The Care Quality Commission
  • Doctor
  • GP practice

Lawrence Hill Health Centre

Overall: Requires improvement read more about inspection ratings

Hassell Drive, Easton, Bristol, BS2 0AN (0117) 954 3060

Provided and run by:
Lawrence Hill Health Centre

All Inspections

3 August 2022

During an inspection looking at part of the service

We carried out an announced inspection at Lawrence Hill Health Centre on 3 August 2022. Overall, the practice is rated as Requires improvement.

Set out the ratings for each key question

Safe - Requires improvement.

Effective – Requires improvement.

Responsive – Good.

Well-led – Requires improvement.

Following our previous inspection on 4 July 2019 the practice was rated Requires Improvement overall and for the key questions Effective and Well Led. The key questions Caring and Reponsive continue to be rated as Good. We found breaches to Regulation 17 and 19 of the Health and Social Care Act Regulations 2014.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Lawrence Hill Health Centre on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on a previous rating of Requires Improvement with identified areas of improvement from July 2019. There were no breaches of Regulation found at the last inspection. The inspection looked at four of the key areas Safe, Effective, Responsive and Well Led. A previous rating of Good for provision of Caring services was carried forward.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit

Our findings

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 have rated this practice as Requires Improvement overall

We found that:

  • The provider had made some improvements towards the areas identified at the previous inspection. However, further improvements were required and new areas identified.
  • There was no oversight of staff recruitment files including Disclose and Barring Service (DBS) checks and vaccinations records.
  • Senior leaders could not clearly demonstrate competency of their staff including mandatory training.
  • Clinical staff were not always able to access Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) decisions in line with guidance.
  • There was no monitoring of controlled drug prescribing.
  • Adaptions to care provisions were provided in line with the diverse patient population including having clinic sessions for screening be converted to education sessions to promote uptake of screening in the Somali patient population.
  • Senior leaders were not measuring any improvement in line with the Vision, values and strategy.
  • An open culture was reported by staff.

We found two breaches of regulations. The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed and that specified information is available regarding each person employed.

The provider should:

  • Continue to improve patient uptake of cervical screening and childhood immunisations.
  • Consider improving oversight of patient referrals to ensure safe transition of care.
  • Complete patient surveys to guide improvement.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

4 July 2019

During an inspection looking at part of the service

We carried out an announced new style focused inspection at Lawrence Hill Health Centre on 4 July 2019 as part of our inspection programme.


The inspection of this service followed 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.
This inspection focused on the following key questions:

  • Effective
  • Responsive
  • Well-Led


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 have rated this practice as requires improvement overall. We have rated the population groups older people; people with long-term conditions; and people whose circumstances may make them vulnerable as good. However, we have rated the population groups families, children and young people; working age people (including those recently retired and students); and people experiencing poor mental health (including people with dementia) as requires improvement.


We found that:

  • Patients received effective care and treatment that met their needs.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.


Whilst we found no breaches of regulations, the provider should:

  • Complete CQC registration process for the current GP partnership and the registered manager for three regulated activities.
  • Document the practice vision, values and business strategy and ensure this is understood by staff and progress is monitored.
  • Review arrangements to monitor and improve rates of average daily prescribing of hypnotic medicines; and exception reporting for patients with COPD and mental health conditions.
  • Review arrangements for and improve uptake of childhood immunisations.
  • Review and improve cancer screening performance in all cancer indicators, including bowel, breast and cervical screening.
  • Review arrangements for storage of paper patient records to prevent access by unauthorised people.
  • Continue efforts to establish a patient participation group (PPG).


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

8 September 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We undertook a comprehensive announced inspection on 2 December 2014. Overall the practice is rated as good for providing an effective, caring, responsive and well led service; however, at the December inspection the practice was rated as requiring improvement for the safe domain. This was because the arrangements for the recording and monitoring of medicines used for the purpose of the regulated activity were ineffective to ensure patient safety. We carried out a focused inspection on 8 September 2015 to review the action the provider had taken to address these issues.

Our key findings were as follows:

  • The provider had reviewed and improved the arrangements for the recording and monitoring of medicines.
  • The provider had ensured that staff understood and implemented the practice’s agreed protocols and procedures for dealing with incidents and emergencies and accessed additional training resources to support staff learning.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

 

2 December 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Dr DS Walsh and Partners is situated in the inner city area of Bristol with approximately 9797 registered patients. We undertook a comprehensive announced inspection on 2 December 2014. Our inspection team was led by a Care Quality Commission (CQC) Lead Inspector, a practice nurse specialist advisor and GP specialist advisor.

Before visiting, we reviewed a range of information we held about the practice and asked other organisations to share what they knew. This included the Bristol Clinical Commissioning Group (CCG), NHS England and Healthwatch.

Our key findings were as follows:

  • Patients were able to get an appointment when they needed it.
  • Staff were caring and treated patients with kindness and respect.
  • Staff explained and involved patients in treatment decisions
  • Patients were cared for in an environment which was clean and reflected good infection control practices.
  • The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
  • The practice met nationally recognised quality standards for improving patient care and maintaining quality.
  • The practice had systems to identify, monitor and evaluate risks to patients.
  • Patients were treated by suitably qualified staff.
  • GPs and nursing staff followed national guidance in the care and treatment they provided.

We saw an area of outstanding practice:

  • The practice worked in partnership with a substance misuse and alcohol rehabilitation project to offer a shared care treatment service to a considerable number of patients. This joint working led to other treatment being made accessible, for example, a nurse led drop in clinics enabled patients who were intravenous drug users to access treatment for wounds.

However, there were also two areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure there are systematic processes in place for the safe management of medicines

In addition the provider should:

  • Ensure that staff understand and implement the practice’s agreed protocols and procedures for dealing with incidents and emergencies
  • The practice should have a patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP

12 November 2013

During a routine inspection

We inspected Dr Walsh and partners on 12 November 2013. We spent the day at the surgery looking at records and speaking with people. We spoke with six patients, three practice nurses, a health care assistant, practice manager and a GP who was also a partner.

We spoke with patients who were visiting the surgery. Patients told us they were happy with the service they received. Patient comments included; 'I usually see the treatment room staff, they are alright and I can usually get an appointment'. 'They are very busy but they are doctors'. 'Sometimes they can be late but they often tell us. It can't be helped sometimes'. All the patients we spoke with told us the doctors understood their needs.

The provider had systems in place for monitoring the quality of the service provision. There was an established system for regularly obtaining opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.

The practice offered a culturally aware service to a diverse population. Staff who worked at the practice were knowledgeable about the cultural needs of their patients, both from a medical and sociological perspective.