Bilbrook Medical Centre

Updated 6 June 2016

The village of Bilbrook is situated in the Seisdon peninsula of Staffordshire three miles outside the city of Wolverhampton. Bilbrook has a population of approximately 5,000. The area is less deprived when compared to national averages sitting in the third less deprived decile.

The practice has been established for over 50 years and now has two GP partners practicing from a purpose-built building. The premises have been developed extensively and now include 15 consulting rooms, a dedicated minor surgery suite and child friendly zones in the waiting area. The practice is accredited to provide training to new and existing doctors at both undergraduate and postgraduate levels. Training facilities include an extensive library with audio-visual facilities.

The practice has a list size of 7,709 patients. The population distribution shows above national average numbers of patients over 65 years of age and below average number of patients less than 40 years of age. The ethnicity data for the practice shows 91.2% of patients are white British.

The two GP partners are assisted by a clinical team consisting of three salaried GPs, a GP registrar, two practice nurses and a healthcare assistant. The administration team consists of a practice manager and ten administration staff.

The practice opens from 8am to 6.30pm, Monday to Friday. Consulting times are staggered throughout the day to provide appointments during opening hours. The practice offers extended hours on Monday evenings between 6.30pm and 8pm and on Tuesday and Thursday mornings between 7am and 8am. When the practice is closed patients are advised to call the NHS 111 service or 999 for life threatening emergencies. The practice has opted out of providing an out of hours service choosing instead to use a third party provider. The nearest hospital with an A&E unit and a walk in service is New Cross Hospital, Wolverhampton.

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bilbrook Medical Centre on 14 March 2016. Overall the practice is rated as Outstanding.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the Care Quality Commission (CQC) at that time.

Our key findings were as follows:

• There was a no-blame; open culture for reporting incidents and near misses. Safety and learning drove continuous improvement at the practice.
• Risks to patients and staff were thoroughly assessed and well managed. The practice used simulated drills when testing emergency procedures.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients were treated with dignity and respect and the premises had been developed to improve patient experience with particular emphasis on vulnerable groups.
• Information about services and how to complain was available and easy to understand.
• Patients told us they could get an appointment when they needed one. Urgent appointments were available the same day.
• The practice had excellent facilities and was well equipped to treat patients and meet their needs. This supported the practice mission statement to provide treatment in a primary care setting.
• There was a clear leadership structure and staff felt very well supported by management. The practice proactively sought feedback from staff, patients and third party organisations, which it acted on.

We saw some areas of outstanding practice:

• Thorough risk assessment processes delivered proactive safety and care in the practice, for example, simulation was used when emergency drills were carried out, children who presented with a rash were isolated to minimise the risk of contamination.
• The practice was proactive in sharing learning from significant events with external stakeholders. For example, an event reported by the practice had resulted in a national safety alert.
• Effective tracker systems were used to monitor newly registered patients, staff rota including absence and referrals made to secondary care. For example, the patient journey was monitored and followed up when required until discharged from hospital.
• A strong culture of education and learning was seen. Education sessions were held twice weekly and protected time was provided monthly for all staff.
• Innovation was used to bring care closer to home. The practice purchased ultrasound equipment and employed a sonographer to provide diagnostic and pelvic ultrasound services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 June 2016

The practice is rated as good for the care of people with long-term conditions. Patients were reviewed in nurse led chronic disease management clinics. We found that the nursing staff had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and asthma. Longer appointments and home visits were available when needed. Written management plans had been developed for patients with long term conditions and those at risk of hospital admissions. For those people with the most complex needs, the GPs worked with relevant health and social care professionals to deliver a multidisciplinary package of care. The practice used the gold standards framework (GSF) to provide end of life care.

