Linden Road Surgery

Updated 7 March 2023

Linden Road Surgery is located in a converted residential property in Bedford at:

Linden Road Surgery
13 Linden Road
Bedford

Bedfordshire
MK40 2DQ

The practice has a branch surgery, on the first floor, at:

Bromham Surgery
Avoca House
Molivers Lane
Bromham
MK43 8JT

We visited both sites as part of this inspection.

The practice runs a small dispensary from the site in Bromham for patients identified as needing this service.

The provider is registered with CQC to deliver the following regulated activities; diagnostic and screening procedures, family planning, maternity and midwifery services and the treatment of disease, disorder or injury.

The practice is situated within the NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board (ICB) and delivers general medical services to a patient population of about 6,300. This is part of a contract held with NHS England.

The practice is part of a wider network of GP practices known as the East Bedford Primary Care Network (PCN). The PCN includes four providers of GP services working together to address local priorities in patient care. The practice works in partnership with another local GP practice. Some staff work across both practices and systems are shared between the two practices.

Information published by Public Health England shows that deprivation within the practice population group is in the fourth lowest decile (4 of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest available data, the ethnic make-up of the practice area is 78% White, 13% Asian, 5% Black, 4% Mixed and 1% Other.

The age distribution of the practice population broadly follows the local and national averages.

The clinical team at the practice includes 2 GP partners, 3 salaried or locum GPs, 2 nurses and 1 healthcare assistant.

Non-clinical staff include a team of reception and administration staff. The practice manager provides managerial oversight for both Linden Road Surgery and the practice with whom Linden Road Surgery works closely with. The practice manager is is based at this other GP practice. A deputy practice manager provides managerial oversight for Linden Road Surgery.

Some GPs work from both the main site in Linden Road and from the branch site in Bromham.

The practice’s main site in Linden Road is open between 8am and 6.30pm on Mondays to Fridays, excluding bank holidays. Evening appointments are available until 8pm on Tuesdays. The branch site in Bromham is open for limited hours on Mondays and Tuesdays.

When the practice is closed, patients can access support, treatment and advice from the NHS 111 service.

Patients can book appointments online, or by telephoning or visiting the practice.

The practice offers a range of appointment types including face-to-face, telephone, video and online consultations.

Appointments are available with doctors, practice nurses, healthcare assistants, a pharmacist or minor illness nurse. Home visits from a doctor or paramedic are available for patients who are unable to go to the practice.

Patients of Linden Road Surgery are also supported by care coordinators, physiotherapists, a social prescriber, health and well-being coaches and a mental health practitioner. These staff are employed by and support the whole PCN.

Patients can get advice for non-urgent medical or administrative matters using an online form and can request prescriptions using an online system.

There is a ‘duty doctor’ system, and an unlimited number of urgent, or ‘same day’, appointments.

Patients can pre-book appointments with a clinician of their choice.

The practice runs a flu vaccine clinic on some Saturdays.

Updated 7 March 2023

We carried out an announced comprehensive inspection at Linden Road Surgery on 1 November 2022. Overall, the practice is rated as requires improvement.

The ratings for each key question are:

• Safe - requires improvement
• Effective - good
• Caring - good
• Responsive - good
• Well-led - requires improvement.

Linden Road Surgery was registered by CQC on 2 March 2021. This was our first inspection of the service.

Why we carried out this inspection

We inspected Linden Road Surgery as part of our regulatory functions under the Health and Social Care Act 2008.

We carried out this inspection because we assess new services to check they are providing safe, effective, caring, responsive and well-led services. The inspection therefore focused on all of these key questions.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• conducting staff interviews using video conferencing facilities
• completing clinical searches and reviewing patient records on the practice’s patient records system to identify issues and clarify actions taken by the provider
• requesting evidence from the provider
• a site visit to Linden Road Surgery and the practice’s branch site in Bromham
• requesting and reviewing feedback from staff and patients who work at or use the service.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services
• information from the provider, patients, the public and other organisations.

We found that:

The practice did not always identify and manage risks effectively to keep patients and staff safe and protected from avoidable harm. For example:

• Not all staff had completed training in line with the practice’s requirements, including in infection prevention and control, basic life support and sepsis awareness.
• The practice had not always taken steps to identify and reduce risks at the site in Bromham, for instance relating to infection prevention and control, fire safety and lone working.
• The practice’s processes to make sure blank prescription stationery was kept securely and used safely were not always effective.
• The practice had not assessed the risks of providing a medicines delivery service and taken action to minimise them.
• The practice did not have a process for recording incidents and near misses about the dispensary.

Most patients received effective care and treatment that met their needs and in a way that kept them safe and protected from avoidable harm. For example:

• Staff had the information they needed and worked together, and with other organisations, to deliver effective care and treatment.
• The practice responded to safety alerts to protect patients affected by them.
• The practice were proactive in helping patients to live healthier lives, for example identifying patients with a learning disability.
• The practice offered patients prescribed repeat medicines or who had long term conditions a structured annual review to check their health and medicines needs were being met.
• Staff gained patients’ consent to care and treatment in line with legislation and guidance.
• However, patients were not always followed-up in a timely way after a flare up of asthma.
• The number of patients tested for cervical cancer screening was below the national target.

People are involved in their care and are treated with compassion, kindness, dignity and respect. For example:

• Patients and others who use the service described care and support given exceeded their expectations.
• More patients felt they had been treated with care and concern, and described their overall experience of a GP practice as positive, than the averages for England and the local area.
• 98% of patients said they were involved as much as they wanted to be in decisions about their care and treatment.
• Information and support available for those who were recently bereaved was comprehensive.
• The practice identified and supported carers. However, the practice could improve their identification of and support for young carers.

The services provided met peoples’ needs. For example:

• The practice understood the needs and preferences of their patients and had developed services in response to them, for example to support patients living in local care homes.
• The practice supported people to access care and treatment in a timely way, including when language may be a barrier.
• The practice responded positively to feedback provided to improve services and care.
• There was a strong focus on learning and improvement.
• Staff were positive about working at the practice.
• However, complaints were not always acknowledged and responded to in a timely way.

The way the practice was led and managed meant the practice could not always demonstrate:

• Oversight of staff recruitment processes, DBS checks and vaccinations.
• Oversight of the completion of staff training and induction programmes.
• Policies and new staff induction programmes were specific to the practice.
• Effective arrangements with other services, such as for cleaning and waste disposal, and to make sure emergency medicines and equipment were available and safe to use if needed.

We found a breach of regulations. The provider must:

• Provide care and treatment in a safe way for service users.

More detail is contained in the requirement notice section at the end of this report.

We also found the following areas for improvement where the provider should:

• Follow-up patients who have had a flare up of asthma in line with national guidance.
• Continue to monitor, and take actions to improve, attendance for cervical screening.
• Develop systems for checking new staff induction programmes are completed fully.
• Identify and support young carers (those under 18 years of age).
• Take steps to acknowledge and respond to complaints in a timely way.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services