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Inspection Summary


Overall summary & rating

Good

Updated 24 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridges Medical Practice on 1 June 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.
  • Data from the Quality and Outcomes Framework showed patient outcomes were above average for the locality and compared to the national average.
  • 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.
  • Data from the National GP Patient Survey showed patients rated the practice slightly lower than others for several aspects of care.
  • Information about services and how to complain was available and easy to understand.
  • Patient feedback about appointment availability was mixed. However, generally, patients told us they could get an appointment with a named GP, there was continuity of care and urgent appointments were 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 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.

We saw an area of outstanding practice:

  • The practice had produced a DVD and YouTube video to give patients with learning disabilities an overview of what was involved in an annual health check. It gave an overview of what an annual health check was for and what type of questions the GP or nurse might ask. The video had received 511 views on YouTube. The practice had distributed copies of the DVD to local day centres and residential facilities for people with learning disabilities. A link to the YouTube video was also sent via social media to help reach a larger audience. The DVD was sent to practices within the surrounding local clinical commissioning groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 24 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average. For 18 of the 19 clinical domains within QOF the practice had achieved 100% of the points available and for all the clinical areas, the practice achieved more of the points available than the clinical commissioning group (CCG) and national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 24 August 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice slightly lower than others for several aspects of care. The practice told us they would review their performance to help them identify how they could further improve.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 24 August 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of their local population and engaged with the NHS England Area Team and clinical commissioning group to secure improvements to services where these were identified. A GP was part of the local Care Home Vanguard to improve access and care in Care Homes.

  • Patient feedback about appointment availability was mixed. However, generally, patients told us they could get 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.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice actively identified patients who were veterans of the armed forces to help direct them to sources of specialist help and support. The practice had 103 patients on this register.

Well-led

Good

Updated 24 August 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the Duty of Candour. The practice manager and GPs encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 24 August 2016

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

  • Effective systems were in place, which helped ensure patients with long-term conditions received an appropriate service, which met their needs. These patients all had a named GP and received an annual review to check that their needs were being met. For those people with the most complex needs, the named GP worked with other relevant health and care professionals to deliver a multidisciplinary package of care.
  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for some of the clinical conditions commonly associated with this population group. For example, performance for diabetes related indicators was better than the clinical commissioning group (CCG) and national averages. The practice achieved 99.9% of the points available. This compared to an average performance of 92% across the CCG and an 89.2% national average. In addition, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 91.8%, compared to a national average of 88.3%.
  • Longer appointments and home visits were available when needed.
  • Patients at risk of hospital admission were identified as a priority, and steps were taken to manage their needs.
  • Staff had completed the training they needed to provide patients with safe care.

Families, children and young people

Good

Updated 24 August 2016

The practice is rated as good for the care of families, children and young people.

  • There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. 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. The needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
  • Immunisation rates were relatively high for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 80.5% to 100% and five year olds from 86.4% to 100%. The average percentage across the CCG for vaccinations given to under two year olds ranged from 81.3% to 97% and five year olds from 89.8% 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.
  • Nationally reported data showed the practice had performed in line with average for providing recommended care and treatment for this group of patients.
  • 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.

Older people

Good

Updated 24 August 2016

The practice is rated as good for the care of older people.

  • Staff provided proactive, personalised care, which met the needs of older patients. Patients aged 75 and over were allocated a named GP to help ensure their needs were met.
  • Good arrangements had been made to meet the needs of ‘end of life’ patients. Staff held regular palliative care meetings with other healthcare professionals to review the needs of these patients and ensure they were met.
  • The practice offered home visits and longer appointment times where these were needed by older patients. The practice had a visiting practice nurse who focussed on meeting the needs of patients in care homes.
  • Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group.
  • The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Working age people (including those recently retired and students)

Good

Updated 24 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice had assessed the needs of this group of patients and developed their services to help ensure they received a service, which was accessible, flexible and provided 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.
  • Nationally reported data showed the practice provided recommended care and treatment that was in line with or above national averages for this group of patients. For example, the percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months is 150/90mmHg or less was the higher than the national average. 87.9% of patients had a reading measured within range, compared to 83.7% nationally.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 August 2016

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

  • The practice had identified 1.3% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services.
  • Performance for mental health related indicators was better than the CCG and national average. The practice achieved 100% of the points available. This compared to an average performance of 92.7% across the CCG and 92.8% national average. For example, 100% of patients with schizophrenia, bipolar affective disorder and other psychosis had a comprehensive agreed care plan documented within the preceding 12 months. This compared to a national average of 88.5%.
  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review within the preceding 12 months was better than the national average at 93.8% (compared to a national average of 84.0%).
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • They 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 24 August 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. In particular, we found the practice were outstanding in providing a caring and responsive service to this population group.

  • The practice held a register of patients living in vulnerable circumstances including patients with learning disabilities.
  • Staff carried out annual health checks for patients who had a learning disability and offered longer appointments.
  • The practice had produced a DVD and YouTube video to give patients with learning disabilities an overview of what was involved in an annual health check. It gave an overview of what an annual health check was for and what type of questions the GP or nurse might ask. The video had received 511 views on you tube. The practice had distributed copies of the DVD to local day centres and residential facilities for people with learning disabilities. A link to the YouTube video was also sent via social media to help reach a larger audience. The DVD was sent to practices within the surrounding local clinical commissioning groups.

  • The practice maintained a register of patients who were veterans of the armed forces. The practice had 103patients on this register.They also kept up to date information about local resources, support groups and organisations, which might be relevant to the needs of veterans. By noting a patient was a veteran on the practice clinical system; this information was available to clinicians in making decisions about treatment options.This included identifying where a veteran may have priority access to NHS hospital care for any condition related to their service.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • Staff provided vulnerable patients with information about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff understood their responsibilities regarding information sharing, the documentation of safeguarding concerns and contacting relevant agencies.