Archived: Clapham Road Surgery

Updated 11 January 2017

Clapham Road Surgery provides a range of primary medical services, including minor surgical procedures from its location at 46-48 Clapham Road, Bedford.

The practice serves a predominantly multi-cultural population of approximately 3,518 patients, including many patients from India, Africa, Asia, Eastern Europe, South America and Australasia. There are higher than average populations of patients of working age (aged between 25 to 45 years) and young people aged between 0 to 9 years. There is a much lower older population between the ages of 50 to 85 years compared to national and local averages. National data indicates the area is one of mid to low deprivation in comparison to England as a whole.

The clinical team consists of one male GP partner, one female salaried GP, two practice nurses and a health care assistant. The team is supported by a managing business partner, a practice manager and a team of administration staff. 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 practice is centrally located near Bedford town centre and operates from a converted three- story property. Patient consultations and treatments take place on the ground floor level and first floor. The practice recently underwent a programme of renovations improving both access and facilities for patients. A stair lift has been installed for patients who require access to the first floor. The practice has no parking facilities however there is a designated disabled parking bay available to patients.

Clapham Road Surgery is open between 8am and 7pm Monday to Friday. Appointments, including those that are pre bookable are available daily from 9am to 11am and 4pm to 6pm. In addition, emergency appointments are available daily between 11.30am and 12.30pm and between 6pm and 6.30pm.

A childhood immunisation clinic takes place every Wednesday from 10.30am -11.30am and an antenatal clinic on Thursdays from 9.00am to 12.00am run by the community midwife by appointment.

When the practice is closed an out of hours service is provided by Bedford Doctors on Call (BEDOC). Information on this service is available in the practice and on the website.

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clapham Road Surgery on 13 July 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.
• The practice had a comprehensive business continuity plan in place which included emergency contact numbers for staff and there was a telephone cascade system in place in case of an emergency.

• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• All unplanned hospital admissions were followed up by the health care assistant and any issues were highlighted to an appropriate clinican.
• The practice had reviewed it’s clinics for childhood immunisations and made improvements to ensure efficiency and to reduce the risk of errors, for example by ensuring that a GP and nurse led each clinic. 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. A number of renovations had been carried out to make the property more accessible for patients with mobility 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 areas where the provider should make improvement are:

• Continue to identify and support carers.
• Continue to encourage patient uptake for cancer screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 January 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.
• The percentage of patients with diabetes who had a foot examination and risk assessment within the preceding 12 months was 91% compared to the local average of 90% and the national average of 87%.
• Longer appointments and home visits were available when needed.
• 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.
• The practice had developed extended templates on the clinical system to improve patient care.
• Annual reviews were offered to all patients with a long term health condition.
• The practice worked with a specialist to assist with the care of patients with asthma and chronic obstructive pulmonary disease (COPD).
• Patients with rheumatoid arthritis were reviewed by GPs to ensure all facets of their care were addressed.

• The practice had developed a process to ensure patients with multiple health conditions received combined appointments; reducing the number of times they needed to attend the practice.

Updated 11 January 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.
• 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 88%, which was comparable to the CCG average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had reviewed it’s clinics for childhood immunisations and made improvements to ensure efficiency and to reduce the risk of errors, for example by ensuring that a GP and nurse led each clinic.
• The practice had a policy to follow up the non-attendance of children using other services to offer support to parents if required.
• We saw positive examples of joint working with midwives and health visitors.

Updated 11 January 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 people, and offered home visits and urgent appointments for those with enhanced needs.
• All patients over 75 years had a named GP.
• Monthly multi-disciplinary team meetings (MDT) were held with community healthcare professionals including the complex care team.
• The practice worked closely with Macmillan nurses and the palliative care team to offer comprehensive care for those patients nearing the end of their life. A named GP provided care to these patients to ensure continuity of care.

• Unplanned hospital admissions were followed up by the health care assistant and any issues were highlighted to an appropriate clinican.

Updated 11 January 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.
• Telephone consultations were offered for patients who did not require a face to face appointment.

• The practice was proactive in offering on line services as well as a full range of health promotion and cancer screening that reflects the needs for this age group. For example, 40% of patients aged 60-69 years had been screened for bowel cancer in the preceding 30 months, where the CCG average was 60% and the national average was 58%.57% of female patients aged 50 to 70 years had been screened for breast cancer in the preceding 3 years, where the CCG average was 74% and the national average was 72%.
• A number of different routes to access appointments were offered to patients including on line services for booking appointments or requesting repeat prescriptions.
• The practice had an information pack supplied to new patients which gave advice on healthy lifestyles and how to treat minor illnesses.

Updated 11 January 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. Home visits were offered to patients unable to attend.
• 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 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.
• Vulnerable patients were identified on the clinical system to ensure all staff were aware of their enhanced needs.
• Patients in this group were offered individualised arrangements to access appointments.

Updated 11 January 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. Home visits were offered to patients unable to attend.
• 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 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.
• Vulnerable patients were identified on the clinical system to ensure all staff were aware of their enhanced needs.
• Patients in this group were offered individualised arrangements to access appointments.