Archived: Bradford Road Medical Centre

Updated 24 January 2017

Bradford Road Medical Centre is situated in the county town of Trowbridge in Wiltshire. The practice serves a population of 10,700 patients, in an area of mixed deprivation which covers some of the most deprived wards in Wiltshire but also some affluent areas. Trowbridge has a well-established Polish population which is the largest minority group.

The general Index of Multiple Deprivation (IMD) population profile for the geographic area of the practice is in the third least deprivation decile. The prevalence of patients with a long standing health condition is 47% compared to the national average of 54%. Patients living in more deprived areas and with long-standing health conditions tend to have greater need for health services. An area itself is not deprived: it is the circumstances and lifestyles of the people living there that affect its deprivation score.

The population age range of the practice is very similar to the local and national average with slightly lower numbers of patients between the ages of 20 to 30, and slightly higher between the ages of nought to four.

The practice is a teaching and training practice and supports medical students, nursing students and GP registrars. (Registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine).

The practice has four GP partners (two female, two male) and four associate GPs (three female and one male). The practice has three nurse practitioners, two practice nurses, one research nurse and two health care assistants (one male, seven female). The clinical team are supported by a practice manager and an administration and reception team.

The practice is open between 8.30am (phone access from 8am) and 6pm (phone access until 6:30pm) Monday to Friday. Appointments are available from 8:30am to 11:45am and 2pm to 6pm daily. Extended hours appointments were offered from 7am on Wednesday and Fridays and until 7pm on Mondays, the practice offered morning appointments between 8am and 10am on some Saturdays.

When the practice is closed the Out of Hours cover is provided by Medvivo which patients can access via NHS 111.

The practice has a Primary Medical Services (PMS) contract to deliver health care services to patients. A PMS contract is a locally agreed alternative to the standard General Medical Services contract used when services are agreed locally with a practice which may include additional services beyond the standard contract.

The practices regulated activities are provided from the following location:

Bradford Road,

Trowbridge,

Wiltshire,

BA14 8Q.

This was our first inspection of Bradford Road Medical Centre.

Updated 24 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bradford Road Medical Centre on 30 November 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 for reporting and recording significant events. Lessons were shared to make sure action was taken to improve safety in the practice.

• Staff had the skills, knowledge and experience to deliver effective care and treatment.

• The practice conducted clinical audits which demonstrated quality improvements for patients and was involved in research studies.

• Risks to patients were assessed and well managed.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Improvements were made to the quality of care as a result of complaints and concerns.
• The practice was actively engaged in merging with two local practices. Throughout the process the partners had engaged with the local community to address any issues or concerns and involve the community.
• The practice management team were encouraging the staff groups to share best practice ideas across the three merging practices and build good communication and working relationships in advance of the merger.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 January 2017

The practice is rated as good for the care of patients 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.

• Performance for diabetes related indicators were comparable to the 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 in the target range was 79% which comparable to the local average of 79% and the national average of 78%.

• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was below the recommended level was 80% which was comparable with the local average of 83% and the national average of 81%.

• 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.

Updated 24 January 2017

The practice is rated as good for the care of families, children and young patients.

• 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 patients who had a high number of accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• The practice had employed a contraceptive services nurse and ran a weekly clinic to improve access for contraceptive services including coil fitting and implants.

• Young patients could be seen for their sexual health needs and/or signposted to an appropriate service for any follow up care.

• Patients told us that children and young patients 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 positive examples of joint working with midwives and health visitors.

Updated 24 January 2017

The practice is rated as good for the care of older patients.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had allocated a named GP for each of their local nursing home patients and conducted weekly visits.

• The GPs worked with the emergency care practitioner and the care coordinator to identify patients in the final stages of their lives to ensure the correct support and care was in place.

• The GPs supported patients who may be at risk of hospital admissions and ensured they had care plans and support in place.

Updated 24 January 2017

The practice is rated as good for the care of working-age patients (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.

Updated 24 January 2017

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

• Performance for mental health related indicators were comparable to the local and national averages, for example:

• The percentage of patients with a serious mental health problem who have a comprehensive, agreed care plan documented in the record, to the year ending March 2015 was 90% which was comparable to the local average of 93% and 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 offered, on the day appointments for those experiencing poor mental health, on site access to psychological support and advised patients how to access support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended A&E 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 had achieved dementia friendly status.

• The practice carried out advance care planning for patients with dementia and had a care coordinator to support their care needs.

• However the percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (2014/15) was 74% which was lower than the local average of 88% and the national average of 84%.

Updated 24 January 2017

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability.

• The practice offered longer appointments or home visits for patients with a learning disability and offered annual health checks.

• 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.