26 August 2016
Dr J Kedward and Partners provides primary medical services from the London Road Surgery located at The Health Centre, 84-86 London Road, Bedfordshire.
The practice has a branch surgery at Elstow Medical Centre, Abbeyfields, Bedford and patients can access services from either of these sites. Both sites were inspected as part of this inspection.
The practice has 15,359 registered patients. The practice has a relatively high turnover of registered patients and, with 27% of patients under 18 years of age, also has a younger age profile than the England average of 22%.
According to national data the geographical area covered by the practice is in the fourth more deprived decile. The prevalence of patients with health related problems in daily life is 47% compared with national average of 53%.
Life expectancy averages for patients is lower than national averages. For males it is 79 years, with the local CCG average 80 years and the England average 79 years. For women, the life expectancy for patients at the practice is 82 years, the local CCG average and the England average is 83 years.
The practice has 0.6% of its registered population living in nursing homes compared to the national average of 0.5%.
The London Road Surgery is a purpose built medical centre, which is approximately 50 years old. The practice shares the building with other health and care services.
Elstow Medical Centre is a modern, purpose built premises providing services approximately four miles away across the town of Bedford. Facilities and space are good. The practice moved into the building in 2008.
Consultation and treatments rooms are all on the ground floor in each building.
The clinical team at the practice is made up of eight GP partners, two salaried GPs, one nurse practitioner, one minor illness nurse and two practice nurses and two health care assistants. At the time of our inspection four trainee GPs were also at the practice. Administration and management is provided by the practice manager, office manager and a team of 18 administrators and reception staff, providing support across a broad range of roles and duties.
The practice provides services under the auspices of a Personal Medical Services (PMS) contract.
- The main site, at the London Road Surgery, is open between 8.00am – 12.30pm and between 1.30pm and 6pm from Monday to Friday.
- Appointments are available between 08.30am and 11.10am in the morning and from 2.00pm until 5.30pm in the afternoon.
- Extended hours appointments are offered from 6.40pm until 8.00pm on Wednesday evening.
- The branch site, at Elstow Medical Centre, is open between 8.00am - 12.30pm and between 1.30pm and 6.00pm from Monday to Friday.
- Extended hours are offered on Saturday morning between 09.00am and 12.00pm for pre-bookable appointments.
During the evening, night and weekend, when the practice was closed, services were provided by Bedford on Call (BEDOC).
26 August 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at London Road Surgery and the branch site of Elstow Medical Centre on 23 February 2016.
Throughout our report, when we refer to ‘the practice’, we are including both sites, unless specifically mentioned by name. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
- The practice had a clear vision, had recognised the needs of patients in the community it served and set out to deliver services to meet the needs of its patients.
- The partners had worked constructively to create an open and transparent approach to safety. A clear system, which was made known to all staff, was in place for reporting and recording significant events.
- Risks to patients were identified, assessed and appropriately managed. For example, the practice implemented comprehensive recruitment checks for new staff, undertook regular clinical reviews and followed up-to-date medicines management protocols.
- We saw that the staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were encouraged and supported to access relevant training, to ensure they had the skills, knowledge and experience to deliver effective care and treatment.
- Feedback from patients was generally positive. Patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Comments from patients on the 20 completed CQC comment cards confirmed these views.
- Results from the GP Patient Survey published in January 2016 were generally positive, with most outcomes comparable with local and national averages. For example, 74% of patients would recommend the practice to someone new to the area, which was in line with the local CCG and national average of 79%.
- The practice provided clear and comprehensive information to patients about the services available. Leaflets with advice about how to complain or provide feedback were available to patients in the waiting area and published on the practice website. Where appropriate improvements were made to the quality of care as a result of complaints and concerns. Outcomes from complaints were shared and learning opportunities identified as appropriate.
- Appointments were readily available. Urgent appointments were available the same day, although not always with the patients named or usual GP. Ninety percent of patients said the last appointment they got was convenient, which was comparable to both local and the national average of 92%.
