Bidford Health Centre

Updated 6 February 2017

Bidford Health Centre provides primary medical services to the village of Bidford-on-Avon and the surrounding area. The practice has a General Medical Services contract with NHS England. (This is a medical services contract which permits the practice to provide primary care services to patients and is agreed locally with South Warwickshire CCG).

Bidford Health Centre has a patient list size of approximately 11,086 including some patients who live in local care homes. Bidford-on-Avon has a higher than average population aged over 65, and levels of social deprivation are lower than the national average. The practice also provides some enhanced services to patients. (An enhanced service is separate from the core contractual requirement of the practice and is commissioned at national or local level to improve the range of services available to patients). For example, the practice offers minor surgical procedures, extended hours access and patient online access.

It is a training practice where GP trainees attend for training. The practice is based within newly constructed purpose built premises with accessible facilities for patients with disabilities. There is a large on site dispensary which dispenses medicines to approximately 6,000 patients.

The clinical team includes one female and two male GP partners, and three female and one male salaried GPs. The practice clinical team also has four trainee GPs, eight dispensers, three nurse practitioners, three practice nurses and two health care assistants. The clinical team is supported by two secretaries and seven members of reception staff.

The practice reception is open between 8am and 6.30pm from Monday to Friday. In addition the practice opens for appointments between 8am and 12pm on alternate Saturdays and every other Monday evening. Appointments are available between 8.30am and 6pm from Monday to Friday, and the practice provides an on-call GP on these days from 8am to 8.30am, and 6pm to 6.30pm, to address any urgent patient needs.

Patients are directed to out-of-hours services provided by NHS 111 when the practice is closed.

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bidford Health Centre on 16 June 2016. Overall the practice is rated as good.

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

• The practice had an effective system for reporting and recording significant events. Robust procedures and measures were used to keep patients safe and help protect them from abuse.
• Risks to patients were effectively assessed and managed by staff.
• The practice used current evidence based guidance to assess patients’ needs and deliver care. Up to date training was provided to ensure staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients told us they found the GPs pleasant, friendly and efficient. The people we spoke with felt they were treated with dignity, compassion and their wishes were respected.
• Information about 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 told us they were able to get appointments when they needed them and urgent appointments were available on the same day, but they could wait several days to see their preferred GP.
• 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 practice was familiar with the conditions of the duty of candour and exercised an open and honest culture.

We saw two areas of outstanding practice:

• The practice held patient education meetings approximately twice a year in conjunction with the Patient Participation Group (PPG). These were held during evenings at the practice and aimed to better inform patients about their health and care. The meetings were well attended and were aimed at patients, their carers, and was also open to other members of the public. For example, one meeting had focused on diabetes information and speakers had included the practice nurses, a patient representative from the local branch of the Diabetes UK charity support group and a local dietician. The success of the practice’s patient education meeting on dementia had confirmed the increasing prevalence in dementia and the local demand for support, as well as helping to increase the number of patients on the carers register. The carers register increased from 43 patients prior to the meeting to 111 during the following year.
• The practice had then formed a committee to set up a memory café for people with dementia and their carers. Practice staff worked with the PPG, carers and patient volunteers to achieve this and the memory café began running for two hours every Monday in premises central to Bidford-on-Avon to ensure this was accessible to everyone affected by dementa rather than only those who were patients of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 February 2017

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

• GPs undertook care planning and medicine reviews for patients with long term conditions such as diabetes, coronary heart disease and hypertension (high blood pressure).
• The nursing team had individual specialisms in long term conditions including chronic obstructive pulmonary disease (COPD), asthma and diabetes.
• Longer appointments and home visits were available for patients with long term conditions.
• The practice held public educational evenings twice a year to inform patients of a variety of long term conditions. The open evenings were advertised in the local press and led by a specialist consultant.
• Clinicians attended a six weekly in house educational meeting with a local consultant to improve their knowledge of long term conditions.
• The practice had installed a free blood pressure monitor in the waiting area to encourage patients to screen themselves for hypertension (high blood pressure). Take home blood pressure machines were also loaned to patients to allow them to accurately monitor their condition and identify triggers.
• A range of services for patients were available at the practice, including diabetic eye screening, phlebotomy (taking blood), and clinics.
• The practice held patient education meetings approximately twice a year in conjunction with the Patient Participation Group (PPG). These were held during evenings at the practice and focused on long term conditions such as diabetes with the aim of better informing patients about their health and care. The practice made these available to anyone who wished to come as well as their own registered patients.

Updated 6 February 2017

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

• A senior partner was the lead member of staff for safeguarding and a salaried GP was the deputy lead. The practice held fortnightly safeguarding meetings with local health visitors.
• Childhood immunisation rates for the vaccinations given were comparable to local and national averages.
• Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Clinical staff showed a clear understanding of Gillick competence and Fraser guidelines. (Gillick competence is concerned with determining a child’s capacity to consent. Fraser guidelines are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment).
• Quality monitoring indicators showed that the practice’s patient uptake of cervical screening was in line with local and national averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered separate flu clinics for children with set appointment times to minimise distress and waiting times.
• The practice provided family planning services and post-natal reviews for mothers and babies.

