Tyntesfield Medical Group

Updated 7 March 2017

Nailsea Family Practice is located close to the centre of Nailsea, North Somerset. The practice has recently changed its name to Tyntesfield Medical Group (TMG) and serves a local and rural population of approximately 31,600 patients from the towns of Nailsea, Backwell and Long Ashton, and the surrounding areas. Nailsea Family Practice served 11,200 patients and merged, in October 2016, to form TMG, with Long Ashton Surgery (6850 patients) and Backwell and Nailsea Medical Group (13,550 patients). The latter operated from two sites, both of which were inspected by CQC in 2015 and which are now branch surgeries. This report relates to Regulated Activities carried out at the main site and includes some details of the Long Ashton branch which we also visited as part of the inspection.

The name and address of the main location is:

Nailsea Family Practice

Towerhouse Medical Centre

Stockway South

Nailsea

BS48 2XX

The branch surgery we visited shares common systems and processes with the main location and the address is:

Long Ashton Surgery

55 Rayens Cross Road

Long Ashton

BS4 1DY

The other branch sites also share common systems and processes and the addresses are:

Brockway Medical Centre

8 Brockway

Nailsea

BS48 1BZ

Backwell Medical Centre

15 West Town Road

Backwell

BS48 1BZ

Nailsea Family Practice has several GP consulting rooms along with rooms for nurse treatment, phlebotomy and minor operations. There are also rooms for health visitors, district nurses and psychological counsellors. A general office is situated away from the front reception desk. The first floor can be accessed by stairs or a lift, and the premises are fully accessible for disabled users.

Nailsea Family Practice is one of 21 GP practices in the NHS North Somerset Clinical Commissioning Group (CCG) area and most registered patients live within a three mile radius of the practice. The practice patient populations do not align with the England average for some age groups, thus giving an indication of the area’s demography, and explaining why there may be increased or reduced demand for certain services. These deviations are most noticeable for the 65 to 69 age group, which is well above the England average; and the 20 to 24 age group, which is well below the England average.

96% of the practice population describes itself as white British, and around 2% as having a Black, Asian and Minority Ethnic background. A measure of deprivation in the local area recorded a score of 10, on a scale of 1-10. A higher score indicates a less deprived area. (Note: an area itself is not deprived, it is the circumstances and lifestyles of the people living there that affect its deprivation score. Not everyone living in a deprived area is deprived and not all deprived people live in deprived areas).

The practice team at Nailsea Family Practice consists of seven GP partners (two male, five female) and five salaried GPs (three female, two male). The nursing team consists of eight nurses and three health care assistants (HCAs). The clinicians are supported by a practice management team of five, along with teams of administrators and receptionists.

The practice team at Long Ashton Surgery consists of an individual provider GP (female) and five salaried GPs (two male, three female). The nursing team consists of two nurses, a phlebotomist and two health care assistants (HCAs). The clinicians are supported by a practice manager, along with teams of administrators, receptionists and a prescribing clerk.

Tyntesfield Medical Group has a Personal Medical Services (PMS) contract to deliver health care services; the contract includes enhanced services such as childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for patients with dementia and minor surgery services. An influenza and pneumococcal immunisations enhanced service is also provided. These contracts act as the basis for arrangements between the NHS Commissioning Board and providers of general medical services in England.

Nailsea Family Practice is open between 8am and 6.30pm Monday to Friday. Appointments are available from 8:30am and telephone access is available from 8am. Appointment sessions are typically from 8.30am until 11.30am and from 3pm until 6pm. Extended hours appointments with a GP and nurse are available from 7.30am to 8am on Monday and Friday; and from 6.30pm to 7pm on Wednesday and Thursday. Appointments are also offered on one Saturday each month from 9am to 12pm. The practice operates a mixed appointments system with some GP appointments available to pre-book and others available to book on the day, or up to six weeks in advance.

