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Bridge Street Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 23 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge Medical Street Practice on 11 May 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 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.
  • Patients appreciated being able to make appointments on the same day and if wanted being able to pre-book an appointment with a preferred GP.
  • The practice was in the later stages of building an extension which would ensure good facilities were available to treat patients and meet their needs, for example, a lift had been installed and disabled access improved.
  • 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 improvements are:

  • The practice should continue to seek out proactive ways to identify patients with caring responsibilities and offer health checks and advice about support services.

  • The practice should continue to monitor patient satisfaction with telephone access to the surgery and where possible find methods to improve this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 September 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, information, 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.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 23 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national averages.

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

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals, mentoring, 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 23 September 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 said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • 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.

Responsive

Good

Updated 23 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the Clinical Commissioning Group and local Federation to secure improvements to services where these were identified, for example, to improve weekend access to GP services for vulnerable patients.

  • Patients said they found it helpful to be able to see a GP on the day but often had to wait if they wished to see a particular GP.

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

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 23 September 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. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was a 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 provider was 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 and had been consulted during the planning of the extension.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 23 September 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. Several of the GPs had expertise in treating patients with long term conditions, for example, diabetic patients could be initiated on insulin at the practice rather than having to go to hospital.

  • The practice's performance for diabetes management was similar to or slightly higher than national averages, for example, 93% of diabetic patients had had a recent foot examination compared to the national average of 90%.

  • Longer appointments and home visits were available when needed.

  • All patients identified as being at risk of hospital admission had a named GP and a structured annual review to check their health and medical 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 provided care for up to 66 residents in a local care home, with two ward rounds each week.

  • Home visits were available when needed.

Families, children and young people

Good

Updated 23 September 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 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.

  • Data showed 81% of eligible women had received a cervical screening test compared with the national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered 24-hour and six-week baby checks.

  • Young children who were ill were always offered an urgent appointment with a GP even if the surgery was fully booked.

  • Staff told us they had good working relationships with midwives, health visitors and school nurses.

  • One of the GPs had an interest in palliative care for children and was medical director for a local children’s’ hospice. We received positive feedback from this service about the care and support provided by the practice.

Older people

Good

Updated 23 September 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.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those who needed them.

  • Older patients at risk of hospital admission had been identified and care plans developed and special notes provided on their records for out of hours services to help avoid unnecessary or inappropriate hospital admissions

  • The practice provided care for approximately 66 patients living in a local care home, most of whom were living with dementia. There was a half day visit on Mondays to review care plans and a second visit on Thursdays to deal with any developing health issues and if necessary contact the AVS (the advanced visiting service is a paramedic led service which could support patients and potentially avoid hospital admission)

  • Nurses visited housebound patients at home to provide immunisations and vaccinations such as for flu and shingles.

Working age people (including those recently retired and students)

Good

Updated 23 September 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.

  • Pre-bookable appointments were available until 7.30pm on Thursday evenings.

People experiencing poor mental health (including people with dementia)

Good

Updated 23 September 2016

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

  • 96% of patients with severe mental health problems had a comprehensive agreed care plan documented in their records 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.

  • 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.

  • The practice provided care for up to 66 patients living in a local care home, many of whom were living with dementia. One of the comment cards said how well the practice looked after a relative who lived in this care home.

People whose circumstances may make them vulnerable

Good

Updated 23 September 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 homeless people, those with a learning disability, and those with alcohol or substance misuse problems.

  • The practice offered longer appointments for patients with a learning disability and staff were often aware of an individual patient’s needs and preferences

  • 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 identified approximately 0.60% of its patient list as having caring responsibilities. It had recognised that this was a low figure and had identified a number of actions it was taking needed to take to improve this and provide better care.