Belmont Medical Centre

Updated 31 October 2017

Belmont Medical Centre is located in Hereford, a cathedral city and county town of Herefordshire. It is approximately 16 miles east of the border with Wales, 24 miles southwest of Worcester and 23 miles northwest of Gloucester. There is access to the practice by public transport from surrounding areas. There are also parking facilities on site. The practice currently has a list size of 7946 patients.

The practice holds a General Medical Services (GMS) contract with NHS England. The GMS contract is held between general practices and NHS England for delivering primary care services to the local communities. The practice provides GP services commissioned by NHS Herefordshire Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

The practice is situated in an area with mid average levels of deprivation with a higher number of patients registered at the practice who are unemployed (11%) compared with the local CCG average (4%) and national average (5%). The practice has a slightly higher than national average number of babies, young children, teenagers and adults in their 20’s, 30’s and 40’s. The premises are modern and purpose built. Patient services are all available on the ground level of the building. The practice premises form part of a complex which includes a pharmacy, physiotherapy and rehabilitation centre, a centre for natural health and a library.

The practice is currently managed by two GP partners (both male). The partners also employ three salaried GPs (all female). Two regular sessional locums (male and female) also work in the practice. They are supported by five practice nurses, one Health Care Assistant, a practice manager, an assistant practice manager, reception manager and a team of administrative and clerical staff. One of the GP partners also works as the CCG primary care prescribing lead.

On weekdays, the practice opens at 8am and closes at 6pm. The practice has a local arrangement with the CCG to close at 6pm. GP consultations generally commence at 8.10am to 11.30am, 2pm to 3pm and 4.30pm to 6pm on weekdays. The practice is part of a federation of 24 practices which offers extended hours GP appointments. Practice patients could therefore pre-book appointments and attend a surgery approximately 1 mile away from the practice. Appointments are available between 6pm and 8pm on weekdays and 8am to 8pm on weekends and bank holidays. The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to Primecare via the 111 service.

Updated 31 October 2017

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Belmont Medical Centre on 25 January 2017. The practice was rated requires improvement for providing safe, effective and responsive services, good for providing caring services and inadequate for being well-led with an overall rating of requires improvement. The full comprehensive report on the inspection carried out in January 2017 can be found by selecting the ‘all reports’ link for Belmont Medical Centre on our website at www.cqc.org.uk.

On 24 August 2017 we carried out an announced, comprehensive follow-up inspection to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 25 January 2017. This report covers our findings in relation to those requirements.

We found the practice had carried out a detailed analysis of the previous inspection findings, and had made extensive changes which had resulted in significant improvements. A comprehensive action plan detailed the actions taken and the processes that had driven improvements since our previous inspection.

Our key findings were as follows:

• Risks to patients were assessed and managed through practice meetings and through discussions with the multi-disciplinary teams.
• The practice had clearly defined systems to minimise risks to patient safety.
• The structured, open and transparent approach to the reporting and recording of significant events and complaints had been maintained and further developed since our previous inspection. Six monthly analyses identified themes and trends. Staff were aware of and understood their responsibilities to report these. Learning was shared with staff at team meetings.
• Arrangements for managing medicines kept patients safe.
• Staff were aware of current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment, including regular training updates.
• The practice had appropriate arrangements to identify patients who were carers to enable them to receive care, treatment and support that meets their needs. They worked in conjunction with Herefordshire Carers Support agency to achieve this.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Patients’ satisfaction with how they could access care and treatment was lower than local and national averages according to the National GP Patient Survey results published July 2017. Patients told us they were happy with the arrangements and could always get appointments as they needed them.
• Information about services and how to complain was available in a range of languages. Improvements were made to the quality of care as a result of complaints, concerns and patient feedback.
• There was effective oversight, planning and responses to practice performance.
• 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Continue to encourage patients to engage in national screening programmes for breast and bowel cancer.
• Continue to strive to improve the patient experience around access to appointments.

The practice is now rated as good for providing safe, effective, caring and well-led services, and requires improvement for providing responsive services. The overall rating for the practice is now good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 October 2017

The practice is rated as good for the care of people with long-term conditions.

• The practice held registers of those patients with long-term conditions.
• GPs were supported by the practice nurses in their lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine 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.
• Performance for overall diabetes related indicators was 100% which was above the CCG average of 95% and national average of 90%. Overall exception reporting was 19% which was above the CCG average of 11% and above the national average of 12%. Reviews of exception reporting showed that national guidance was followed. Patients had been encouraged to attend a structured education programme about the importance of screening, but a number of patients had not responded.

Updated 31 October 2017

The practice is rated as good for the care of families, children and young people.

• Children and young people were seen on the same day if they needed an appointment.
• There were systems to identify and follow up children who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• Immunisation rates were high for all standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. We saw evidence to confirm this including care planning.
• Performance for cervical screening indicators was in line with CCG and national averages. For example the percentage of women aged 25-64 receiving a cervical screening test in the last five years was 80%, compared with CCG average of 80% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of engagement and joint working with midwives and health visitors.

Updated 31 October 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 patients in its population and offered longer appointments where needed.
• They were responsive to the needs of older patients. Home visits were offered and urgent appointments for those patients unable to access the practice.
• The practice provided enhanced services for older people which included risk profiling, care planning and over 75s health checks.
• The practice held regular meetings with the multi-disciplinary team (MDT) for the planning and delivery of palliative care for patients approaching their end of life. The practice knew how many patients they had who were receiving palliative care and kept a palliative care register.
• The practice directed older patients to appropriate support services.

Updated 31 October 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 worked as part of a federation that offered appointments to patients outside of usual working hours. Patients could access services from 6pm to 8pm on weekdays and from 8am to 8pm on weekends and bank holidays at a local surgery one mile away.
• 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.

Updated 31 October 2017

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

• Longer appointments were available for those patients with mental health needs or dementia.
• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 100% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was above the CCG average of 90% and above the national average of 89%. Exception reporting was 15.6% which was above the CCG average of 12.7% and above national average of 12.7%.
• 82% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was slightly below the CCG average of 83% and national average of 84%. The practice had not exception reported any patients.
• Patients experiencing poor mental health (including those with dementia) were placed on a register, had a care plan in place and were invited to see a GP for a comprehensive review at least once a year.
• A dementia nurse was attached to the practice and held clinics when required and undertook home visits to see patients and carers. The nurse acted as a link between primary and secondary care and signposted patients to holistic services including a singing group.

Updated 31 October 2017

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

• The practice held registers of patients living in vulnerable circumstances.
• We saw evidence that circumstances were considered in care planning and treatment for vulnerable patients and the practice regularly worked with other health care professionals to deliver care and treatment.
• The practice had a dedicated list of patients (39) registered as having a learning disability. Nurses had completed training and had recently commenced health checks for these patients. Invites had been sent to 31 patients and health checks had been completed for 11patients in the last two months. The practice used information to support care planning and offered longer appointments for patients with a learning disability.
• The practice provided help and support for patients with caring responsibilities, liaising closely with Herefordshire Carers Support Agency to achieve this.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff were trained and 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.