Archived: Grange Medical Centre

Updated 25 February 2016

Grange Medical Centre provides services for 6234 patients. This patient list and staff are shared with the branch surgery, Oaklane Surgery, Bradford. At the time of the inspection both services were separately registered with CQC. Please see separate report for Oaklane Surgery.

Grange Medical Centre is situated within the Bradford City Clinical Commissioning group and is registered with CQC to provide primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

Grange Medical Centre is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services. They offer a range of enhanced services such as childhood immunisations and extended opening hours to access appointments. The practice offers drop in clinics for emergency cases and babies.

There are similar numbers of male and female patients, with 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 40 than the national average. The National General Practice Profile states that 69% of the practice population is from an Asian background with a further 7.7% of the population originating from black, mixed or non-white ethnic groups. The practice estimates that 90% of the practice population is from an Asian background.

There are three GP’s, two of whom are male and one is female. The practice is staffed by three part time practice nurses who work 12 hours per week each and two full time health care assistants (HCA’s), one of which is male. The practice also engages the services of a pharmacist. The clinical team is supported by a practice manager and a team of administrative staff. The staff team is reflective of the population it serves and are able to converse in several languages including those widely used by the patients, Urdu, Punjabi and English.

The practice catchment area is classed as being within one of the most deprived areas in England.

Grange Medical Centre is situated within an older building with car parking available. It has disabled access and facilities.

The practice is open between 8.30am and 8.15pm Monday and Tuesdays with appointments made available between 8.30am and 8pm. On a Wednesday, Thursday and Friday, the surgery is open between 8.30am and 6.30pm and appointments are available between these times. Two drop in sessions per week on a Monday and Thursday are available for patients to visit the practice without an appointment. A further two sessions per week are also offered at the Oaklane site on Mondays and Wednesdays. Extended hours surgeries are offered on Mondays and Tuesdays.

The Out of Hours service is provided by an external contractor, Local Care Direct. When the surgery is closed patients are transferred to Local Care Direct for non-urgent medical advice. Patients are also advised of the NHS 111 service.

Updated 25 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grange Medical Centre on 10 December 2015.Overall the practice is rated as good.

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. Staff understood their responsibilities to raise concerns and report incidents.
• Risks to patients were assessed and well managed.
• 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 we spoke with on the day of the visit 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, the practice offered several “drop in” clinics during the week in response to concerns from the patient participation group, (PPG). A number of urgent appointments were available the same day.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

The Patient Participation Group (PPG) held events and talks in the surgery, sports centres, mosques and day centres, highlighting health issues and promoting services at the surgery. The GP's proactively engaged with the PPG and met regularly with them. By highlighting health issues, conditions and available clinics, attendance for screening such as cervical screening had improved.

The areas where the provider should make improvement are:

The practice should maintain up to date records of staff training and ensure that mandatory training is documented.

The practice should ensure that all members of staff who undertake a formal chaperone role undergo training, so that they develop the competencies required for the role.

The practice should ensure that a risk assessment for the control of substances hazardous to health (COSHH) is available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 February 2016

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

• Nursing and Health care staff had lead roles in chronic disease management.

• The practice was actively championing the Bradford beating diabetes initiative.

• Diabetes indicators for the practice were below the national average, but comparable to other practices in the area. For example the number of patients with diabetes with a record of a foot examination within the last 12 months was 62%, compared with the national average of 88%. The practice had identified these issues following audit and had plans to improve outcomes with help from the Bradford beating diabetes initiative. Dedicated Diabetes clinics were now held at the practice and foot checks were being under taken for low risk patients and referrals made for those at higher risk.

• Longer appointments and home visits were available when needed.

Updated 25 February 2016

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

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

• Immunisation rates were  high for all standard childhood immunisations and above average for the CCG. Rates for immunisations for those under 12 months ranged from 98-100%.

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

• Cervical screening rates were below national average 72% compared to 82%. These were seen to be improving slowly through QOF scores and the GP’s were liaising with the PPG, who held talks and visited local community centres, schools and mosques to encourage women to attend for screening.

• Appointments were available outside of school hours and the premises were suitable for children and babies. A number of appointments were held back each day so that children could be seen in an emergency. Baby changing facilities were available. 

• We saw good examples of joint working with midwives and health visitors.

• The practice operated an open access baby clinic once per week.

Updated 25 February 2016

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

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

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Patients aged 75 and over had a named GP and were offered an annual health check.

• The percentage of people aged 65 or over who received a seasonal flu vaccination was 77% which is higher than the national average of 73%.

• The practice held regular meetings with members of the palliative care team.

• We found easy access for those with poor mobility.

Updated 25 February 2016

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

• 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.

• 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. Including alcohol and smoking cessation clinics, podiatry, a well woman clinic and a weekly session run by a dietician.

• The practice had extended hours until 8.15pm on a Monday and Tuesday.

• The on line booking and cancelling of appointments was available and patients were able to request prescriptions on line.

• Patients were able to receive appointment reminders by way of text messages to their mobile phones. This was only activated once a patient had given consent.

Updated 25 February 2016

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

• 54% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.

• Mental health outcomes for the practice were low. Only 48% of patients with a mental health issue had a comprehensive care plan, however, this figure had increased by 44% over the last year. The practice discussed mental health outcomes as a priority for the forthcoming year.

• 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.

• It 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 people with mental health needs and dementia.

• The practice discuss mental health issues as a standing agenda item at their clinical meetings and GP’s had recently attended training on mental health strategies.

Updated 25 February 2016

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• It offered longer appointments for people with a learning disability and carried out annual health checks. There were easy read leaflets available for cytology and breast examination.

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

• It had told vulnerable patients about how to access various support groups and voluntary organisations. Information was also available in the waiting area.

• The practice held a register of people who were carers and this would be noted and appear on the person’s record. A local Carers organisation ensured that the practice was up to date with information for carers.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were very clear regarding their responsibilities around information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.