Bulkington Surgery

Updated 31 March 2016

Bulkington Surgery is located in Bulkington, a village near Bedworth, north Warwickshire. The practice covers a large rural area and comprises the villages of Bulkington, Burton Hastings, Withybrook, Shilton and Ansty. The boundary extends to the outskirts of Coventry, Bedworth and Nuneaton. The practice is a partnership and provides primary medical services to patients in a semi-rural area. Locally there are some areas of deprivation.

The practice is housed in a purpose built facility built in 1999 and located in the village centre. The health visiting team, physiotherapy team and children’s centre are located next door. There were 5,440 patients registered with the practice at the time of the inspection; 26% were aged over 65. This includes patients, some with dementia living within warden supported accommodation on three sites.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice has four partner GPs (male and female), two part time practice nurses and a healthcare assistant. They are supported by a practice manager and administrative and reception staff.

The practice is open from 8.30am to 12.30pm and from 1.30pm to 6.30pm during the week. Appointments were available throughout those times. Extended hours opening was not currently provided, having been stopped several month before our inspection because there was no patient demand. The practice continues to keep this under review and would reinstate this if demand changed. When the practice is closed, patients can access out of hours care through NHS 111. The practice has a recorded message on its telephone system to advise patients. This information is also available on the practice’s website and in the patient practice leaflet.

Home visits are available for patients who are unable to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book new appointments without having to telephone the practice.

The practice treats patients of all ages and provides a range of medical services. This includes minor surgery, disease management such as asthma, diabetes and heart disease. Other appointments are available for maternity care, family planning and smoking cessation.

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bulkington Surgery on 18 January 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well led services.

Our key findings across all the areas we inspected were as follows:

• There was a consistently high level of patient satisfaction with all aspects of the practice and care received.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• GPs had areas of specialist training that took into account the needs of the practice population.

• Risks to patients were assessed and well managed.

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

• 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.

• Information about services and how to complain was available and easy to understand.

We saw the following areas of outstanding practice:

• The practice was aware of the effects of loneliness on older people and worked with the University of the Third Age (U3A) which ran a befriending service in the village community centre. This was used by 10-20 patients every month.

However there were areas of practice where the provider should make improvements:

• Review the frequency of checks of uncollected prescriptions to minimise the risk of patients not receiving their medicines as prescribed.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 31 March 2016

The practice is rated as good for the care of people with long-term conditions. The practice used a chronic disease management system to monitor patients with chronic diseases. This was a responsibility held by the practice nurses. Patients at risk of hospital admission were closely monitored. Longer appointments and home visits were available when needed. Patients were reviewed at least annually, sometimes more frequently depending on the condition they had and its severity. All patients diagnosed with a long term condition 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 GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice also offered dietary, weight management and smoking cessation advice.

Patients newly diagnosed with cancer were given a comprehensive ‘starter pack’ of information. This included material issued by Macmillan and information about where additional support and advice could be obtained.

Updated 31 March 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 of abuse. For example, children and young people who had a high number of accident and emergency (A&E) attendances. All GPs had a specialist interest in child health and had received specialist training in paediatrics

The practice ran baby clinics and offered appointments with the midwife who was based at the practice. The practice had a policy of providing same day appointments for children and appointments were also available outside of school hours. The premises were suitable and accessible for children, with changing facilities for babies. We saw good examples of joint working with midwives, health visitors, school nurses and district nurses. The practice notified Child Health Services when babies and children did not attend for their vaccinations.

A comprehensive family planning service was offered and patients were encourage to attend pre-pregnancy counselling, to see a GP when pregnancy was achieved and then book an appointment with the practice midwife.

The practice website included a ‘teen zone’ to publicise services available for young people in a contemporary and relevant way.

The practice offered a number of online services including booking appointments and requesting repeat medicines.

Updated 31 March 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice had a large number of patients within this population group (26% of the total) and cared for patients who lived within warden supported accommodation on three sites. Proactive, personalised care was offered to meet the needs of the older people in its population. Clinical staff had an area of interest in older people and this was reflected in their training and experience. A GP attended the annual national conference for the care of the elderly and all GPs had completed training in safe prescribing in older people which had resulted in a reduction in anti-biotic prescribing.

A dementia care protocol was in place which detailed how the care of patients with dementia should be managed. Patients had an annual review (or more frequently if needed) with their carer, where appropriate. The practice was aware of the effects of loneliness on older people and referred patients to the University of the Third Age (U3A) which ran a befriending service in the village community centre.

Home visits were offered for those unable to reach the practice. Health checks were carried out for all patients over the age of 75 years. At the time of our inspection, the practice was delivering its 2015-2016 flu vaccination programme. The practice was involved with a frailty audit project which targeted patients who had been identified as being at increased risk. These patients were under enhanced review by a GP and the community nursing team. This work was also carried out in conjunction with social services and had resulted in a lower than average unplanned hospital admission rate for this population group.

A scheme was also in place to refer older patients to local leisure centres for supervised exercise classes for older people.

The practice had a protocol in place which encouraged advanced care planning and anticipatory prescribing. The practice worked to ensure all support was in place for end of life patients to be cared for at home, if this was their choice, rather than in secondary health care.

Updated 31 March 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. Telephone consultations were available for patients who were unable to reach the practice during the day. The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs for this age group. The practice nurse had oversight for the management of a number of clinical areas, including immunisations.

Updated 31 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams to plan care and treatment with patients who experienced poor mental health, including those with dementia. It carried out advanced care planning and annual (or more frequently if required) health checks for patients with dementia and poor mental health. This was in line with the practice’s mental health and dementia review protocol and included patients with a learning disability who lived in a local community home.

The GPs and practice nurses understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.

The practice had advised patients experiencing poor mental health how to access various support groups and voluntary organisations. There was close working with the community mental health team and patients could be referred or refer themselves to the local Improving Access to Psychological Therapies service for counselling and support. Counsellors met patients at the practice.

The practice had joined Dementia Action Alliance (DAA) and had undertaken a large amount of work and training on dementia to make the practice ‘dementia friendly’. This also led to staff members setting up a  'Friday Friends', a weekly café for patients and carers of patients with dementia, held in the village community centre. Staff used their own time to carry out fundraising and assist with the organisation and running of the group in conjunction with the patient participation group (PPG). 

There was a system in place to follow up patients who had attended accident and emergency (A&E). Staff had received training on how to care for people with mental health needs and dementia.

Updated 31 March 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 those patients with a learning disability. The practice had carried out annual health checks and offered longer appointments for patients with a learning disability. Carers of patients were included when appropriate.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had advised vulnerable patients on how to access various support groups and voluntary organisations. Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments and offered additional attention such as longer appointments. The practice identified and closely monitored vulnerable patients who frequently attended accident and emergency (A&E).

The practice had a large traveller population and had worked proactively for several years to increase the immunisation rates within this community and reduce the use of unnecessary anti-biotic medicines.

Staff had received training and knew how to recognise signs of abuse in adults whose circumstances made them vulnerable and children who were considered to be at risk of harm. 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.