Hartwood Healthcare

Updated 10 January 2017

Hartwood Healthcare, Hartcliffe Health Centre, Bristol, BS13 0JP provides support for approximately 7670 patients in the Hartcliffe area in South Bristol and in the neighbouring communities of Highridge and Withywood, where there are higher than average levels of deprivation.

Hartwood Healthcare is sited in a Healthcare Centre in a central position in the community of Hartcliffe. The practice shares facilities with another GP service, Hillview, and other local services provided by Bristol Community Health, such as podiatry, physiotherapy and midwifery services.

The building is accessible to patients with restricted mobility, wheelchair users and children’s pushchairs. There is a pharmacy on site. There are nine consulting rooms and a shared treatment. The waiting room and reception area is divided into distinctive separate areas including a reception point for visitors using the services hosted or provided by Bristol Community Health. There are administrative offices, staff toilets, and shared staff rooms. There are parking spaces for staff and a small number accessible parking bays for patients.

There are five partners and four salaried GPs, six male and three female who provide 50 sessions per week. There are two practice nurses. The practice provides the four nursing staff including two health care assistants, a phlebotomist (blood testing) for the treatment suite service that is shared with Hillview Surgery. The practice employs a pharmacist to attend the practice for 22 hours per week and has engaged a Patient Champion who works across three other practices in the local area. The clinical staff are supported by a practice manager and an administration team. The practice is a training practice for medical students and is also involved in clinical research.

The practice is open from 8:30am until 12:30pm and then 1.30pm until 6:30pm Monday to Friday. Later appointments are available up to 7:30pm on Mondays and Tuesdays for those patients who are unable to attend at other times.

The practice has a Personal Medical Services contract with NHS England (a locally agreed contract negotiated between NHS England and the practice). The practice is contracted for a number of enhanced services including extended hours access, facilitating timely diagnosis and support for patients with dementia, patient participation, remote care monitoring and childhood vaccination and immunisation scheme. One GP is a GP with Special Interests (GPwSI) in family planning.

The practice does not provide Out Of Hour’s services to its patients, this is provided by BrisDoc. Contact information for this service is available in the practice and on the website. Patients are directed to the 111 service during lunchtimes when the practice is closed.

Patient Age Distribution

0-4 years old: 8.7% (higher than the national average)

5-14 years old: 14.3% (higher than the national average)

The practice told us they had 517 (7% of the practice population) aged 75 years and above.

Population Demographics

% of Patients in a Residential Home: 0.4 %

Disability Allowance Claimants (per 1000) 93.4 (higher than the national average of 50.3)

% of Patients in paid work or full time education: 48.4 % ( lower than the national average of 60.2%

Practice List Demographics / Deprivation Index of Multiple Deprivation 2010 (IMD): 49.9 (National

average 23.6)

Income Deprivation Affecting Children (IDACI): 50 (National average 22.5)

Income Deprivation Affecting Older People (IDAOPI): 32 (National average 22.5)

Hartwood Healthcare delivers on average 1,200 appointments each week. There is a high home visiting rate with 79 patients housebound and 517 over the age of 75 years. The practice along with two others that provide a service the population in this area have a high level of patients with long term respiratory problems.

Updated 10 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hartwood Healthcare on 3 December 2015. Following our comprehensive inspection overall the practice was rated as good with requires improvement for the safe domain. Following the inspection we issued requirement notices. The notices were issued due to a breach of Regulation 12 of The Health and Social Care Act (Regulated Activity) Regulations 2014, Safe care and treatment and for a breach of Regulation 19 of The Health and Social Care Act (Regulated Activity) Regulations 2014, Fit and Proper persons employed.

The issues were:

• Regulation 12: The provider must ensure the Patient Group Directions adopted by the practice to allow nurses to administer medicines in line with legislation are signed by the clinical governance lead for the nursing staff.

• Regulation 19: The provider must ensure that personnel employed to carry on the regulated activity did not have the appropriate checks through the Disclosure and Barring Service and the practice did not hold the required specified information in respect of persons employed by the practice as listed in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A copy of the report detailing our findings can be found at www.cqc.org.uk.

We carried out an announced focused inspection at Hartwood Healthcare on 4 October 2016 to follow up the requirement notices which were issued on 3 December 2015 and to assess if the practice had implemented the changes needed to ensure patients who used the service were safe.

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

• We saw evidence that the provider had ensured there were safe systems in place for Patient Group Directions. These were adopted by the practice to allow nurses to administer medicines in line with legislation had been signed by the clinical governance lead for the nursing staff.

• We saw evidence that the provider had ensured that an appropriate system was in place for personnel employed to carry on the regulated activity. Staff now had the appropriate checks through the Disclosure and Barring Service and the practice now held the required specified information in respect of persons employed by the practice as listed in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following this inspection the practice was rated overall as good and good across all domains.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 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 was similar to the Clinical Commission Group (CCG) and national average. For example, the percentage of patients with a diagnosis of diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2013 to 31/03/2014) was 66.58%.

• Longer appointments and home visits were available when needed. There were some particular areas that were outstanding in this area in regard to the provision of insulin conversion at the practice and the home visits carried out by the practice nurses for the on- going monitoring of patients with long term conditions.

• 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.

Updated 18 February 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.

• Childhood immunisation rates for the vaccinations given were comparable to the Clinical Commissioning Group (CCG)/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 87.3% to 98.6% and five year olds from 90.1% to 97.9%.

• 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’s uptake for the cervical screening programme was 79.9%, which was comparable to the CCG average of 81.8% and the national average of 81.1%.

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

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 18 February 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.

Updated 18 February 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.

Updated 18 February 2016

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

• Performance for mental health related indicators was similar to the Clinical Commissioning Group (CCG) and national average. For example, the percentage of patients diagnosed with dementia whose care has been reviewed in a face to face review in the preceding 12 months (01/04/2013 to 31/03/2014) was 86%.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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.

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

Updated 18 February 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 difficulties

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.

• The practice demonstrated how they encouraged uptake of the cervical screening programme by supporting patients who found it difficult to participate undertaking the test. Nursing staff did this by assessing and routinely offering sexual health advice to all patients including those with a learning disability and undertook cervical tests where appropriate. The practice told us they had a 66% take up of those eligible for cervical testing in this population group.