Archived: Hillside Bridge Surgery

Updated 16 October 2018

Hillside Bridge Surgery provides services for 5,307 patients. The surgery is situated within the NHS Bradford City Clinical Commissioning Group and is registered with Care Quality Commission (CQC) to provide primary medical services under the terms of an alternative provider of medical services (APMS) contract. This is a time limited contract between general practices and NHS Bradford City CCG for the delivery of services to the local community.

The provider is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder or injury and maternity, surgical procedures, family planning and midwifery services.

There is a higher than average number of patients under the age of 39, in common with the characteristics of the Bradford City area. There are fewer patients aged over 45 than the national average. The National General Practice Profile states that 54% of the practice population is from an Asian background with a further 12% of the population originating from black, mixed or non-white ethnic groups.

The registered provider at the practice is Dr Poonam Jha who provides one clinical session per week at the practice. Additional clinical sessions at the practice are covered by one male salaried GP and four long term locum GPs, one of whom is female. There are two, part time self-employed female advanced nurse practitioners and a part time practice nurse. Two health care assistants (one male, one female) support the nursing team and there is a practice pharmacist who provides one session per week.

The clinical team is supported by a part time practice manager, a part time office manager and a team of administrative staff.

The characteristics of the staff team are reflective of the population it serves and they are able to converse in several languages including those widely used by the patients, Urdu, Punjabi, English and a number of Eastern European languages.

The practice catchment area is classed as being within one of the most deprived areas in England. Information published by Public Health England, rates the level of deprivation within the practice population group as one, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. People living in more deprived areas tend to have a greater need for health services. Male life expectancy is 74 years compared to the national average of 79 years. Female life expectancy is 80 years compared to the national average of 83 years.

Hillside Bridge Surgery is situated within a purpose-built health centre with car parking available. It has disabled persons’ access and facilities and there is a pharmacy on site.

The reception is open from 8.00am until 6.30pm four days per week and on a Wednesday from 8.00am until 8pm when an extended hours clinic is offered. An additional 50 appointments per month are also available to patients as part of a GP alliance initiative. Patients can attend at three sites across the Clinical Commissioning Group area.

When the surgery is closed patients are advised of the NHS 111 service for non –urgent medical advice.

On the day of inspection, we did not see that the provider was displaying their ratings on the practice website. We asked the practice to immediately review this.

Following a comprehensive inspection on 3 July 2018 the practice was rated as inadequate overall. The practice was in breach of Regulation 12: Safe Care and Treatment and Regulation 17: Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

Warning notices were issued to the practice on 24 July 2018. The practice was required to be compliant with the concerns documented in the warning notice in relation to Regulation 12 by 1 September 2018.

This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements in relation to Regulation 12.

Compliance in relation to the Regulation 17 warning notice which was issued on 24 July 2018 will be assessed at a further inspection.

Updated 16 October 2018

This practice is rated as Inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? – Inadequate

We carried out an announced comprehensive inspection of Hillside Bridge Surgery on 03 July 2018. The current provider, Dr Poonam Jha, registered the location with the CQC in October 2017 after taking over the management of the surgery on 01 June 2017. There was some continuity of staffing between the previous and current provider.

At this inspection we found:

• The practice did not have appropriate systems in place to manage risk so that safety incidents were less likely to happen. When incidents did happen, we saw that significant events forms were incomplete and there was limited written evidence of dissemination to staff, learning from these incidents or changes in policies or procedures.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Feedback from six of the eight patients we spoke with on the day of inspection emphasised concerns regarding the practice and specifically the unhelpful and negative attitude of some staff members. A number of patient comment cards also reflected these concerns; as well as highlighting issues relating to accessing appointments and contacting the practice. One patient told us they were frightened to ring the practice.
• The practice did not have reliable systems for the appropriate and safe handling of medicines.
• The practice could not provide evidence of DBS checks for five staff who had worked for the previous provider; this included a GP and a nurse. (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.)
• Not all staff at the practice had received up to date training. This included child and adult safeguarding training and infection prevention and control.

The areas where the provider must make improvements as they are in breach of regulations are:

• The provider must ensure that safe care and treatment is provided in a safe way to patients.
• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Continue to review and improve the identification of carers to enable this group of patients to access the care and support they may require.
• Review and improve their approach to the management of infection prevention and control within the practice.
• Continue to review and improve the uptake of cancer screening at the practice.
• Improve the approach to auditing infection prevention and control in the practice to ensure that all areas of the practice are reviewed.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 17 August 2018

Updated 17 August 2018

Updated 17 August 2018

Updated 17 August 2018

Updated 17 August 2018

Updated 17 August 2018