Archived: Bilborough Medical Centre

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