Updated 6 February 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice recognised that it had a growing population of older people which had increased rapidly in recent years, and had tailored its services to meet their needs. For example, the practice was participating in a local initiative to intervene and support older patients in the early stages of frailty with the aim of reducing emergency admissions. It had began the project by stratifying patients aged over 75 into three categories according to their level of risk.
• The practice liaised with a care navigator from Age UK to support patients and had also appointed their nurse practitioner as care coordinator for older people.
• The practice had patients at four local care homes, where staff described the service the practice provided to patients as attentive and individualised. Each care home told us they had a nominated GP at the practice that carried out a twice weekly visit to review patients. Staff explained that this was invaluable as it meant that GPs were familiar with each patient and offered excellent continuity of care.
• The practice dispensary offered a free medicine delivery service to housebound patients. All members of staff who carried out deliveries had undergone a Disclosure and Barring Service check.
• Clinicians held monthly multidisciplinary meetings with community nurses and the palliative care team to discuss specific patients.
• The practice carried out over 75s health checks and had been able to identify a number of illnesses as a result. For example, during 2015 the practice had made 66 new diagnoses of atrial fibrillation, 59 new diagnoses of dementia and 20 new diagnoses of depression. The practice was then able to effectively plan and manage care and treatment for the patients.

Updated 6 February 2017

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

• The practice offered extended hours to assist patients who could not attend during normal working hours. These were held weekly on alternate Monday evenings and Saturday mornings.
• Online appointment booking and text messaging reminders were available. The text messaging service also gave patients the option of cancelling an appointment or providing feedback by text.
• A GP advice phone line service gave patients the option of having their consultation over the phone where appropriate. Minor illness clinics were also available with the nurse practitioner, and the practice website provided a self-help section.
• The practice offered a range of screening and health promotions to meet the needs of working age people. NHS health checks were available during extended hours on Saturday mornings.
• Patients could attend a travel advice clinic with a practice nurse and vaccinations were available at the practice.
• There was a virtual patient participation group to assist those who would not be able to attend meetings during usual hours, so that feedback could be given regularly by email.

Updated 6 February 2017

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

• Together with the patient participation group (PPG) the practice had formed a committee to set up a memory café for patients with dementia after identifying an increasing prevalence in dementia. The memory café ran for two hours every Monday in premises central to Bidford-on-Avon. The memory café was funded by a local charity called Friends of Bidford Health Centre.
• Clinical staff at the practice liaised with local multi-disciplinary teams to provide continuity of care to patients experiencing poor mental health, including those with dementia.
• A number of the practice staff had trained as dementia friends.
• The practice computer system flagged patients eligible for dementia screening and supported clinicians in completing a cognitive assessment. Routine dementia screening was also carried out during all chronic disease reviews.
• All patients with enduring mental health issues were provided a comprehensive annual review with care plan. Patients were repeatedly invited by letter and phoned if they failed to attend.
• The practice held public evening education meetings twice annually to inform patients about long term conditions including dementia. The last meeting was attended by approximately 100 people.

Updated 6 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held registers of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients who required them.
• Patients considered to be at risk had personalised care plans.
• The practice communicated closely with a local learning disability care home and provided a named GP for patients. The practice had developed a standard template for recording information from learning disability health checks, and had visited 27 patients over the previous five months to conduct these.
• The practice dispensary offered a medicine delivery service to assist patients with mobility difficulties.
• Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities and how to contact relevant agencies. There were lead members of staff for safeguarding, and GPs were trained to an appropriate level in safeguarding adults and children.
• Staff had been trained appropriately in vulnerability issues such as domestic abuse and female genital mutilation.
• Disabled facilities were available at the practice including parking, wheelchairs, step free access to consultation rooms and a hearing loop.
• The practice had approximately 100 traveller families registered with the practice and encouraged them to engage with services using a holistic approach to cultural barriers. For example, staff approached issues such as literacy with sensitivity and were respectful of cultural beliefs. The practice told us they had stressed the importance of permanent registration to provide continuity of care.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 111 patients as carers (approximately 1% of the practice list), this had increased from 43 carers a year previously. The practice had a carer’s corner in the patient waiting area encouraging carers to register and displaying information about various avenues of support available, such as a local memory café and helplines.
• All staff had additionally completed IRIS (Identification and Referral to Improve Safety) training in domestic violence.
• Practice staff worked with the PPG, carers and patient volunteers to facilitate evening events to support carers.
• The practice facilitated a local drug and alcohol organisation to offer a weekly clinic from the premises.