Archived: picton @ whetley medical centre

Updated 23 March 2017

Picton@whetley medical centre provides services for 1,539 patients and is situated within Whetley Medical Centre at 3 Saplin Street, Bradford, West Yorkshire, BD8 9DW.

Picton@whetley medical centre is situated within the Bradford City Clinical Commissioning group (CCG) and provides primary medical services under the terms of an Alternative Provider Medical Services (APMS) contract. This is a contract between general practices and primary care organisations for delivering services to the local community.

They offer a range of enhanced services such as, learning disabilities health check scheme and the avoiding unplanned admissions and proactive care management scheme.

There is a higher than average number of patients under the age of 39, in common with the characteristics of the Bradford City area and fewer patients aged over 40 than the national average. The National General Practice Profile states that 67% of the practice population is from an Asian background with a further 8% of the population originating from black, mixed or non-white ethnic groups.

There are two male GP partners and two permanent male locum GPs. The practice is also staffed by two part time practice nurses and an advanced nurse practitioner (ANP) plus an ANP in training and has a part time health care assistant (HCA), all of whom are female. The practice is also supported by a pharmacist from the CCG.

The clinical team are supported by a practice manager, a business services manager and a team of administrative staff.

Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 75 years compared to the national average of 79 years. Female life expectancy is 80 years compared to the national average of 83 years.

The surgery is situated within a large health centre which also hosts other GP surgeries. Car parking is available. The surgery has level access and disabled facilities.

Picton@whetley medical centre reception is open between 8.00am and 6pm Monday to Friday and appointments were available from 8.30am to 6pm daily at this location. Extended hours access was available at the providers’ Westbourne Green site (approximately four minutes’ walk away) from 7am on a Thursday and 7.30am on a Friday morning. Patients could also see a Nurse, ANP or a HCA on a Saturday between 9am and 1pm at the Westbourne Green site.

The Out of Hours walk-in service is provided by an external contractor, Local Care Direct at Hillside Bridge Health Centre. Patients are also advised of the NHS 111 service.

On 8 April 2016 an unannounced comprehensive inspection was carried out at this location. Numerous concerns and breaches of the Health and Social Care Act were found and the decision was taken to suspend the registration of the provider. The previous provider was asked to provide a detailed action plan to the Care Quality Commission (CQC) in response to the breaches of regulations identified.

The action plan submitted did not assure the CQC the provider had the ability to make the necessary changes and the registration of the provider was cancelled.

The service was placed into special measures and a new provider, Picton Medical Centre was awarded the contract to provide services from the same location on 18 April 2016. The service was re-named Picton@whetley medical centre.

Updated 23 March 2017

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection of this practice on 8 April 2016 which was previously managed by a different provider, following a number of concerns that were raised with the Care Quality Commission. The previous provider was Dr Subrata Basu.

We rated the practice as inadequate in all five domains of safe, effective, caring, responsive and well led. The practice was placed into special measures and the registration of the provider at that time was cancelled.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Subrata Basu on our website at www.cqc.org.uk.

A new provider, Picton Medical Centre was awarded a contract to provide regulated activities at the same location from 18 April 2016. The new provider changed the name of the practice to Picton@whetley medical centre.

We undertook an announced comprehensive inspection on 2 February 2017 to check that the practice had responded to the concerns which were identified during the inspection of 8 April 2016. The practice is now rated as good overall.

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

• The practice had sought to continuously improve the quality of healthcare offered to patients since being awarded the contract to provide services from this location. For example, they had identified a significant number of previously undiagnosed long term conditions and had improved the systems for reviewing patients’ medicine needs, therefore improving health outcomes for patients. In addition they had improved patient access by providing online services and making appointments available for those patients who needed them.
• 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 including where previous concerns had been identified. For example, we saw evidence of the appropriate provision and management of emergency medicines and vaccines, the implementation of policies and procedures and the proactive and timely review of repeat medicines.
• Staff assessed patients’ individual needs and delivered care in line with current evidence based guidance. Additional staff had been recruited and 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. They commented positively on the changes to the practice since the new provider had taken over and on the excellent care and support they had received from the new GPs and the practice team.
• 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 said they found it easy to make an appointment with a GP or a nurse and there was continuity of care, with urgent appointments, telephone triage and consultation available the same day.
• The practice had introduced colour coded signs to orientate patients with visual or language issues around the practice.
• A priority moving forward for the practice was to identify if a patient was also a carer. The practice were proactively asking older people at appointments if they had any caring responsibilities and we saw that written information was available to direct carers to the various avenues of support available to them.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was able to evidence that they had reviewed infection prevention and control measures and the health and safety of patients and the environment.
• There was proactive management of the practice and a clear leadership structure. Staff felt very 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.