Long Ashton Surgery is open between 7.30am and 6.30pm Monday to Friday. Appointments are available from 8am and telephone access is available from 8am. Appointment sessions are typically from 8am until 11.20am and from 2.30pm until 6pm. Extended hours appointments with a GP are available from 7.30am to 8am, Monday to Friday, and once a week on alternate Wednesdays and Thursdays, from 6.30pm to 7.30pm. The practice operates a mixed appointments system with some GP appointments available to pre-book and others available to book on the day, or up to four weeks in advance.

Tyntesfield Medical Group has opted out of providing Out Of Hours services to its own patients. Outside of normal practice hours, patients can access NHS 111, and an Out Of Hours GP service is available. Information about the Out Of Hours service was available on the practice website, on the front doors of the main and third branch sites, in the patient registration packs, and as an answerphone message.

Nailsea Family Practice acts as a teaching and training practice for junior doctors and currently has one registrar in their final year of a postgraduate medical training programme.

Updated 7 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nailsea Family Practice on 6 December 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence-based guidance. Staff had 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 91% of patients said they could get through easily to the practice by phone (compared with the national average 73%).
• The practice worked closely with patient volunteers to improve care. For example, a voluntary service worked with the practice in order to identify patients in need and otherwise unable to attend, and arranged transport to the practice and the local hospital.
• The practice hosted a range of talking therapy services for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The services were funded by the local clinical commissioning group (CCG) and were available on referral. For example, the practice worked closely with organisations such as Positive Steps, Addaction and Wellspring.
• The practice participated in a social prescribing scheme to support patients who attend their GP surgery but did not necessarily require medical care. Social prescribing supported patients with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs.
• Staff had lead roles that improved outcomes for patients, such as a carer’s champion.
• The practice received almost 100% of the points available (558.5 from a total of 559) for the Quality and Outcomes Framework (QOF). QOF rewards practices for the provision of 'quality care' and helps to fund further improvements in the delivery of clinical care.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

We saw two areas of outstanding practice: 

• There were several examples of the practice proactively working with its patient participation group (PPG) to make changes to the practice and raise awareness of patients. For example, liaison with a local school to explore ways to improve services for young people; Health Awareness Days held on Saturday mornings; and evening education sessions held for patients.
• The practice was proactive in helping to establish Nailsea District Leg Club and we saw evidence of improved clinical outcomes and social benefits for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 March 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management, such as in diabetes care and patients at risk of hospital admission were identified as a priority.
• Performance for patients with long-term conditions either compared with or exceeded national averages. For example, 84% of patients with asthma, on the register, had had an asthma review in the preceding 12 months, compared to the national average of 75%. The review included three patient-focused outcomes that act as a further prompt to review treatment.
• Longer appointments and home visits were available when needed.
• 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.
• The practice routinely offered longer appointments for patients with complex medical needs.
• The practice identified patients at risk of developing diabetes and implemented changes that could help to delay or prevent the progression of this health condition.

Updated 7 March 2017

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 patients 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 practice assessed the capability of young patients using Gillick competencies. These competencies were an accepted means to determine whether a child was mature enough to make decisions for themselves.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding five years was 81%, which was comparable to the national average of 82%.
• 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.
• The practice hosted a confidential sexual health clinic for young people, which provided advice on relationships, and general and sexual health issues.

Updated 7 March 2017

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 patients in its population.
• Older patients with complex care needs or those at risk of hospital admissions had personalised care plans which were shared with local organisations to facilitate continuity of care.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• A carer’s champion worked closely with district nurses, occupational therapists and social services agencies to avoid unplanned hospital admissions for older patients.
• The practice initiated the use of a recognised clinical measure of fitness and frailty in older patients to assess their health needs.
• The practice helped to establish a Leg Ulcer Club for wound management in the local community.

Updated 7 March 2017

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 offered extended morning and evening appointments during the week, and on one Saturday a month, with a GP and nurse.
• Patients were able to book appointments and order repeat prescriptions online.
• The practice was developing a system for text reminders for appointments.
• Telephone appointments were offered where appropriate, as an alternative to face-to-face consultations.

Updated 7 March 2017

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

• 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to both the clinical commissioning group (CCG) average of 85% and national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their records in the preceding 12 months was 94%, which exceeded the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 7 March 2017

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.
• 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.
• The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary, booked for a same day appointment at the practice.