Putnoe Medical Centre

Updated 31 March 2017

Putnoe Medical Centre is part of the NHS England and Bedfordshire Clinical Commissioning Group (CCG).

The practice is registered with the CQC to provide the following activities:

• Diagnostic and screening procedures,
• Treatment of disease, disorder or injury,
• Maternity and midwifery services,
• Surgical procedures,
• Family planning.

The current contract for providing GP services was awarded to the Putnoe Medical Centre Partnership in 2008. The provider also delivers the services of a Walk in Centre, which opened in 2009 and is available to all NHS patients who require urgent medical attention for minor illness or injury.

All services are provided from one registered location at Putnoe Medical Centre, Putnoe, Bedford, Bedfordshire, MK41 9JE.

Services are provided under the auspices of an Alternative Provider Medical Services (APMS) contract (an APMS is a contract agreed locally with NHS England under negotiated contracts.)

The building has good facilities for patients, including access arrangements, with graduated walking ramps and automatic doors to the main entrance, easy access toilets and baby changing facilities.

The ground floor reception and waiting areas are bright and open plan. The reception area is equipped with an electronic patient arrival registration screen and a hearing loop for the hard of hearing. Consultation and treatments rooms are located mainly on the ground floor, a lift is available to the first floor if required. Administration and management offices, a staff rest room and meeting rooms are also provided on the first floor.

Putnoe Medical Centre is located on the northern side of Bedford and provides GP services to an area that includes outlying villages and urban areas. There are public transport links available, with footpaths and cycle paths linking the practice to surrounding housing and major roads to the town centre. Car parking is available on site and in adjacent roads.

According to national data the area falls in the ‘fifth least deprived decile’ and is one of average deprivation. Average life expectancy for people living in the area is the same as the local CCG average and one year higher than national averages. Male life expectancy at 80 years compared to the national average 79 years. Female life expectancy for the area was 84 years, while the national average 83 years.

The practice has approximately 12,000 registered patients, with the age profile of the patient group broadly following the England average.

The practice has six GP partners (five male and one female) and employs three (female) salaried GPs. There are four minor illness nurses, seven (part-time) practices nurses, one health care assistant and one phlebotomist. Putnoe Medical Centre is accredited as a training practice, and at the time of inspection had one male GP registrar in training in post. (A GP registrar is a doctor in training.)

Administration and management is provided by the Quality Manager, who is also a partner at the practice, a practice manager and a team of secretaries, administrators and reception staff, who form a Patient Services Team.

The GP practice reception is open from 8am to 7pm every day Monday to Friday and from 8am to 2pm on Saturdays. Appointments are available from 8.30am to 6.30pm Monday to Friday and from 10am to 11am on Saturdays.

Appointments can be booked up to four weeks in advance, with urgent and emergency appointments are available on the same day. For the urgent appointments patients are advised consultations may be with the duty doctor rather than their preferred, or usual, GP.

Out-of-Hours emergency services are provided by Bedford on Call (BEDOC). This service is staffed by local Bedford based GPs and is available from 6.30pm to 8.00am 7 days a week.

Information about the provision of services was available on the practice website, via leaflets and posters on display within the practice and by recorded message on the practice telephone system.

Telephone calls made to the practice during the out-of-hours period are automatically redirected to the Out-of-Hours service.

Updated 31 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Putnoe Medical Centre Partnership on 18 October 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. 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.
• The practice had been involved in developing clinical templates for patient care which had been shared across the CCG.
• Feedback from patients about their care was generally positive, with 90% of patients stating they had confidence and trust in the last GP they saw.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements to services as a result.
• The practice had a clear vision which had the safe delivery of high quality services to patients as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

There were areas of practice where the provider should make improvements:

• The system for recording medical alerts should ensure all actions are recorded centrally.
• A complete log of drugs stored on the emergency trolley should be maintained and monitored.
• Staff should be advised when the practice amends the business continuity plan.
• Continue to encourage patients to attend cancer screening programmes.

• The prescription management policy should include a process to deal with uncollected prescriptions and safe storage of prescription stationery.
• The practice should continue efforts to identify and engage with those patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2017

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.
• 97% of the patients on the diabetes register had been referred to a structured education programme in the preceding 12 months (1 April 2015 to 31 March 2016) compared to local CCG average of 93% and national average of 92%.
• Effective arrangements were in place to ensure patients with long term conditions including diabetes, were regularly invited for a review of their condition.
• 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.
• The practice held a Gold Standard Framework (GSF) palliative care register, where all patients have a named GP. Patients were discussed with other health care professionals, including Macmillan and community nurses at monthly meetings.

Updated 31 March 2017

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 comparable to local and national averages for 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.
• 74% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was in line with the local CCG average of 76% and the national average of 74%.
• 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, health visitors and school nurses.
• Clinics were provided on site for children’s services, including health visitor, speech therapist and post-natal well-being for mothers.

Updated 31 March 2017

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 for patients unable to travel and urgent appointments for those with enhanced needs.
• At the time of our inspection, the practice had 83 patients who were living in 17 care homes across the area. GPs undertook weekly visits to one home where 23 patients resided. Residents in other care homes were provided with the services as they were required.
• All of these patients are offered an annual review of their care needs.
• A coffee morning had been established to enable elderly patients and local residents to combat loneliness and social exclusion.

Updated 31 March 2017

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.
• Data showed 58% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to 59% locally and 58% nationally.
• Data showed 57% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 74% locally and 72% nationally.
• 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.
• Appointments had been made available during lunchtimes, for those patients not able to attend at other times during normal working hours. Telephone consultations were also available.

Updated 31 March 2017

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

• 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which matched the local average and was higher than the national average of 84%.
• 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 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.
• Clinics were available on site with a nurse trained in supporting Parkinsons Disease.
• Staff had received dementia friends training and demonstrated a good understanding of how to support patients with mental health needs and dementia.

Updated 31 March 2017

The practice is rated as outstanding 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.
• The practice offered longer appointments for patients with a learning disability.
• 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 support groups and voluntary organisations.
• A dedicated patient support team was able to arrange transport for patients with mobility concerns.
• The practice acted as a food bank voucher issuing centre for those patients considered to be at most risk.
• 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’s computer system alerted GPs if a patient was also a carer. The practice had identified 85 patients (0.7% of the total practice list) as carers and 238 patients (approximately 2%) identified as being cared for.
• The practice worked closely with the Bedfordshire Carers Group, for example the group recently attended a ‘patient open evening’ to provide information of support available