Nightingale Valley Practice

Updated 29 March 2017

Nightingale Valley Practice is located in the Brislington area of Bristol. They have approximately 15750 patients registered. The practice operates from two locations:

Brooklea Health Centre

Wick Road

Brislington

Bristol

BS4 4HU

And

Riverside Surgery

Wyatts View

St Anne’s Park

Bristol

BS4 4WW

Nightingale Valley Practice is sited in a leased purpose built health centre which is shared with other healthcare providers. The consulting, treatment rooms and administration area for the practice are situated on one level. There are treatment rooms (for use by nurses, health care assistants and phlebotomists); reception and administration and records room; and a waiting room area. There is patient parking immediately outside the practice with spaces reserved for those with disabilities. Riverside Surgery is also a purpose built leased surgery which has two consulting rooms and one treatment room, a large waiting area. The surgery premises are sited in a local shopping precinct and with plenty of parking and accessibility to a local pharmacy.

The practice is made up of six GP partners, five salaried GPs and the practice manager. The practice is a teaching practice with three GPs as trainers and they had three GP registrars at the time of this inspection. They have an advanced nurse practitioner, senior nurse and two practice nurses and two healthcare assistants. The practice is supported by an administrative team consisting of medical secretaries, receptionists and administrators. The Nightingale Valley practice is open from 8.00am until 6.30pm Monday, Thursday and Friday. On Tuesday the practice opens from 7.00am and closes at 7.30pm. On Wednesday the practice opens 8.00am and closes later at 7.30pm. The Riverside Surgery is open between the hours 8.00am to 12.30pm, Monday and Thursday, 7.00am Wednesday and Friday. There is no morning surgery on Tuesdays. The practice opens for afternoon surgeries from 2.00pm to 6.00pm Monday to Thursday and is closed on Friday afternoons.

The practice has a Personal Medical Services contract with NHS England (a nationally agreed contract negotiated between NHS England and the practice). The practice is contracted for a number of enhanced services including extended hours access, immunisations and unplanned admission avoidance.

The practice is a training practice and also offers placements to medical students and trainee GPs.

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 practice website.

Patient Age Distribution

0-4 years old: 7.67% (higher than the national average)

5-14 years old: 10.29% (higher than the national average)

15-44 years old: 45.28%

45-64 years old: 23.43%

65-74 years old: 7.53%

75-84 years old: 4.19%

85+ years old: 1.6%

Patient Gender Distribution

Male patients: 50.31 %

Female patients: 49.69 %

Other Population Demographics

% of Patients in a Residential Home: 0.12 %

% of Patients on Disability Living Allowance: 4.3 % (higher

than the national average)

% of Patients from BME populations: 1.22 %

Practice List Demographics / Deprivation

Index of Multiple Deprivation 2010 (IMD): 19.26

Income Deprivation Affecting Children (IDACI): 0.2 –

Income Deprivation Affecting Older People (IDAOPI): 0.18

Updated 29 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Nightingale Valley Practice on 26 November 2015. Overall the practice was rated as good but the safe domain was rated as requires improvement. This was because of areas of risk were identified at its branch site (Riverside Surgery. Wyatts View, St Anne’s Park, Bristol BS4 4WW). Following the inspection we issued a requirement notice. The notice was issued due to a breach of Regulation 12 of The Health and Social Care Act (Regulated Activity) Regulations 2014, relating to safe care and treatment.

Areas of risk identified at the Riverside branch site were:

• The provider must ensure improvements in respect of the management of infection control.
• The provider must ensure that Control of Substances Hazardous to Health (COSHH) items are stored safely and in accordance with guidance.
• The provider must ensure that there is a method of assuring that a trained first aider is present at all times when the practice is open, or that the practice has carried out a proper risk assessment to evidence that a first aider is not required.

The full comprehensive report on the 26 November 2015 inspection can be found by selecting the ‘all reports’ link for The Nightingale Valley Practice on our website at www.cqc.org.uk.

This inspection was a focused desk top inspection carried out on 10 February 2017 to confirm that the practice had carried out their action plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 26 November 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is now rated as good.

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

• We saw documentary evidence that the practice completed an audit for the management of infection control and produced an action plan. Some of the actions on the plan were due to be completed by the time of this follow-up inspection, and we saw documentary evidence that this had happened.
• We saw documentary evidence that the practice had taken steps to ensure that substances hazardous to health were stored safely and in accordance with guidance.
• We saw documentary evidence that the practice had addressed the issue of a trained first aider being present at all times when the practice was open.

Following this inspection the practice was rated overall as 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. Nurse lead roles included palliative care, care planning, diabetes, asthma and chronic obstructive pulmonary disease (COPD) and prescribing.

• Longer appointments and home visits were available when needed.

• Patients with long term conditions had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people 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. 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 percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding year, based on data from the practice, was 80.74% which was comparable to other practices.

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

• We saw good examples of joint working with midwives, health visitors and school nurses. All vulnerable families had a named GP which provided continuity of care to the whole family.

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.

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

• The practice could access a community based nurse specifically overseeing the care of older people.

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. .

• The practice hosted counsellors for substance misuse three days a week which included appointments later in the day for patients who worked.

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 those with a learning disability.

• It offered longer appointments for people with a learning disability.

• 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.

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 those with a learning disability.

• It offered longer appointments for people with a learning disability.

• 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.