- Services were provided from two sites across Bedford, patients could attend at either location. Both sites occupied purpose built premises which had access to good facilities and equipment in order to treat patients and meet their needs.
- There was a clear leadership structure and we noted there was positive outlook among the staff, with good levels of morale in the practice. Staff said they felt supported by management.
- The practice proactively sought feedback from staff and patients in a variety of ways, which it acted on.
- An externally funded project had facilitated the provision of a ‘Community Health Champion’. The project was identified as a ‘social prescribing’ initiative, designed to improve access to services for people who may face health inequalities.
- 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 review issues concerning patient confidentiality at reception and consider what further action may be available to protect patient sensitive and personal information.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
26 August 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.
- 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 constructively with relevant health and care professionals to deliver a multidisciplinary package of care.
- The practice had created positive links with local groups and charities which offered support and advice to patients, for example with Diabetes UK.
- The practice had clear protocols in place to support the treatment of patients with long-term conditions. For example, the practice offered longer appointments to these patients and home visits were available when needed.
- The practice held records of the number of patients with long term conditions. These patients are seen at the surgery on a regular basis and invited to attend specialist, nurse-led clinics.
- Arrangements were in place to ensure patients with diabetes were invited for a review of their condition twice yearly.
- 96% of the patients on the diabetes register had influenza immunization in the preceding 01 August to 31 March 2015, which was comparable with the national average of 94%.
- Nurse led clinics ensured annual reviews and regular checks for patients with asthma and COPD were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions. All patients who were admitted to hospital were reviewed by the practice respiratory nurse after discharge.
26 August 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.
- 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 uptake for cervical screening was 80% which was in line with the national average of 82%.
- 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 and social services.
- The practice supported a number of initiatives for families with children and young people. For example, the practice held regular meetings with the Bedfordshire 0-19 Team, to support vulnerable children and families.
- Immunisation rates for all standard childhood immunisations were broadly similar to local CCG performance averages. The practice provided flexibility over times for immunisation appointments.
26 August 2016
The practice is rated as good for the care of older people.
- The practice had accurate and clear information about the patients it cared for. They had 11% of patients over 65 years of age and 1.5% over 85 years on the practice list. Most lived at their own homes, some with carers or other support. The practice had 201 carers recorded on their register, which represented approximately 1.5% of the patient list.
- The practice had 0.6% of patients living in residential care homes, which was in line with the national average of 0.5%.
- 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. GPs were able to offer home visits to those patients who are unable to travel into the surgery. On-the-day or emergency appointments were available to those patients with complex or urgent needs.
- The practice had clear objectives to avoid hospital admissions where possible. For example, when GPs visited patients who lived in residential care homes they ensured that patient medication was reviewed regularly and other routine tests were undertaken without the need for patient admission to hospital.
26 August 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 reflected the needs for this age group.
- The practice offered access to telephone appointments and telephone consultations to avoid unnecessary visits to the surgery.
- Extended opening hours were available at the London Road Surgery on Wednesday evening and at the Elstow Medical Centre on Saturday mornings.
26 August 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
- 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 hosted the alcohol counselling services.
- 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. Reception staff had additional training to facilitate easier access to services for patients.
- The practice’s computer system was able to identify to GPs if a patient was also a carer. The practice had worked hard to identify carers and had identified 201 patients as carers, which amounted to approximately 1.5% of the practice list
26 August 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, which included homeless people, travellers and those with a learning disability.
- The practice offered longer appointments for patients with a learning disability.
- The practice regularly worked positively and collaboratively 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.
- Patient registration processes had been simplified to make registration as a new patient easier. The practice offered temporary registration arrangements when required by patients.
- Staff had received awareness training to assist them in recognising 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.
- An externally funded project had facilitated the provision of a ‘Community Health Champion’, a project based initiative to work across social boundaries and improve access to services for people who may face health inequalities. Clear and positive links had been created and maintained with local support groups and organisation and national charities.