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Inspection Summary


Overall summary & rating

Good

Updated 7 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bingley Medical Practice on 12 January 2016. 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 their responsibilities to raise concerns and report incidents and near misses.
  • Risks to patients were assessed and safely managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they could book urgent appointments when they needed to and these were available the same day.
  • 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. We found positive working relationships between the staff.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

  • The practice offered a district wide immediate access service providing advice and support to people with mental health problems.

  • A&E attendances were significantly lower than the national average with prevalence at 69% of the national average (2885 attendances in 2014 from a practice population of more than 12500) the third best performing practice in the CCG.

We saw areas of outstanding practice:

  • The practice provided a ‘temporary’ practice manager to ‘Bevan Healthcare’ which provides services for homeless people, people in temporary or unstable accommodation, refugees or those seeking asylum and others who find it hard to access the health care and support they need. The practice works closely with other organisations and with the local community in ensuring bespoke services are provided to meet patients’ needs.

  • The practice had obtained the Leeds Clinical Teaching Excellence Award in 2012, only one other primary care organisation had achieved this ward. The award took into consideration that Imperial College of London medical students chose this practice for out of London placements. The practice offered medical student training for Year 1, 2, 5 and extended research students from the Leeds Medical School. The practice regularly had three GP registrars on placement and three of the partners were qualified trainers. Nurse mentoring was provided for nurses in training and qualified nurses. All the nurses were qualified nurse mentors for training. The practice offered work experience for A level students who hoped to study Medicine as a career.

  • The practice had obtained the Quality Practice Award in 2011 via the Royal College of General Practitioners (RCGP). This involved an onsite visit which took place during a normal working day to assess the practice and interviews with members of staff.

The areas where the provider should make improvement are:

  • Develop a more effective audit of the named GP prescription pads in order to make them more secure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 April 2016

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 learned and shared widely throughout the practice, action was taken to improve safety in the practice and improve patient care.

  • When there were unintended or unexpected safety incidents, people received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • The service had a dedicated Safeguarding lead who demonstrated a good understanding of the needs of the local population and promoted this within the practice.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 7 April 2016

The practice is rated as good for providing effective services.

  • Staff referred to best practice guidance including the National Institute for Health and Care Excellence.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for staff.

  • Staff worked well with multidisciplinary teams, to understand and meet the range and complexity of people’s needs.

  • The practice PPG met on a bi-monthly basis.

  • The practice management team was involved in local and national groups.

  • The practice had obtained the Quality Practice Award in 2011 via the Royal College of General Practitioners (RCGP).

  • A&E attendances were significantly lower than the national average with prevalence at 69% of the national average (2885 attendances in 2014 from a practice population of more than 12500) the third best performing practice in the CCG.

Caring

Good

Updated 7 April 2016

The practice is rated as good for providing caring services.

  • 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.

  • Staff treated patients courteously, with kindness and respect, and maintained confidentiality.

  • Patient feedback regarding the practice was generally positive; however data showed that patients rated the practice higher than Clinical Commissioning Group (CCG) averages for most aspects of care.

Responsive

Good

Updated 7 April 2016

The practice is rated as good for providing responsive services.

  • The practice 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.

  • Patients said urgent appointments were available the same day and that the last appointment they had was convenient.

  • 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 that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • The practice had an active patient participation group PPG. We spoke with five members of the group on the day of the inspection.

  • The practice offered two self-check rooms for patients to check their blood pressure.

Well-led

Good

Updated 7 April 2016

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

  • The practice had a clear vision and strategy as to how it would continue to meet patients’ needs in the future. Staff were clear about the vision and their responsibilities in relation to this.

  • 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. There were systems in place to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents

  • The practice proactively sought feedback from staff and patients, which it acted on. The PPG was encouraged to provide feedback and meet regularly.

  • There was a strong focus on continuous learning and improvement at all levels.

  • The practice had obtained the Leeds Clinical Teaching excellence award in 2012, only one other primary care organisation had achieved this ward. The practice was recognised nationally as being an excellent base for providing the training and experience for new GPs and as a result medical students from the medical School of Imperial College London sought placements at Bingley Medical Practice. The practice regularly had three GP registrars on placement and three of the partners were qualified trainers. Nurse mentoring was provided for nurses in training and qualified nurses. All the nurses were qualified nurse mentors for training.

  • The practice offered work experience for A level students who hoped to study Medicine as a career.

Checks on specific services

Older people

Good

Updated 7 April 2016

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.

  • We found easy access for those with poor mobility e.g. lifts and disabled parking.

  • A large nursing home was located directly opposite the practice and the practice were proactively working with the home to make sure that the residents were supported appropriately.

  • The practice held Palliative Care Gold Standard meetings involving District Nurses, GP’s and the Macmillan nurse.

People with long term conditions

Good

Updated 7 April 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

  • The practice held a multi-disciplinary Long Term Conditions clinic weekly

  • Outcomes for patients with diabetes were similar to the national average

  • 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 medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 7 April 2016

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

  • Access for this group was effective as the practice was open on Mondays 7am to 8pm.

  • There were systems in place to identify and follow up children living in disadvantaged

  • 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 numbers of women attending for cervical screening was in line with national averages.

  • Appointments were available outside of school hours and the premises were suitable for children and babies with toys available.

  • We saw good examples of joint working with midwives, health visitors and school nurses.

  • The practice routinely made early contact with new parents.

  • There were alerts on patient records where there were active child protection plans.

Working age people (including those recently retired and students)

Good

Updated 7 April 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 had introduced some 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 text messaging service to remind patients about appointments and consent for this was sought from patients before implementation.

People whose circumstances may make them vulnerable

Good

Updated 7 April 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 homeless people, travellers and those with a learning disability.

  • The practice offered longer appointments for people with a learning disability and annual health checks.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice had told 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.

  • We saw that seven adults were on the adult safeguarding register. There were alerts on patient records where there were active adult protection plans.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 April 2016

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

  • 45% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
  • 93% of people experiencing poor mental health have a comprehensive care plan, 85% had a record of blood pressure, 90% had a record of alcohol consumption.
  • Weekly counselling sessions were offered at the practice to patients.

  • The practice regularly worked with multi-disciplinary teams in the case management of people 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 may have been experiencing poor mental health, and who had attended accident and emergency.

  • Staff had a good understanding of how to support people with mental health needs and dementia.

  • 72 Palliative care patients were on the practice register. Gold Standard Palliative care meetings were held every month.

  • 112 mental health patients were recorded on the practice register. The practice had set up a service where Matrons visited care homes for proactive management (mainly for patients with Schizophrenia).

  • 49 patients were on the learning disability register. Staff from the community trust attended some of these reviews and provided the practice with accessible information.

  • The practice offer a district wide first response service for immediate access to advice and support for Mental Health problems.