Updated 6 June 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 who were at risk, for example, children and young people who had protection plans in place. Appointments were available outside of school hours and the premises were suitable for children and babies. Same day emergency appointments were available for children. There were screening and vaccination programmes in place and the practice indicators were comparable with the local Clinical Commissioning Group averages. The practice worked with the health visiting team to encourage attendance. New mothers were offered post-natal checks and development checks for their babies. The practice website and posters in the waiting room promoted breastfeeding. The waiting areas included sections that had been converted to play areas for young children. The practice had a protocol to isolate from the main waiting area children identified to have rashes to minimise the risk of contamination to other patients.

Updated 6 June 2016

The practice is rated as good for the care of older people. Every patient over the age of 75 years had a named GP and all hospital admissions were reviewed. This included patients that resided in nursing and care homes. Each care home had a named, designated GP who performed regular visits. 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, risk profiling and case management. All over 75 year olds had a completed care plan. The practice was responsive to the needs of older people and offered home visits and offered longer appointments as required. The practice had identified and supported patients who were also carers.

Updated 6 June 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. A range of on-line services were available, including medication requests, booking appointments and access to health medical records. The practice offered all patients aged 40 to 75 years old a health check with the nursing team. The practice offered extended opening hours and a full range of health promotion and screening that reflected the needs for this age group. The practice had developed it’s presence on social media as a way to communicate health messages within the community. The practice had extended the telephone consultation service and made around 30 telephone consultation calls per day. Patients could access the travel clinic by telephone to be assessed for vaccination requirement.

Updated 6 June 2016

The practice is rated as outstanding for the care of people experiencing poor mental health (including people with dementia). Patients who presented with an acute mental health crisis were offered same day appointments. People experiencing poor mental health were offered an annual physical health check. The practice had regular meetings with other health professionals in the case management of patients with mental health needs. A voluntary counsellor attended the practice on a weekly basis to support patients with mental health needs. The practice was a high achiever in depression assessments performed (84% compared with a national average of 75%).

Dementia screening was offered to patients identified in the at risk groups. Advance care planning was carried out for patients with dementia. A dementia training and awareness day had been arranged for all practice staff. The practice had a higher than average prevalence for dementia patients (1.2% compared to CCG and national average of 0.7%). This had doubled since 2014 and was attributed to the continued dementia related education. The QOF achievement for dementia reviews completed on patients within six months of diagnosis was 95%, CCG average 71%, national average 82%). All staff had received Dementia Friends training and the practice had undertaken a self-assessment process to become a dementia friendly practice.

The practice worked closely with the health visiting team to support mothers experiencing post-natal depression. It had told patients about how to access various support groups and voluntary organisations and signposted patients to support groups where appropriate. The practice website included links to emotional wellbeing resources.

Updated 6 June 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. We found that the practice enabled all patients to access their GP services and assisted those with hearing and sight difficulties. A translation service available for non-English speaking patients was clearly displayed at the reception. One of the GPs could sign Makaton. Makaton is a language programme using signs and symbols to help people communicate. The building had an automated entrance door, a sliding door for the disabled toilet and disable parking bays in the car park. Raised seating in the waiting area was provided for patients with reduced mobility. All treatment and consultation rooms were on the ground floor but a lift had been installed to assist and required access to the second floor of the building. Staff told us that isolated patients were supported by the GP delivering the prescription to the pharmacy and a home delivery requested.

The practice held a register of patients with a learning disability and had developed individual care plans for each patient. Out of 21 patients on the learning disabilities register, 13 had received annual health checks for the year ending 21 March 2016 and three had declined. Longer appointments were offered for patients with a learning disability and carers were encouraged by GPs to be involved with care planning. There was a policy to provide patients with learning disabilities with appointments on a day and at a time to suit the individual.

The practice had a register of vulnerable patients and displayed information about how to access various support groups and voluntary organisations. For example there were posters for a local substance misuse support service. Staff knew how to recognise signs of abuse in vulnerable adults and children and demonstrated a proactive care programme. For example, concerns were shared with the community matron and patients invited for an appointment. 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. Practice staff told us that vulnerable patients could use their services as a safe haven. This included offering a quiet room, refreshments and an informal chat if a vulnerable patient presented showing signs of distress.