Archived: Midford House

Updated 3 July 2019

The Bath and North East Somerset Enhanced Medical Services (BEMS+), based at Midford House in Bath is a local not-for-profit organisation that works across the community to improve patient care through providing high quality community based clinical services and by linking together local General Practices to help develop and provide those services.

They have an Alternative Provider Medical Services (APMS) contract to enable them to provide primary medical services within their area. They also have a standard NHS contract to provide other NHS Services.

The organisation is funded by the NHS to provide a wide range of services including fracture clinics, dermatology clinics, deep vein thrombosis (DVT) diagnostics, vasectomy surgery, an Earlier Home Visiting Service, and a Patient Referral Support Service to the whole of the population in the locality.

• The Fracture and soft tissue injury clinics were held across two sites, the Paulton Hospital and the BMI Bath Clinic. Patients could access X-rays, plaster and a physiotherapy service at these locations.

• The Deep Vein Thrombosis (DVT) diagnostic clinic was provided at the Combe Down GP Surgery in Bath. They employed a sonographer (a specialised healthcare professional) three days a week who was able to carry out ultrasound tests to identify a DVT.

• The dermatology clinics were held weekly at two GP practices, one in Bath and another in Paulton. These clinics were held by two GPs with a special interest in dermatology. The purpose was to triage specific conditions for appropriateness to secondary/primary care and then treat patients with a wide range of skin conditions. If the condition requires removal, biopsy or further tests this can be carried out in the clinic as a 'one stop' service for patientsThe GPs worked closely with the Dermatologists at the Royal United Hospital in Bath.

• There were vasectomy clinics held three times a month at two GP surgeries, one in Bath and another in Paulton. Patients were counselled by their own GP and then referred to the clinics. Follow up appointments are carried out by the BEMS+ staff.

• The Earlier Home Visiting service was provided by a specialist paramedic and a General Practitioner. All GPs in Minerva, Independent practices and Norton Radstock could refer patients to the service Patients were triaged by their own GP and if an early visit was required they were added to a list held by BEMS+ where a home visit was requested and completed.

• The service also provided an Improving Access (IA) service on behalf of all GP practices in B&NES. This service was for patients needing routine, bookable in advance, GP or nurse appointments outside of normal GP Practice opening times. Appointments were available between the hours of 6.00pm and 9.00pm on weekdays, and 8.00am to 12.00 midday on Saturdays and Sundays. The service operated from sites in Bath, Paulton and Keynsham.

Their work also includes improving online access for GPs to the patient record through the use of mobile computing technology BEMS+ works with other community providers including the Royal United Hospital, Virgincare, South Western Ambulance Service NHS Foundation Trust (SWASFT) and B&NES (Bath and North and East Somerset) local authority.

BEMS+ are registered with CQC to provide regulated activities: diagnostics and screening, surgical procedures, maternity and midwifery and the treatment of disease, disorder and injury.

BEMS+ provides the clinical services in five host locations situated in the local community reducing the need for patients to visit large acute hospitals in the locality. The host clinical sites include community hospitals, GP practices and The Bath Clinic.

The service management team operates from the headquarters at Midford House, St. Martins Hospital, Midford Road Bath, BA2 5RP.

The GPs, nurses and healthcare staff delivering these services were employed by BEMS+, self employed or sub contracted from practices, Virgin Care and the Bath Clinic.

On this inspection we visited the headquarters at Midford House and:

The vasectomy and dermatology clinic at; -

Elm Hayes Surgery

Clandown Road

Paulton

Bristol

Avon

BS39 7SF

The Fracture Clinic at: -

Paulton Community Hospital

Salisbury Road

Paulton

Bristol

Avon

BS39 7SB

The Improved Access surgery at: -

The Oldfield Surgery

45 Upper Oldfield Park

Bath

Avon

BA2 3HT

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 3 July 2019

This service is rated as Good overall. (This was their first inspection)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Outstanding

We carried out an announced comprehensive inspection at Banes Enhanced Medical Services + Limited at Midford House as part of our inspection programme. The organisation provides a wide range of services including fracture clinics, dermatology clinics, deep vein thrombosis (DVT) diagnostics, vasectomy surgery an earlier Home Visiting Service, and a Patient Referral Support Service to the whole of the population in the locality.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Midford House provides a referral support service which are not within CQC scope of registration. Therefore, we did not inspect or report on this service.

This service is registered with CQC under the Health and Social Care Act 2008 in respect of the provision of diagnostics and screening, surgical procedures, maternity and midwifery and the treatment of disease, disorder and injury.

Thirty three patients provided written feedback about theorganisation , via CQC Comments Cards. We also spoke with 14 patients during our inspection. All patients commented on the high standard of care provided by clinical staff as well as the kindness and courtesy offered by reception staff. All patients said they felt involved in decision-making about the care and treatment they received. They told us they felt listened to and supported by staff, and with 15 minute appointments in improving access for example, they had sufficient time during consultations to make an informed decision about the choice of treatment available to them.

Our key findings were:

• The provider provided care in a way that kept patients safe and protected them from avoidable harm.
• There were comprehensive systems to keep people safe, which take account of current best practice.
• Services were planned and delivered in a way that met the needs of the local population. The importance of flexibility, choice and continuity of care was reflected in the services provided.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The provider organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

We saw the following outstanding practice:

• The provider was an integral part of the local community and actively promoted the health of the population. Feedback from patients was consistently positive about the service they received from them
• The culture of the provider and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.
• Leaders had an inspiring shared purpose, striving to deliver and motivate staff to succeed. There was a strong culture of continuous improvement.

Dr Rosie Benneyworth BM BS BMedSci MRCGPChief Inspector of Primary Medical Services and Integrated Care