Priory Medical Practice

Updated 29 March 2017

The Priory Medical Centre is based at 48 The Glebe, Clapham, Bedford, MK41 6GA and provides services from a purpose built surgery. There is a large car park and disabled access is available. The practice serves a population of approximately 6,800 patients with a lower than average male and female population between the ages of 0 to 34 years and similar or higher than average population aged between 39 and 80 years. National data indicates the area served is less deprived in comparison to England as a whole and has low levels of unemployment.

There is a dispensary at the practice that provides medicine for patients who live more than one mile from a pharmacy, which we inspected on the day.

The ground floor reception and waiting areas are bright and open plan. The reception area is equipped with electronic patient arrival registration screens and a hearing loop for the hard of hearing. All consultation and treatments rooms are located on the ground floor. Administration and management offices, a staff rest room and meeting rooms occupy the first floor.

The clinical team consists of two GP partners (one male and one female), a female salaried GP, three practice nurses, a health care assistant (HCA) and two dispensary staff. The team is supported by a practice manager, a practice administrator and a team of reception and administration staff.

The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities. The practice undertakes a number of regulated activities; diagnostic and screening procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury.

The Priory Medical Centre is open between 8am and 6.30pm Mondays to Fridays. Appointments are offered between 9am and 5.30pm on Mondays to Fridays. When the practice is closed the out of hours service is provided by Bedford Doctors on Call (BEDOC) for patients requiring the services of a GP. Information about this is available in the practice and on the practice leaflet, website and telephone line. 

Updated 29 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Priory Medical Centre on 10 November 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 operated a personalised list for each GP to provide continuity of care.
• The practice worked well with multidisciplinary teams, including community services to plan and implement care for their patients.

• Data from the national GP patient survey published in July 2016 showed patients rated the practice higher than others for several aspects of care.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice held regular staff and clinical meetings where learning was shared from significant events and complaints.

• 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 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 March 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 percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months, was 74%, where the CCG and national averages were 78%.
• Longer appointments and home visits were available when needed.
• All these patients were offered 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 a multidisciplinary package of care.
• The practice offered a range of in-house services, for example 24 hour blood pressure monitoring, ECG, phlebotomy, spirometry testing service (testing for chronic obstructive pulmonary disease) and smoking cessation.
• All patients in this group were offered flu vaccinations at appropriate times. Poor attenders could be given review checks and seasonal vaccinations opportunistically.

Updated 29 March 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 relatively 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.
• The practice’s uptake for the cervical screening programme was 73%, which was comparable to the CCG average of 83% and the national average of 81%. The practice were actively encouraging women to attend by sending reminders and offering information in a range of languages and sending reminders.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors. Ante-natal clinics were held weekly by a community midwife in the surgery.

Updated 29 March 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.
• All patients over the age of 75 had a named GP and the personalised lists enabled good support to patients in this group.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Individual care plans were discussed at practice meetings to avoid unplanned admissions for patients identified as at risk.
• The practice dispensary team and GPs offered weekly blister packs to people who needed support to manage their medication.

Updated 29 March 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 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 offered health checks to all new patients, for everyone over the age of 16 years and those aged 40 -74 years, these included blood tests.
• Telephone consultations were available, so that results could be discussed over the phone without patients having to attend a face to face appointment.

Updated 29 March 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.
• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 77% where the CCG average was 86 and the national average was 84%.
• The practice nurse undertook ad-hoc dementia screening and could refer patients to the memory clinic if appropriate.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• Performance for mental health related indicators were above or in line with local and national averages. For example, the percentage of patients with diagnosed psychoses who had a comprehensive agreed care plan was 88% where the CCG and national averages were 89%.
• The practice informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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.
• The lead GP had a specialist interest in mental health and we saw examples of specific support given including referrals to specialist services; both community and in-patient services.

Updated 29 March 2017

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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly 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 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 a register for carers, they had identified 84 patients (1.2% of patients registered) on the practice list as carers. The practice made efforts to identify and support carers in their population.
• Homeless patients were well supported and given information on obtaining care via the local nominated surgery.
• Patients with alcohol or drug related problems were referred to the Hub (a local support service) in Bedford for confidential treatment.
• The practice worked closely with the local Crisis Resolution/Home Treatment (CRHT) teams who enabled patients who were in crisis, and not able to function at their normal level, to be supported in their own homes.