We saw areas of outstanding practice:

• The new provider was able to demonstrate an outstanding response to a significant area of concern we had identified at the inspection of the previous provider. At the inspection in April 2016 we saw that clinical decisions were taken at the practice by unqualified staff, which allowed patients to continue to request and receive medication without the review of a clinician. At this inspection under the new provider, we found that a total of 1,065 patients who were registered with the practice and received regular, repeat prescriptions were reviewed by a GP within one month of the new provider being awarded the contract. This had led to urgent referrals being made to secondary care and a total of 3,578 inappropriately prescribed items being stopped. This led to a significant cost saving for the local health economy.
• The practice manager had completed a training programme to issue food bank vouchers to vulnerable individuals and could offer this service to vulnerable patients. We were told that several members of the team also distributed food, sleeping bags and clothing opportunistically to local homeless people on a weekend and encouraged them to register with a GP.

The area where the provider should make improvements are:

• The practice should continue with their plans to identify vulnerable patients and carers and ensure that the service offered continues to meet their needs.

I am taking this service out of special measures. This recognises the considerable improvements the new provider has made to significantly improve the quality of care provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 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 and regularly reviewed.
• Patients would be invited to reviews by telephone so that they could pick a time and date to suit them and speak to a member of staff in their own language.
• For Diabetic patients, Insulin initiation and monitoring had been introduced and the practice had identified 24 new patients with diabetes and 30 new patients with asthma within a nine month period. ECGs, spirometry and 24 hour blood pressure monitoring were available at a neighbouring practice.
• The new provider had undertaken 129 diabetic checks in the nine months from April 2016 which was over twice as many as the previous 12 months under the previous provider.
• Longer appointments, urgent 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 including voluntary services and the community matron.

Updated 23 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 relatively high for all standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 76% and the national average of 82%. However, evidence showed that the new provider had conducted 101 cervical screening tests in the nine months prior to our inspection compared to 78 in the previous year under the previous provider.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice held quarterly meetings with midwives, health visitors and school nurses. When appropriate the practice would invite representatives from the local family centre to meetings.
• Antenatal clinics, eight week baby checks, and initial childhood immunisations were available at the practice.
• The practice engaged with a national children’s charity to review how they worked with children and young people and had a teenage confidentiality policy in place.
• The practice made patients aware of additional services available in the local community including sexual health advice for young people and advice on weaning and nursery places.

Updated 23 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. All patients aged over 75 had a named GP and had been invited or attended a health check. We were told that health checks for all patients aged 65 and over would be completed by March 2017.
• The practice were proactively using the health check appointments to screen patients for dementia using a recognised assessment tool and to identify carers within the practice population. Patient packs were available which gave information to older patients regarding relevant services.
• The practice was proactive in meeting the needs of older people, and offered home visits, vaccinations, blood tests, medicine reviews and long term conditions reviews in the patient’s own home.
• The practice had increased the support available to older people which included reviews by the GP and community matron as necessary. Referrals would be made to carers’ support and voluntary services including benefits advice services if necessary.
• Urgent appointments were available for older patients and those who were deemed vulnerable also had access to a dedicated telephone line to enable easy communication with the practice.
• The practice had developed a template for unplanned admissions and we saw that care plans were in place and that all patients in this group were reviewed every three months.

Updated 23 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 enhanced the services previously offered to include early morning extended hours access and a Saturday morning clinic at a neighbouring surgery.
• Telephone triage and consultation was available.
• The practice had introduced online services, a text message reminder and results service and had a social media page to improve communication and ease of access for the patient population.
• Patients could book appointments and reviews up to eight weeks in advance and longer if clinically necessary.

Updated 23 March 2017

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

• Staff had a good understanding of how to support patients with mental health needs and dementia. A programme of proactively screening older patients for dementia was underway; this would ensure that annual reviews and support was available for these patients.
• Evidence supplied by the practice showed that in the nine months between April 2016 and January 2017, 71% of patients with schizophrenia, bi-polar affective disorder and other psychoses had a comprehensive care plan recorded in their notes. The previous provider average was 75% for the year 2015/2016, compared to the CCG average of 90% and the national average 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 had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including groups specifically targeted at patients from South Asian origins.
• 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. 

Updated 23 March 2017

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, travellers and those with a learning disability.
• The practice offered annual reviews and longer appointments for patients with a learning disability. Longer appointments were also available for those with complex needs.
• The practice had introduced colour coded signs to orientate patients with visual or language issues around the practice.
• 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. The practice hosted a patients advisory session each week to support patients with social issues including housing problems, debt, immigration and benefits advice.
• 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 manager had completed a training programme to issue food bank vouchers to vulnerable individuals and could offer this service to vulnerable patients. We were told that several members of the team also distributed food, sleeping bags and clothing opportunistically to local homeless people on a weekend and encouraged them to register with a GP.
• Patients could take advantage of walking groups arranged from the Westbourne Green site.
• The practice could evidence that previous high numbers of emergency admissions to hospital had reduced since April 2016 by 15% and was now 8% below the CCG average.
• A priority moving forward for the practice was to identify if a patient was also a carer. The practice were proactively asking older people at appointments if they had any caring responsibilities and we saw that written information was available to direct carers to the various avenues of support available to them.