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The Bridges Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 31 October 2017

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of The Bridges Medical Practice on 2 December 2016. The practice was rated as requires improvement in the well led domain and good in safe, effective, caring and responsive domains. The overall rating for the practice was good. The full comprehensive report following the inspection on 2 December 2016 can be found by selecting the ‘all reports’ link for The Bridges Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection of The Bridges Medical Practice on 28 September 2017. The inspection was carried out to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 2 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

The practice had suitable governance arrangements and systems for assessing and monitoring risks and the quality of the service provision.

  • There were appropriate systems and processes in place to ensure prescription stationery was kept securely, logged and its usage tracked.

  • Records showed that training was planned for and there were completed records of training provided to staff, with dates identified for refresher training in line with practice policy.

  • Appropriate checks had been carried out with regard to safety of the premises used for the regulated activities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 October 2017

Effective

Good

Updated 31 October 2017

Caring

Good

Updated 31 October 2017

Responsive

Good

Updated 31 October 2017

Well-led

Good

Updated 31 October 2017

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

  • There were appropriate systems and processes in place to ensure prescription stationery was kept securely, logged and its usage tracked.

  • Records showed that training was planned for and there were completed records of training provided to staff, with dates identified for refresher training in line with practice policy.

  • Appropriate checks had been carried out with regard to safety of the premises used for the regulated activities.

Checks on specific services

People with long term conditions

Good

Updated 24 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.
  • Performance for diabetes related indicators was 89% which was similar to the CCG average of 94% and national average of 90%. The practice also offered an insulin conversion service and liaised closely with the diabetes specialist nurse at the local hospital.
  • Longer appointments and home visits were available when needed.
  • 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 and care professionals to deliver a multidisciplinary package of care.
  • The practice offered a range of additional in house services, including a portable device to monitor heart function over time in patients’ homes and spirometry to help diagnose and monitor lung conditions.
  • The practice made referrals to a local multidisciplinary service for patients with complex medical and social care needs.

Families, children and young people

Good

Updated 24 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.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The practice’s uptake for the cervical screening programme in 2015-16 was 80%, which was comparable to the CCG average of 84% and the national average of 82%.
  • Appointments were available outside of school hours.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • Same day appointments were available for children and those patients with medical problems that require same day consultation.
  • The practice had recently introduced a sit and wait system between 11.30am and 12.30pm every day to enable patients to be seen on the day. GPs and nurse practitioners offered this service each day and patients attending the sit and wait appointments were seen by their named GP where possible.
  • There were facilities for children including baby changing and a separate children’s area with a table, chairs and toys.

Older people

Good

Updated 24 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 patients, and offered home visits and urgent appointments for those with enhanced needs. The practice employed an emergency care practitioner and nurse practitioner who provided additional home visits during mornings and afternoons to patients.
  • All patients had a named GP to promote continuity of care.
  • One of the GPs partners had written a business plan for an elderly care service jointly funded by local practices aimed at hospital admission avoidance and supporting patients living in residential homes.
  • A GP had written the business plan for a community pharmacist to conduct medicine reviews for patients with complex needs on an ongoing basis.

Working age people (including those recently retired and students)

Good

Updated 24 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 offered a range of additional in house services, including minor operations, joint injections, treatment for vertigo, and dermatoscopy to examine skin lesions.
  • Early morning and late evening appointments were available with GPs, nurses, and nurse practitioners for patients who could not attend at other times.
  • The practice provided telephone consultations for patients.
  • Text messages were used for appointment reminders and to request feedback.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 February 2017

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

  • 94% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the CCG average of 86% and national average of 84%.
  • Performance for mental health related indicators was 95% which is comparable to the CCG average of 96% and national average of 93%.
  • The practice percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who had been reviewed within recommended timescales was 77% which was lower than the CCG average of 87% and national average of 83%. A review of patient records had taken place and appropriate clinical action had been undertaken by GPs.
  • 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 had registered as ‘dementia friendly’ and staff had undertaken training on how to support patients with dementia.

People whose circumstances may make them vulnerable

Good

Updated 24 February 2017

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, travellers and those with a learning disability.
  • 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.
  • The practice offered facilities to encourage access for patients speaking languages other than English, with mobility or sensory difficulties.
  • Notices were displayed in reception inviting patients with specific communication needs to inform the practice so that these could be accommodated.
  • The practice worked closely with drug and alcohol misuse services and offered a substitute prescribing service.