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Bell House Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 12 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bell House Medical Centre on April 2014. 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 and all staff were aware and involved in issues relating to patient safety.

  • 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.
  • 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.
  • Generally patients said they found it easy to make an appointment although some patients reported having to wait longer if they wished to see a named GP. Patients told us they could always see a GP if they needed to with urgent appointments available the same day.
  • The practice had adequate facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management and demonstrated evidence of a cohesive team. 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.

There were areas where the practice should make improvements:

  • The practice should ensure that information regarding how to complain is provided in the waiting area.
  • Continue to carry out regular fire drills
  • Continue to identify and support carers
  • Review the practice business continuity plan routinely to ensure information remains up to date

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 July 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and evidence that learning took place as a result of investigation of these.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. For example, all staff were trained in safeguarding and the practice had a policy and lead GP to provide guidance to staff.
  • Risks to patients were assessed and well managed. 

Effective

Good

Updated 12 July 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance. For example, we saw evidence of audits carried out by the practice in response to changes in best practice from the National Institute of Care Excellence (NICE).
  • Clinical audits demonstrated quality improvement in clinical areas, such as arthritis.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 12 July 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Patients spoke positively regarding their care and treatment at the practice and told us they were treated with compassion, dignity and respect. They reported feeling involved in decisions about their care and treatment and patient survey results aligned with these views.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice maintained a register of carers and offered flu vaccinations and health checks to this group of patients.

Responsive

Good

Updated 12 July 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population, for example, the practice were aware of the significant increase in patients at higher risk of diabetes and had taken steps to actively screen these patients.
  • The practice engaged with the NHS England Area Team and Luton Clinical Commissioning Group to secure improvements to services where these were identified and participated in local enhanced service schemes.
  • Patients said generally they found it easy to make an appointment but there was a longer wait for appointments with a named GP. They reported that they could always see a GP if they needs to with urgent appointments available the same day.
  • The practice had adequate facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available, but we noted this was kept behind the reception desk. There was information on the practice website which explained the complaints procedure which was easy to understand and we saw that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 12 July 2016

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management and were aware of who was the lead GP for each area. The practice had a number of policies and procedures to govern activity and held regular meetings where governance was discussed.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The partners and management were aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels and we saw evidence of feedback and briefing for staff in training as well as feedback from the CCG meetings and educational sessions.
Checks on specific services

People with long term conditions

Good

Updated 12 July 2016

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 had systems in place to address patients who did not attend for medication review and suffered with a long term condition.
  • Longer appointments and home visits were available when needed.
  • 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 the most complex needs, the named GP worked with relevant health care professionals to deliver a multidisciplinary package of care.
  • The practice carried out audits to ensure best practice was provided to patients with long term conditions.
  • The practice had access to an Asian dietician and language specific education programmes for patients with diabetes.
  • The practice offered ‘one stop’ appointments for patients with more than one long term condition to prevent the need for several visits to the practice.

Families, children and young people

Good

Updated 12 July 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 considered 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.
  • Cervical screening rates were 76% which were comparable with the national average of 74%.
  • Appointments were available outside of school hours and whilst the front entrance to the practice was not easy for pushchair or mobility aid access, the practice had made provision for access via the back of the building.
  • We saw positive examples of joint working with midwives and health visitors.
  • Chlamydia screening was also offered to young people aged from 15 to 24 years.
  • The practice had access to a mental health crisis team specifically for patients aged 16 to 35 years.

Older people

Good

Updated 12 July 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 and all patients had a named GP.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs and held a list of patients who were housebound.
  • Older patients at risk of admission to hospital, who were vulnerable or on the palliative care register were discussed at monthly multi-disciplinary meetings to ensure an holistic approach to care.
  • The practice had reminders on the computer system to alert staff to older patients who required a health or medicine review.

Working age people (including those recently retired and students)

Good

Updated 12 July 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.
  • Post-natal checks were available which included depression screening and family planning advice and eight week baby checks were provided prior to immunisation.
  • Patients who had suffered gestational diabetes were screened yearly for diabetes.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 July 2016

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

  • 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
  • 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months compared with the national average of 88%
  • 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.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • All new patients who were newly diagnosed with dementia were referred to the psycho-geriatrician.
  • The practice had access to the mental health crisis team.
  • The practice 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 patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 12 July 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.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice had recently employed two staff who could speak Bengali and Urdu to help patients whose first language was not English as there had been a significant increase in patients of this ethnic origin.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • Information regarding about how to access various support groups and voluntary organisations was provided for vulnerable patients, for example the community drugs and alcohol service.
  • 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.