You are here

Bridge Street Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 28 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge Street Medical Centre on 11 January 2017. 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.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • 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.
  • Feedback from patients about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice in line with, or above, others for most aspects of care.
  • 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.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Patients said there was continuity of care, with urgent appointments available the same day.
  • There was a clear leadership structure and staff felt well supported by management.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • There was scope to improve the minutes of various team meetings to evidence improvement and shared learning.
  • The practice should continue to promote the patient participation group and encourage feedback from patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 February 2017

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. However there was scope to improve the recording of minutes where these lessons were shared.
  • 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.
  • Arrangements were in place to respond to emergencies and major incidents.
  • We reviewed three personnel files and found that all of the appropriate recruitment checks had been undertaken for all staff prior to employment. For example, proof of identification, references, qualifications, registration with the appropriate professional body and the appropriate checks through the Disclosure and Barring Service listed.
  • Appropriate standards of cleanliness and hygiene were maintained. We saw evidence of staff cleaning checks and monitoring of the cleaners and staff reported any issues raised. We saw evidence that actions were planned or taken to address any improvements identified in the audit.
  • The practice had a legionella policy, water temperatures were checked regularly and taps were run when they were in limited use.
  • The practice had 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.

Effective

Good

Updated 28 February 2017

The practice is rated as good for providing effective services.

  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. QOF is a system intended to improve the quality of general practice and reward good practice. The most recent published results showed that the practice had achieved 99% of the total number of points available, with 11% exception reporting.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • 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 28 February 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2016 showed patients rated the practice generally higher than others for many aspects of care. For example, 94% of patients said they had confidence and trust in the last GP they saw compared to the CCG and the national average of 95% and 85% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG and the national average of 85%.
  • Feedback from patients about their care was positive. 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.

  • The practice had a high student population, but had identified 52 patients as carers (0.5% of the practice list). Written information was available to direct carers to the various avenues of support available to them.

Responsive

Good

Updated 28 February 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • Results from the National GP Patient Survey published in July 2016 showed that patient’s satisfaction with how they could access care and treatment was above local and national averages. For example 76% of patients were satisfied with the practice’s opening hours compared to the CCG and the national average of 76% and 85% of patients said they could get through easily to the practice by phone; this was above the CCG average of 75% and the national average of 73%.
  • People told us on the day of the inspection that they were able to get urgent appointments on the same day when they needed them.
  • The practice had good 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. However there was scope to improve the minutes of meetings where this information was shared.

Well-led

Good

Updated 28 February 2017

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 an overarching governance framework which supported the delivery of the strategy and good quality care.
  • The provider was aware of and complied with the requirements of the duty of candour. The GP and practice manager encouraged a culture of openness and honesty.
  • The practice proactively sought feedback from staff and patients, which it acted on. There was a strong focus on continuous learning and improvement at all levels. 
Checks on specific services

People with long term conditions

Good

Updated 28 February 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 practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). The most recent published results were 99% of the total number of points available with a 11% exception reporting rate which was in-line with the CCG average and one percentage point above the national average (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). We saw that exception reporting across all indicators was generally in line with local and national averages.
  • Longer appointments and home visits were available when needed.
  • 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 and care professionals to deliver a multidisciplinary package of care.
  • The practice had administered flu vaccinations to 50% of patients on the practice at risk register during the 2016 to 2017 flu vaccination clinics at the time of the inspection.

Families, children and young people

Good

Updated 28 February 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. Childhood immunisation rates for the vaccinations given were low when compared to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds from April 2015 to March 2016 were below the CCG and national averages of 90%, with the practice achieving 85% to 88% in three sub-indicators and 97% in one sub-indicator. Five year olds were from 73% to 86% which was also below the CCG average of 88% to 93%. The practice had a high student population and reported a high proportion of overseas patients and families with limited records of previous childhood immunisation.
  • 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 83%, which was above the CCG and the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
  • 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, health visitors, college and school nurses.

Older people

Good

Updated 28 February 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice worked closely with the multi-disciplinary team, out-of-hours and the nursing team to ensure proactive palliative care planning.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were above local and national averages.
  • The practice operated a daily ‘Quick Access clinic’ for urgent, on the day appointments which began at 11am. The practice ensured that a quota of these appointments were designated to patients aged over the age of 65, as we were told they have identified a need for this within the patient population.

  • The practice had administered flu vaccinations to 61% of patients aged over 65 years during the 2016 to 2017 flu vaccination clinics at the time of the inspection.

Working age people (including those recently retired and students)

Good

Updated 28 February 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 encouraged its patients to attend national screening programmes for bowel and breast cancer screening. The bowel cancer screening rate for the past 30 months was 58% of the target population, which was in-line with the CCG average of 59% and the national average of 58%.The breast cancer screening rate for the past 36 months was 61% of the target population, which was below the CCG average of 74% and the national average of 72%.
  • Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for patients aged 40–74. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.
  • The practice operated a daily ‘Quick Access clinic’ for urgent, on the day appointments which began at 11am. During the university term time, the practice also operated a daily walk-in clinic for young people aged 17-25. This operated from 11am to 12 midday to ensure ease of access for students.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 February 2017

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

  • The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 93%, which was above the CCG average of 90% and the national average of 89%. Of the 94 patients identified as experiencing poor mental health on the practice register since April 2016, 77% had received a health check with appointments scheduled for the remaining patients.
  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2015 to 31/03/2016) was 88%, which was in-line the CCG average of 88% and above the national average of 84%. At the time of our inspection the practice register had recorded 13 patients identified as having dementia, of these 88% had a care plan in place and had undergone a review since April 2016.The practice referred patients to various support services as required.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 28 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice had identified 11 patients with a learning disability on the practice register. We saw that since April 2016, 55% had received a recent health review with appointments planned for the remaining patients. 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.