Bridge Street Medical Practice

Updated 23 September 2016

Bridge Street Medical Practice is situated in the centre of Loughborough in north west Leicestershire. Loughborough is a busy market town with a well-established university. The practice is in a Victorian building on a busy road. It recognised that the building was not suitable and, over the last 12 months has had extensive building work done, extending the premises, providing modern facilities and improving disabled access with a ramp at the front of the building and a lift and disabled toilets inside. There is limited parking but there are public car parks nearby.

The practice has a General Medical Services (GMS) contract and is a training practice for trainee GPs. It provides minor surgery and joint injections.

It has five GP partners, three male and two female, who work between six and eight sessions a week, and a female locum GP who has worked regularly for the practice for a number of years. There are three practice nurses and a health care assistant, who are all female. There are also administrative staff including a practice manager and assistant practice manager, secretaries, reception staff, and at times an apprentice.

The practice is open between 8am and 6.30 pm Monday to Friday. Appointments are available from 8.30am to 12 noon and from 2pm to 6pm with pre-bookable appointments up to 7.30pm on Tuesday evenings.

Out of hours services are provided by DHU (Derbyshire Health United). A phone number for the services is provided on the practice website and on an answerphone message when the practice is closed.

The practice has just over 8000 patients registered with it with slightly higher proportions of patients aged 55 to 85 plus.

At registration the practice had identified a number of issues with its premises which have now been resolved with the extension and modernisation of the building.

Updated 23 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bridge Medical Street Practice on 11 May 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.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients appreciated being able to make appointments on the same day and if wanted being able to pre-book an appointment with a preferred GP.
• The practice was in the later stages of building an extension which would ensure good facilities were available to treat patients and meet their needs, for example, a lift had been installed and disabled access improved.
• 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 improvements are:

• The practice should continue to seek out proactive ways to identify patients with caring responsibilities and offer health checks and advice about support services.

• The practice should continue to monitor patient satisfaction with telephone access to the surgery and where possible find methods to improve this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 September 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. Several of the GPs had expertise in treating patients with long term conditions, for example, diabetic patients could be initiated on insulin at the practice rather than having to go to hospital.

• The practice's performance for diabetes management was similar to or slightly higher than national averages, for example, 93% of diabetic patients had had a recent foot examination compared to the national average of 90%.

• Longer appointments and home visits were available when needed.

• All patients identified as being at risk of hospital admission had a named GP and a structured annual review to check their health and medical 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 provided care for up to 66 residents in a local care home, with two ward rounds each week.

• Home visits were available when needed.

Updated 23 September 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. 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.

• Data showed 81% of eligible women had received a cervical screening test compared with the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice offered 24-hour and six-week baby checks.

• Young children who were ill were always offered an urgent appointment with a GP even if the surgery was fully booked.

• Staff told us they had good working relationships with midwives, health visitors and school nurses.

• One of the GPs had an interest in palliative care for children and was medical director for a local children’s’ hospice. We received positive feedback from this service about the care and support provided by the practice.

Updated 23 September 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 who needed them.

• Older patients at risk of hospital admission had been identified and care plans developed and special notes provided on their records for out of hours services to help avoid unnecessary or inappropriate hospital admissions

• The practice provided care for approximately 66 patients living in a local care home, most of whom were living with dementia. There was a half day visit on Mondays to review care plans and a second visit on Thursdays to deal with any developing health issues and if necessary contact the AVS (the advanced visiting service is a paramedic led service which could support patients and potentially avoid hospital admission)

• Nurses visited housebound patients at home to provide immunisations and vaccinations such as for flu and shingles.

Updated 23 September 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.

• Pre-bookable appointments were available until 7.30pm on Thursday evenings.

Updated 23 September 2016

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

• 96% of patients with severe mental health problems had a comprehensive agreed care plan documented in their records compared with the national average of 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.

• The practice provided care for up to 66 patients living in a local care home, many of whom were living with dementia. One of the comment cards said how well the practice looked after a relative who lived in this care home.

Updated 23 September 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, those with a learning disability, and those with alcohol or substance misuse problems.

• The practice offered longer appointments for patients with a learning disability and staff were often aware of an individual patient’s needs and preferences

• 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.

• The practice had identified approximately 0.60% of its patient list as having caring responsibilities. It had recognised that this was a low figure and had identified a number of actions it was taking needed to take to improve this and provide better care.