Archived: Dr Mills and Partners

Updated 14 May 2015

Dr Mills and Partners Highfield Health Centre is registered with CQC to provide primary care services, which includes access to GPs, family planning, surgical procedures, treatment of disease, disorder or injury and diagnostic and screening procedures. It provides GP services for patients living in the Tong area of Bradford. The practice has six GPs, a management team, practice nurses and healthcare assistants, finance staff, administrative staff and cleaners.

The practice is open 8am to 6pm on Monday to Friday with a Wednesday opening of 7am to 7:15pm. When the practice is closed patients accessed the out of hours NHS 111 service.

The practice is part of NHS Bradford District CCG. It is responsible for providing primary care services to 7,300 patients. The practice is meeting the needs of an increasingly young patient list size that is generally comprised of an equal number of women and men.

Updated 14 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced inspection at Dr Mills & Partners on 17 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, caring, responsive and effective services and outstanding for being well led. It was also good for providing services for older people, people with long term conditions, families, children and young people, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• 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.

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• The practice developed additional enhanced services and through joint working achieved Investors in People and the Quality Practice Award.

We saw areas of outstanding practice including:

• The practice employed a person who worked with alcohol dependent patients and the success of this work was evident in patients’ reduced dependency on alcohol and the proportion of patients with alcohol problems also reducing.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 May 2015

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. 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.

Patients with long term conditions were monitored via a recall system where they were offered annual or more frequent reviews where appropriate.

The practice had named GP leads for each chronic disease area. The nursing team were trained to support the main areas relevant to the patients and they had access to a set of protocols for each of these areas which were overseen by one of the GPs.

There was a high prevalence of diabetes within the practice population. The staff had been proactive in meeting the needs of these patients and the practice had achieved high standards across all nine areas of the Bradford Beating Diabetes programme in comparison to other practices. Two of the GPs and a practice nurse had been trained to Level 2 standard. A member of the administration team had special responsibility to oversee patient recalls and booking of appointments which had led to a very low DNA rate compared to other practices in the area.

Updated 14 May 2015

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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

The practice offered targeted and specialist clinics and appointments to try and capture this patient groups needs. There were set ‘Mum & Baby’ clinics which were run alongside the Health Visitors. These included eight week checks. There were also vaccinations and immunisations available with the nurses and the practice remained high achievers.

The practice population had been an area of high teenage pregnancies and poor sexual health for a number of years. The practice offered a full range of contraception and sexual health screening. Bradford was one of the only areas to see improvements in this statistic.

Updated 14 May 2015

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 offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Older people were allocated a named GP. They were contacted by the practice to inform them of their named GP who took lead responsibility for ensuring that they received appropriate care. GPs worked with relevant associated health and social care professionals to deliver a multi-disciplinary care package that met the needs of this patient group. The practice operated an ‘Integrated Care Team’ where any high risk patients could be referred for a multidisciplinary team approach to their care. This was effective where the patient needs were more social than clinical.

The doctors held a weekly ward round for the nursing and care homes where any patients who were given cause for concern could be seen. The visits included new patient reviews, medication reviews, Do Not Attempt Resuscitation (DNACPR) reviews and the practice could see patients that may have had recent emergency admissions. In addition the practice had a full six monthly review of each of the care homes in the area. This was a virtual review as not all the residents in the care homes were seen by the GPs.

Risk analysis took place and the practice held a register of patients who had unplanned admissions. This incorporated many of the elderly and nursing home patients who had an individual care plan and assigned GP. The care plans were reviewed on each contact with the patient and the entire register was reviewed every quarter at a practice meeting. Any patients that had an admission or A&E attendance would be contacted within three days and offered a follow up appointment if required.

The practice also offered a Seasonal Flu and Shingles vaccination for its eligible elderly patients.

Updated 14 May 2015

The practice is rated as good for the population group of the working-age people including those recently retired and students. The needs of this group had been identified and the practice had made adjustments to its services 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 which reflected the needs for this age group.

Working age people traditionally had difficulty with access to appointments therefore the practice provided early morning doctors, nurse and phlebotomy appointments and some late night GP appointments. The practice had also introduced some lunch time phlebotomy appointments. In addition to this they offered on-line booking of appointments and prescription request to make it easier for working patients to contact the practice.

Updated 14 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). People experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It 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. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

The practice was proactive in identifying and supporting patients with poor mental health. The practice participated in the Dementia Identification Scheme and had achieved a diagnosis rate of 74.94%. The practice actively supported patients through the Gateway Worker and the Primary Care Mental Health Team.

Updated 14 May 2015

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. It had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability.

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

All members of staff received training around safeguarding of children and vulnerable adults. The safeguarding lead was identified and available to talk to about issues that arise.

The practice had a social worker working with them who they could refer to and they was able to offer a range of supporting services to the more vulnerable patients. In addition the practice had an alcohol worker and they were currently seeking a benefits worker. The practice also had access to the ‘Bridge and Ripple’ teams who supported patients with substance abuse.