Archived: Ashburnham Road Surgery

Updated 17 February 2017

Ashburnham Road Surgery at 8 Ashburnham Rd, Bedford, Bedfordshire provides primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. The practice population is ethnically mixed, and provides medical services to a large South Asian population with others of Afro Caribbean, Eastern European and a lower number of white British patients. National data indicates the area served is one of average deprivation in comparison to England as a whole.

The practice serves a population of approximately 3335 patients with a higher than average population for both males and females ages 0-14 years of age and 25 to 39 years especially males. The practice population has a lower than average population of females aged 40 to 85 years and over.

The clinical staff team includes a male GP partner supported by a regular female locum GP, a female practice nurse and a male healthcare assistant. The team is supported by a practice manager reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

The practice had a branch surgery at 178, Ampthill Road, Bedford, Bedfordshire. This location was not inspected at this time.

The practice operates out of converted detached house and has no parking facilities, however there is public parking available nearby. Patients who require parking are advised to book appointments at the branch surgery which has adequate parking.

The practice is open Monday to Friday from 8am to 6.30pm, with extended hours appointments available on Monday evenings until 7.30pm. The practice is closed on Thursday afternoons from 1pm and has a reciprocal cover arrangement with a neighbouring practice. There are a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

Patients requiring the services of a GP outside these hours were directed to the out of hours service at Bedford Doctors On call (BEDOC).

Updated 17 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashburnham Rd Surgery on 25 August 2016. 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.
• Risks to patients were assessed and well managed.
• Staff were aware of their responsibilities in helping to safeguard and protect patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice held regular staff and clinical meetings where learning was shared from significant events and complaints.
• They worked well with the multidisciplinary team to plan and implement care for their patients.
• The practice had higher than average survey results for patient satisfaction.
• 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.
• 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 named GP and there was continuity of care, with urgent appointments available the same day.
• The practice offered extended hours appointments.
• The practice had made alterations to the building to offer better 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.

The areas where the provider should make improvement are:

• Continue to support and encourage patients to form a patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 February 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice undertook regular avoiding unplanned admissions audits.
• The percentage of patients with diabetes, on the register, with a record of a foot examination in the preceding 12 months was 99% above the CCG average of 90% and the national average of 89%.
• Staff worked together and with other health and social care services to understand and meet the range and complexity of patients’ needs along with assessment and planning of ongoing care and treatment.
• Longer appointments and home visits were available when needed.
• Patients identified with high frailty risks were given individual managed care plans and were regularly reviewed by the clinical team and discussed at multidisciplinary team meetings.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with more complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 17 February 2017

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, children and young people who had a high number of A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.

• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Parents were offered fast track appointments if they were particularly concerned.
• The practice’s uptake for the cervical screening programme was 63%, which was comparable to the CCG average of 76% and the national average of 74%.
• We saw positive examples of joint working with childrens community services including the child and adolescent mental health teams.
• Family planning and contraceptive advice was available.
• Interpreter services were available for young asylum seekers/child refugees.
• All staff were trained and alert for safeguarding, domestic violence, FGM (female genital mutilation) and people trafficking issues.
• All safeguarding and multi-agency safeguarding hub (MASH) requests for information were treated as high priority.
• The practice worked with local schools and any child with health and or social development problems would be referred to the child development centre.

Updated 17 February 2017

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice provided influenza, pneumonia and shingles vaccinations to this group.
• Referrals were made to the social services older people’s team and occupational therapy where there may be social care concerns or if a patient needed supported living help.
• If patients had mobility problems the receptionist would arrange for them to have appointments on ground floor.
• District nurses were alerted to housebound patients where there were concerns about their health.
• The practice held palliative care meetings in accordance with the national Gold Standard Framework (GSF) involving district nurses, GP’s and other local services.

Updated 17 February 2017

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 offered bookable, extended hours appointments on Monday evenings until 7.30pm for those patients that otherwise were not able to attend regular clinics due to work commitments.
• Telephone consultations were available daily.
• 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 provided NHS health checks for patients aged 40-74 years.
• Smoking cessation was available from the practice.
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• The practice worked with social services working age peoples team where there were social care concerns.

Updated 17 February 2017

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

• Staff had a good understanding of how to support patients with mental health needs and dementia.
• Patients who had more complex psychological or mental health illnesses were offered an extended appointment.
• The practice carried out regular health assessments with opportunistic and regular checks for patients at risk of dementia and/or cancer including memory assessments.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Patients with mental ill health were routinely monitored and an annual health reviews were offered.
• The practice carried out advance care planning for patients with dementia.
• The practice held a register of patients experiencing poor mental health and invited them to attend annual reviews. The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% above the CCG and national averages of 89%.
• The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 days after and not later than 56 days after the date of diagnosis was 86% above the CCG and national averages of 81%.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
• Reception staff were vigilant in checking that patients with poor mental health received their medication on time and regularly. They would also monitor their use of medicines and alert the GP to any concerns for example medicine being requested too soon, or too often.

Updated 17 February 2017

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

• Patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability were offered annual reviews which included a health assessment, medication review and an up to date health plan. Many of these patients were cared for by their families at home rather than in a residential care facility and the practice offered home visits to undertake reviews.
• Longer appointments were available at the practice for patients in this group.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Vulnerable patients were highlighted on the clinical system. GPs monitored the status of the patient and any further risk factors they may encounter and if high risk, their details were passed on to the local safeguarding team. The reception staff were also made aware of any potential vulnerable adults to help ensure that patients saw a GP regularly.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations to ensure they received effective health care despite of difficulties of dealing with homelessness, drug and alcohol addiction.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, including referrals to the community mental health team, P2R (addiction services) and the social services working or older age peoples team as appropriate.
• 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.
• The practice had identified approximately 2% of the practice patient list who were carers.
• Staff worked closely with carers to ensure they attend surgery for appointments and involving them in all decisions regarding the patient’s healthcare.