Archived: Park Grange Medical Centre

Updated 17 May 2016

Park Grange Medical Centre provides services for 2552 patients. The surgery is situated within the Bradford City Clinical Commissioning group and is registered with CQC to provide primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

Park Grange Medical Centre is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services. They offer a range of enhanced services such as childhood immunisations, facilitating timely diagnosis and support for people with dementia and enhanced services for those with a learning disability.

There is a higher than average number of patients under the age of 39, in common with the characteristics of the Bradford City area. There are fewer patients aged over 40 than the national average. The National General Practice Profile states that 69% of the practice population is from an Asian background with a further 7.7% of the population originating from black, mixed or non-white ethnic groups.

There is a lead GP at the practice that works full time and four locum GPs that regularly support the practice on a sessional basis. One of these locum GPs is female. The practice is staffed by two part time practice nurses who work 8 hours per week each and two part time health care assistants (HCA’s). The practice also engages the services of a pharmacist. The clinical team is supported by a practice manager and a team of administrative staff. The staff team is reflective of the population it serves and are able to converse in several languages including those widely used by the patients, Urdu, Punjabi and English.

The practice catchment area is classed as being within one of the most deprived areas in England. People living in more deprived areas tend to have a greater need for health services.

Park Grange Medical Centre is situated within an older building with car parking available. It has disabled access and facilities. At the time of our inspection the surgery was undergoing a refurbishment and was building an extension.

The reception is open at 8.15am each day and closes at 6.30pm Monday to Thursday with appointments available between 8.30am and 6.30pm. On a Friday the practice offers late night appointments until 7.45pm. There is a drop in clinic at lunchtime each day between 12pm and 12.30pm.

When the surgery is closed patients can access the Pharmacy First minor ailments scheme or the walk in centre at Hillside Bridge Health centre. Patients are also advised of the NHS 111 service for non –urgent medical advice.

Updated 17 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Grange Medical Centre on 17 March 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, recording and reviewing significant events.
• Risks to patients were assessed and well 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. We saw evidence that the people affected received reasonable support and a verbal and written apology where necessary.
• Patients said that when they made an appointment it was convenient and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had begun an extension and refurbishment of the building.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff, patients and the patient participation group (PPG) which it acted on.
• We observed that for some staff recruitment checks had not been undertaken prior to their employment.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas of outstanding practice:

Diabetic patients were offered a proactive health and medication review prior to the month of Ramadan (this is ninth month of the Islamic calendar and Muslims traditionally fast during daylight hours). The practice aimed to assist patients to fast whilst maintaining control of their condition. Additional smoking cessation clinics were also held at this time.

The practice would contact people the day before an arranged review to remind them of this. They would then contact them an hour before they were due to attend the review, this had reduced the number of people who did not attend appointments and increased attendance at appointments. The practice could then offer appointments that were no longer needed to other patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 May 2016

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

• Outcomes for patients diagnosed with diabetes were consistently comparable to, or above national averages, for example 100% of diabetic patients had received an influenza vaccine in the preceding 12 months.
• Longer appointments and home visits were available when needed and for those who required ongoing monitoring.
• The practice actively participated in CCG initiatives to improve chronic disease management, these included, Bradford beating diabetes, Bradford breathing better, Bradford healthy hearts and the Diabetes 9 Care processes.
• The practice had reduced the need for patients to attend hospital appointments by offering in house assessments, for example Electrocardiogram (ECG) monitoring.
• The lead GP worked collaboratively with other professionals and attended monthly integrated care team meetings where complex patients could be discussed with other professionals, referrals made and advice sought.
• The practice pharmacist offered home visits to patients to review and discuss their medication needs. This had improved medication concordance, reduced the number of medications that patients were taking and medication wastage.
• 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 with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 17 May 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.
• Child hood immunisation rates were consistently above CCG averages with 100% of children at the age of two immunised.
• The percentage of patients with asthma, on the register, who had a review in the preceding 12 months, was 79% which was above CCG and national averages.
• 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 percentage of women whose notes recorded that a cervical screening test had been performed was 81%, CCG average 76%, national average 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Children under six were offered priority appointments on the same day.
• The GPs held a joint clinic with health visitors and the nursing team to complete, eight week checks, baby immunisations and post-natal checks in one appointment.

Updated 17 May 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. The health care assistant would routinely arrange home visits for house bound patients who required ongoing monitoring.
• All patients in this population group were offered regular reviews of an advanced care plan, involving families and carers if appropriate. This would include discussions regarding end of life care and resuscitation.
• All patients in this age group had a named GP.
• The practice pharmacist offered home visits to patients to review and discuss their medication needs. This had reduced the number of medications that patients were taking and medication wastage.
• The practice had an unplanned admissions protocol for older people and reviewed patients when they were discharged to avoid readmission to hospital.

Updated 17 May 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 offered an extended hours clinic on a Friday until 7.45pm. Same day and advanced booking appointments were also available. The practice had also recently introduced a lunch time drop in clinic as a direct result of feedback from patients and the PPG.
• Patients could request a telephone appointment if they were unable to attend the surgery.
• The practice was planning to extend the range of online services to include online prescriptions and told us they were developing the website to offer health promotion advice.
• Patients could consent to text message reminders to be sent to their phones.

Updated 17 May 2016

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

• 83% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• Outcomes for people with mental health issues were consistently good. For example, the percentage of patients with a mental health issue whose alcohol consumption had been recorded in the preceding 12 months was 100% compared to the national average of 90%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients as necessary to the local team providing psychological therapies and employed a locum GP with a specialism in psychiatry.
• The practice carried out advance care planning for patients with dementia, involving families and carers where appropriate.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• When individuals had been experiencing poor mental health and had attended accident and emergency, the practice had a system in place to follow up these patients.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice was participating in the Dementia direct enhanced service scheme. This is an initiative designed to improve services for patients who may be at risk of dementia, diagnosed with dementia or be a carer for someone with dementia.

Updated 17 May 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 carers and those with a learning disability.
• The practice offered longer appointments and annual health reviews for patients with a learning disability and liaised with the local learning disability team when expert advice was required. They would also refer to voluntary services, for example night sitting services to reduce stress for carers. Of the practice population, 2% of patients were identified as having a learning disability which is above CCG and national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• As part of an ongoing refurbishment the practice was to install a hearing loop for patients with hearing impairment.
• 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. We were told staff training had included female genital mutilation, forced marriages and the Prevent strategy (Prevent is part the counter-terrorism strategy aimed at stopping people becoming terrorists or supporting terrorism.)