Archived: Bilborough Medical Centre

Updated 28 April 2017

Bilborough Medical Centre provides primary medical services to 9914 patients and is part of the Nottingham City Clinical Commissioning Group. Patients can access services at two sites:

• The main surgery – Bilborough Medical Centre, Bracebridge drive, Bilborough, Nottingham, NG8 4PN. The practice is located in a purpose built premise and includes an independent dental practice and pharmacy service. The practice has occupied its current premises since 1990 and all patient services are provided from the ground floor. The practice is accessible by public transport and car parking is available on site.

• A branch site - Assarts Farm Medical Centre, 8 Upminster Drive, Nuthall, Nottingham, NG16 1PT. We did not visit the branch surgery as part of our inspection.

The level of deprivation within the practice population is below the national average with the practice population falling into the second most deprived decile. Income deprivation affecting children and older people is below the national average.

At the time of inspection, the clinical team comprised of five GP partners, a pharmacist, two practice nurses, a phlebotomist and a healthcare assistant. The GP partnership and management were due to undergo significant changes shortly after our inspection. The practice is a teaching practice for medical students.

The clinical team is supported by a part-time managing partner (practice manager), an assistant practice manager and a team of reception and administrative staff.

The opening times at Bilborough Medical Centre are 8am to 6.30pm Monday to Friday and 8am to 12pm Saturday and Sunday. GP consulting times are from 9am to 12pm and 3.30pm to 6pm Monday to Friday. Extended hours were offered from 7am to 8am Monday and Tuesday as well as 8am to 12pm on Saturday and Sunday.

The opening times at Assarts Farm Medical Centre are 8am to 1pm and 3pm to 6.30pm on Monday to Friday; with the exception of Thursday when the surgery opens 8am to 1pm. GP consulting times are from 9am to 12pm and from 3.30pm to 6pm. Extended hours are offered between 6.30pm and 7.30pm on Wednesdays. Patients can access routine appointments on weekends at the main location.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by NEMS and is accessed via 111.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bilborough Medical Centre on 19 August 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• We inspected the practice at a time when the GP partnership was changing and staff were still being consulted about the changes. This meant a future change in the leadership structure and governance arrangements were being reviewed.

• The practice had a clear vision and strategy to deliver high quality care and promote positive outcomes for patients. However, the overarching governance framework did not always operate effectively to ensure the delivery of good quality care.

• Patients were at risk of harm because processes for managing vaccines and the cold chain process were not always effective and in line with recommended guidance.

• The management of records relating to the delivery of regulated activities needed to be strengthened to ensure they were detailed and held securely.

• Information about services and how to complain was available.The practice investigated and responded to complaints.

• There was a system in place for acting upon significant events and patient safety alerts.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• The practice was committed to providing training and professional development to ensure staff had the skills, knowledge and experience to deliver effective care and treatment.

• A regular programme of clinical audit demonstrated quality improvement, and we saw examples of full cycle audits that had led to improvements in patient outcomes.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice was proactive in coordinating integrated care pathways with other providers; and this was reflected in the wide range of services available to patients.

• The practice offered seven day access and most patients said they were able to obtain an appointment with a GP when needed. Telephone access was regularly reviewed by the practice and the patient participation group, as this was an area of concern for patients.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had a very engaged patient participation group (PPG) which influenced practice development.

We saw areas of outstanding practice including the following:

• The practice proactively engaged in public health initiatives to improve the health and wellbeing of patients within the local community. In May 2016, the senior GP partner and managing partner had received a national award in recognition of the “over 60s MOT preventative public health project” undertaken at the practice. Patients aged between 60 and 70 years with a smoking history were offered a lung health check. A mobile CT scanner was used and patients did not have to attend hospital for initial scans. Positive outcomes achieved from this project included early diagnosis of lung disease or lung cancer and early access to treatment options. This project also reduced the workload on secondary care by providing the service in a primary care setting which was closer to patients’ homes. The findings of the project was used to inform service delivery within the local area; and plans were in place to roll out this model of care in 2017 across some the Nottingham GP practices, in recognition of the benefits this created for patients.

• The practice had set up a “welfare rights benefit clinic” in September 2015 in liaison with other agencies. Families on low income and patients attending the weekly substance misuse clinic accessed this service for information and advice on finances, management of debt, housing and benefits.

The areas where the provider must make improvements are:

Ensure effective systems are operated to enable the provider to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients as well as to improve the quality and safety of services. This includes:

• Maintaining detailed records relating to the management of regulated activities securely: patient group directions, patient specific directives, and meeting minutes detailing discussions about significant events and patient safety alerts.
• The management of vaccines and cold chain by staff to ensure it is in line with recommended guidance.

The areas where the provider should make improvements are:

• Continue to proactively identify carers and ensure they are supported with their needs.

• Continue to review access to nurse and GP appointments and feedback from patients on waiting times by planning and monitoring staffing needs.

• Continue to review and improve telephone access and processes for making appointments in consultation with patients and the patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 28 April 2017

The provider was rated as requires improvement for safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Clinical staff had lead roles in chronic disease management and a wide range of services were provided. This included access to a diabetes specialist nurse clinic and spirometry for patients with diabetes, asthma and chronic obstructive pulmonary disorder (COPD). COPD is the name for a collection of lung diseases.

