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Archived: Hillside Bridge Health Centre Requires improvement

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Inspection Summary


Overall summary & rating

Requires improvement

Updated 12 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hillside Bridge Health Centre on 13 September 2016. 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 approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.

  • Results from the national GP patient survey showed the practice was rated below average for its satisfaction scores on consultations with GPs and nurses.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. We saw that development and learning was prioritised by the practice and 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 during consultations with their GP.
  • 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 GP and there was continuity of care, with urgent appointments available the same day.
  • There was a clear leadership structure and staff felt supported by management. Staff told us that they would feel confident to raise any concerns with the lead GP or practice manager.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • Overall the practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice ensured that every locum always completed an ‘End of Shift Check Out Form’ which ensured continuity of care for patients.
  • All patients who attended accident and emergency (A&E) or had an unplanned hospital admission were reviewed and their needs assessed.

The areas where the provider should make improvements are

  • The provider should develop an action plan to address low patient satisfaction scores.
  • Put systems in place to improve and monitor patient satisfaction so that it is in line with national survey results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 December 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 things went wrong patients received reasonable support, truthful information, and a 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. We saw evidence of multidisciplinary discussions at team meetings, where vulnerable children, adults and families were discussed.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 12 December 2016

The practice is rated as good for providing effective services.

  • Clinical audits and peer reviews had been carried out within the practice. However it was noted that many of the audits discussed on the day of inspection were single cycle.
  • Child immunisation rates were significantly below average for some age groups.

  • The practice’s uptake for the cervical screening programme was 64%, which was below the CCG average of 76% and the national average of 81%.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • There was evidence of appraisals and personal development plans for all staff.
  • The practice participated in Clinical Commissioning Group (CCG) initiatives such as Bradford Beating Diabetes and could offer specialist support to patients requiring help with insulin management. This reduced the need for patients to attend the local hospital.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. The practice held joint protected learning afternoons every quarter with other health professionals, where meetings, discussions and training would take place. Staff were up to date with their training and attend additional learning and development events which would improve patient care.
  • Staff worked effectively and collaboratively with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Requires improvement

Updated 12 December 2016

The practice is rated as requires improvement for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice lower than others for some aspects of care. For example, 64% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 76% and the national average of 85%.
  • Patients we spoke to on the day said they were treated with compassion, dignity and respect.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw on the day of inspection that staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Requires improvement

Updated 12 December 2016

The practice is rated as requires improvement for providing responsive services.

  • The provider should develop an action plan to address low patient satisfaction scores.
  • Staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, the surgery and walk-in service met the health needs of a significant number of the local transgender community. The practice was also participated in a local programme for the proactive screening of potentially undiagnosed diabetics and had introduced an additional Saturday morning clinic to improve access for working patients.
  • The practice had also recently purchased an Atrial Fibrillation screening tool having recognised that it was underdiagnosed in this area.
  • Practice patients were also able to access the walk-in service which was attached to the practice and which was open 2pm to 8pm 365 days per year.
  • Patients said they found it easy to make an appointment with a 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 implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example the addition of crayons, colouring paper and toys for toddlers in the waiting area.

Well-led

Good

Updated 12 December 2016

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

  • The practice had a “virtual” patient participation group (PPG) and therefore had a limited ability to fully engage with patients. At the time of inspection the practice was establishing an “operational PPG” to try to stimulate more effective engagement.
  • The practice was aware of and complied with the requirements of the duty of candour. The practice encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • Local Care Direct Limited had developed a set of internal key performance indicators. It monitored these on a monthly basis and used the information to assess progress in important aspects of service delivery, for example staffing levels and appointment availability.
  • The practice proactively sought feedback from staff and patients, which it acted on. The practice had installed a tablet at reception in June 2016 to gain effective feedback from the patients it served.
Checks on specific services

Older people

Requires improvement

Updated 12 December 2016

The practice was rated as requires improvement for the care of older people. The issues identified as requiring improvement affected all patients, including this population group.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. For example, practice nurses made home visits to administer flu vaccinations to older patients who struggled to attend the surgery.
  • Care plans had been developed for older patients who were identified as being at risk.

People with long term conditions

Requires improvement

Updated 12 December 2016

The practice was rated as requires improvement for the care of people with long-term conditions. The issues identified as requiring improvement affected all patients, including this population group.

  • Nursing staff had lead roles in chronic disease management, which included diabetes, chronic obstructive pulmonary disease (COPD) and asthma, and patients at risk of hospital admission were identified as a priority.

  • Longer appointments and home visits were available when needed.
  • 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 multidisciplinary packages of care.
  • The practice offered 24 hour blood pressure monitoring and in-house spirometry.

Families, children and young people

Requires improvement

Updated 12 December 2016

The practice was rated as requires improvement for the care of families, children and young people. The issues identified as requiring improvement affected all patients, including this population group.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

  • We were told by the practice 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 uptake for the cervical screening programme was 64%, which was below the CCG average of 76% and the national average of 81%.
  • Immunisation rates were relatively low for all standard childhood immunisations.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. Additionally, patients could access the walk-in centre out of the practice core hours.
  • All staff had received safeguarding training and were aware how to follow up concerns.

Working age people (including those recently retired and students)

Requires improvement

Updated 12 December 2016

The practice was rated as requires improvement for the care of working age people (including those recently retired and students). The issues identified as requiring improvement affected all patients, including this population group.

  • The practice was proactive in offering online services, which included appointment booking and repeat prescription requests.
  • A range of health promotion and screening was offered that reflected the needs for this age group, this included weight management advice and smoking cessation support.
  • Telephone consultations were available to those unable to attend the surgery.

People whose circumstances may make them vulnerable

Requires improvement

Updated 12 December 2016

The practice was rated as requires improvement for the care of people whose circumstances may make them vulnerable. The issues identified as requiring improvement affected all patients, including this population group.

  • The practice held a register of patients living in vulnerable circumstances and used this information to coordinate services. For example, it used the mental health register to recall patients for regular reviews and a carers register to offer winter flu immunisations.

  • The practice and walk-in centre provided regular services for members of the nearby traveller community.
  • The practice offered longer appointments for patients with enhanced needs such as those with a learning disability or the frail elderly, and offered health checks and care planning.
  • The practice 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. 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.
  • Staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, the surgery and walk-in service met the health needs of a significant number of the local transgender community.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 12 December 2016

The practice was rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The issues identified as requiring improvement affected all patients, including this population group.

  • The most recently published QOF results showed that 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG and national average of 84%.
  • The practice regularly worked closely with other health professionals in the case management of patients experiencing poor mental health, including those with dementia
  • Practice staff told us they also worked closely with relatives of patients who had poor mental health including dementia when this was appropriate.
  • The practice had a system in place to follow up patients who had attended accident and emergency when they may have been experiencing poor mental health.
  • The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.