Archived: Linden Road Surgery

Updated 5 August 2016

Linden Road Surgery is based in a residential area of Bedford with easy access to the local train station and the town centre. Primary medical services are provided from a total of three sites to approximately 3,780 patients, the practice has been established since 1988. The practice holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.The main surgery consists of two story premises which have good disabled access and ground floor waiting and consulting rooms. In addition the practice maintains two small branch premises; one in Bromham and one in Tyne Crescent, for the benefit of the practice population living in those areas. The branch surgery in Bromham has a small dispensary for eligible patients. Neither of these locations were inspected as part of this inspection.

The practice population has a higher number of patients aged 65 to 85 years and older. National data indicates that this area is in the mid-range of the deprivation scale.

The clinical team consists of two male GP partners and a female practice nurse and a dispenser. There is a practice manager and seven administrative and reception staff who provide support to the clinical team. The practice use a female locum as there is no female GP permanently employed at present.

The practice is open between 8am and 6.30pm on Monday to Friday with extended evening hours on Tuesdays until 7.30pm. Patients requiring a GP outside of normal hours are advised that the surgery telephone number is automatically transferred to the out of hours service, provided by Bedford Doctors on Call (BEDOC).

Telephone consultations and online appointment bookings are available.

Updated 5 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Linden Road Surgery on 15 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 and recording 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Staff worked closely with other community services and external care agencies.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. This was reflected in the national patient survey and from reports from patients.
• Annual health checks were offered to anyone registered as a carer.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.
• 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 and complied with the requirements of the duty of candour.

The area where the provider should make improvement is to ensure that there is a proactive approach to identifying and supporting carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 August 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 demonstrated a robust recall system for annual reviews for patients with a learning disability, asthma, chronic obstructive pulmonary disease (COPD), diabetes and coronary heart disease (CHD).

• The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months was 76% compared with the national average of 75%.

• The practice results for diabetes indicators were comparable to local and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 77%, comparable to the CCG and national averages of 84%.

• Longer appointments and home visits were available when needed.

• All patients in this group 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 including spirometry and shared diabetes management.

Updated 5 August 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.

• The practice had child safeguarding as a standing agenda item at meetings. Midwives, health visitors and social services were invited to attend the meetings and worked jointly with the practice team to provide effective and safe care to this group.

• Immunisation rates were relatively high for all standard childhood immunisations and the practice maximised the uptake of this service by offering flexible appointments with the nurse. Non-attenders were actively followed up.

• 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 practice’s uptake for the cervical screening programme was 92% which was 10% above the national average.

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

• We saw positive examples of joint working with midwives and health visitors.

Updated 5 August 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.

• Regular meetings were held with community staff to coordinate care for older patients or those in need of end of life care.

• The care of older patients was supported by a sensitive and patient-focused approach to home visiting, telephone consultations and same day appointments.

• Regular visits were undertaken to local nursing homes and there was good communication between staff and GP’s.

• The practice offered a medicine home delivery service for patients on the identified as requiring this service.

• Home visits were available for patients who were housebound because of illness or disability.

Updated 5 August 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 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.

• Patient survey results showed good satisfaction rates for convenient appointment times and patients having a good experience.

• Flu vaccination clinics were offered on Saturdays for patients unable to attend Monday to Friday.

• Late evening appointments and telephone consultations had been implemented following patient feedback.

Updated 5 August 2016

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

• Dementia screening was offered where appropriate.

• The practice results for mental health were comparable to local and national data. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 89% (CCG average 87%, national average 88%)

• 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.

• Staff had undertaken dementia friends training.

Updated 5 August 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 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.

• Safeguarding information was shared with all staff at practice meetings.

• Annual health checks were offered to anyone registered as a carer (1.3% of the practice list).