Archived: Burton Road Surgery

Updated 7 April 2016

Burton Road Surgery provides primary medical services to approximately 2,223 patients in Lincoln.

Burton Road Surgery is a member of a group of four GP practices run by Universal Health Ltd who are a venture between Lincolnshire and District Medical Services and Lincolnshire Partnership NHS Foundation Trust. Universal Health Ltd took over the contract for this location on 1 July 2015. At the time of our inspection, Universal Health Ltd had recently completed a full workforce review and re-structure of the practice management structure and administrative and reception roles.

The practice faced closure when its contract with Lincolnshire Community Health Service (LCHS) was due to expire in March 2015. However, following a patient campaign ‘save our surgery’ and a consultation period, a five year contract was awarded to Universal Health Ltd.

The practice has a higher distribution of patients between the ages of 25-49 years and an even distribution of male/female patients.

At the time of our inspection the practice employed: A salaried GP, three locum GPs, a primary care manager, a nurse practitioner, a practice nurse, two receptionists and a health care support worker. The primary care manager was also supported by an interim practice manager.

The practice has an Alternative Provider Medical Services (APMS) contract. The APMS contract is the contract between general practices and NHS England for delivering care services to local communities.

The practice is one of four locations of which the provider is Universal Health Ltd, each location is registered separately with the Care Quality Commission (CQC), the address for this location is 181 Burton Road, Lincoln. Lincolnshire, LN1 3LT.

The practice is open from 8am to 6.30pm Monday to Friday. Pre-bookable appointments and on the day ’urgent’ appointments are available. Pre-bookable appointments can be booked up to two weeks in advance. The practice provides telephone consultations for patients and a home visit service from both GPs and nurse practitioners. The practice offers on-line services for patients such as on-line appointment booking, ordering repeat prescriptions and electronic prescription service (EPS).

The practice has an active patient participation group (PPG) who meet every four months. The PPG has approximately 12 members.

The practice is located close to the city centre of Lincoln and is located in a period terraced property. Due to its city centre location there was limited on street car parking available near to the practice.

The practice lies within the NHS Lincolnshire West Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services. There are significant health inequalities in Lincolnshire West, linked to a mix of lifestyle factors, deprivation, access and use of healthcare.

The practice has opted out of the requirement to provide GP consultations when the surgery is closed. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust.

Updated 7 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Burton Road Surgery on 18 December 2015. Overall the practice is rated as requires improvement.

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

• There was an open and transparent system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.

• 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.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• The provider was aware of and complied with the requirements of the Duty of Candour.

• Risks to patients were assessed and well managed, with the exception of those relating to Disclosure and Barring Service checks (DBS check). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

• The provider was unable to provide evidence that staff acting as a chaperone had received the relevant training and there was no evidence that chaperones had a DBS check in place.

• Data showed patient outcomes were low compared to the locality and nationally.

• Although some clinical audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.

• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Ensure all clinical staff and those who have contact with vulnerable adults and children have a DBS check in place.

• Ensure all staff who act as a chaperone are competent to fulfil the role.

• Ensure chaperones have a DBS check in place or a policy or risk assessment in place to define the requirements for chaperones to have a DBS check.

• Carry out clinical audits and re-audits to improve patient outcomes.

In addition the provider should:

• Ensure all clinical staff are aware of the location of emergency drugs and the contents of the emergency drugs bag.
• Carry out a disability access audit to assess disabled access for patients and identify reasonable adjustment measures to be taken.
• Ensure appropriate records and evidence of staff training are held by the practice.
• Ensure the infection control lead receives an appropriate level of infection control training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 April 2016

The practice is rated as requires improvement for the care of people with long term conditions. The provider was rated as good for being caring, responsive and well led. However it was rated as requires improvement for providing safe care and being effective. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Nursing staff had lead roles in chronic disease management such as Diabetes and patients at risk of hospital admission were identified as a priority.
• Nursing staff provided home visits for patients.
• Longer appointments and home visits were available when needed.
• The percentage of patients with hypertension having regular blood pressure tests was 82.6% which was lower than national average of 83.65%.
• The practice provided an in-house smoking cessation service.
• Patients with a long-term condition had a named GP. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Updated 7 April 2016

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as good for being caring, responsive and well led. However it was rated as requires improvement for providing safe care and being effective. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice’s uptake for the cervical screening programme was 76.4%, which was lower than the national average of 81.83%.
• Appointments were not available outside of school hours.

• 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.

• Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this.

• There was a weekly antenatal clinic at the practice which was provided by a midwife.

Updated 7 April 2016

The practice is rated as requires improvement for the care of older people. The provider was rated as good for being caring, responsive and well led. However it was rated as requires improvement for providing safe care and being effective. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice had a nurse lead for frail elderly patients and carried out home visits for these patients on a weekly basis. The nurse lead also provided influenza vaccinations during home visits. Longer appointments were available for older people when needed, and this was acknowledged positively in feedback from patients.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

Updated 7 April 2016

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). The provider was rated as good for being caring, responsive and well led. However it was rated as requires improvement for providing safe care and being effective. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.

• Although 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 did not offer extended opening hours.

Updated 7 April 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as good for being caring, responsive and well led. However it was rated as requires improvement for providing safe care and being effective. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.

• 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 April 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as good for being caring, responsive and well led. However it was rated as requires improvement for providing safe care and being effective. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including patients with a learning disability and offered longer appointments for these patients.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.