• Nationally reported data showed the practice performed well in the management of patients with long terms conditions with most patient outcomes above local and national averages.

• The care for patients with diabetes was prioritised. For example, patients had access to the diabetic retinopathy clinic and a diabetes specialist nurse; and positive outcomes  were achieved for patients. Performance for diabetes related indicators was 98.7% which was above the local average of 82% and the national average of 89.8%. This was achieved with an exception reporting rate of 11% which was in line with the local average of 10% and national average of 12%.

• The practice had an effective system in place to recall patients for 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 followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• Routine appointments were available seven days a week. Home visits were available when needed.

Updated 28 April 2017

The provider was rated as requires improvement for safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Immunisation rates were relatively high for most of the standard childhood immunisations. However, the storage of vaccines required improvement to ensure they were safe and effective in use.

• The management of vaccines required improvement to ensure they were safe for use.

• Routine appointments were available seven days a week and outside of school hours.

• The practice was awarded the ‘You’re Welcome’ status for meeting the criteria for young people friendly health services.

• Patients (aged 13 to 24 years) could access free condoms, sexual health information and advice as part of the c-card scheme.

• Family planning advice including long acting contraceptives such as implants and coils were available to patients.

• The practice had baby changing facilities and breastfeeding mothers were welcomed.

• Antenatal and post-natal care was provided in liaison with the midwife and health visitor.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and those at risk of abuse.

Updated 28 April 2017

The provider was rated as requires improvement for safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice had received a national award in recognition of the work undertaken as part of the “over 60s MOT preventative public health project”. Patients aged between 60 and 70 with a smoking history were offered a lung health check. A mobile CT scanner was used and patients did not have to attend hospital for initial scans. Positive outcomes achieved for patients included early diagnosis of lung cancer in a primary setting and closer to home, as well as support in receiving early treatment.

• Patients aged 75 years and over were assigned a named GP who was responsible for overseeing their care.

• Nationally reported data showed the practice had achieved maximum Quality and Outcomes Framework (QOF) points (100%) for conditions commonly found in older people including heart failure, osteoporosis and rheumatoid arthritis.

• The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services.

• The practice held monthly multidisciplinary meetings to ensure the care needs of patients assessed as being at high risk of hospital admission and those receiving palliative care were reviewed and had care plans in place.

Updated 28 April 2017

The provider was rated as requires improvement for safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Although patients could access travel vaccinations available on the NHS and those received on private treatment, the storage of vaccines required improvement to ensure they were safe and effective in use. The practice was a designated Yellow Fever centre.

• The practice offered seven day access for its patients and this ensured choice and flexibility. Opening times were between 8am and 6.30pm five days a week and 8am to 12pm on weekends. Extended hours were offered two mornings a week at the main location and one afternoon at the branch site.

• The practice hosted a wide range of services for its patients to enable access closer to home. This included smoking cessation clinics, non-obstetric ultrasound scanning, podiatry and physiotherapy services. Patients could also access in-house services which included minor surgery and treatment room services such as phlebotomy and ear irrigation.

• 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 rates for bowel and cancer screening were below the local and national averages. For example, the practice had achieved an uptake rate of 46% for bowel cancer screening which was below the local average of 53.5% and the national average of 58%.

• Staff were working towards improving the uptake rates through patient education, display of information and engagement with the patient participation group. The practice had also displayed a case study detailing a patient’s experience of undertaking the bowel cancer screening.

• Approximately 82% of patients with hypertension had the last blood pressure reading measured in the preceding 12 months which was in line with the local and national averages of 83%. This was achieved with an exception reporting rate of 3% which was in line with the local and national averages of 4%.

Updated 28 April 2017

The provider was rated as requires improvement for safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

Nationally reported data showed positive outcomes were achieved for patients.

• 93% of patients with poor mental health had their care reviewed in a face to face meeting in the preceding 12 months compared to the CCG average of 87% and the national average of 89%. This was achieved with an exception reporting rate of 17% which was above the local average of 12% and national average of 13%.

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months compared to the CCG average of 86% and the national average of 84%. This was achieved with an exception reporting rate of 3% which was below the local average of 5% and national average of 7%.

• The practice worked with multi-disciplinary teams in the case management of patients.

• Patients had access to a counsellor for mental health support and staff had a good understanding of how to support patients with mental health needs and dementia.

• Information was available for 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 accident and emergency and where they may have been experiencing poor mental health.

Updated 28 April 2017

The provider was rated as requires improvement for safe, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, a GP with a special interest ran a weekly substance misuse clinic with a specialist substance misuse worker.

• The patient participation group and some practice staff helped in setting up a food bank at a local church. Patients on low incomes were given vouchers and referred to the weekly service.

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

• A flexible approach was taken when carrying out annual health checks for people with a learning disability and this included undertaking them at a local day centre and providing easy read information.

• Patients whose first language was not English had access to translation services and some of the staff spoke other languages.

• Staff were aware of their responsibilities of safeguarding vulnerable adults and children and had received relevant training including domestic violence awareness.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.