme.

Updated 5 July 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 undertook the Care Home Enhanced Service and made weekly visits to three care homes by a designated GP.

• The practice undertook the Admissions Avoidance Enhanced service which identified those patients most at risk and ensured they had a care plan in place to support them to remain out of hospital.

Updated 5 July 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.

• Same day appointments were available and the practice opened on Saturday morning for routine appointments.

• The practice had specialist nurses trained in minor illness management.

• The practice provided a minor injury service.

Updated 5 July 2016

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

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

• The practice were part of a joint working dementia care project with other practice and healthcare providers.

• 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.

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

Updated 5 July 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 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.

• 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.