Dr Gladstone Bello Also known as Dr Bello's Surgery

Updated 12 July 2016

Dr Gladstone Bello , also known as Dr Bello's Surgery, is a small single handed GP surgery providing primary care services to around 2,250 patients in Accrington within East Lancashire under a general medical services (GMS) contract with NHS England. The local Clinical Commissioning Group (CCG) is East Lancashire.

The practice moved into shared premises in 2012 which is located in a residential area in Church, Accrington. The building is a former public house, which was sympathetically modernised and several original features have been incorporated into the refurbished design as a local GP surgery.

The practice team consists of a single-handed principal GP and a practice nurse who also works as the community matron, providing care for patients aged over 75 years old for the practice and two local practices. One of the senior receptionists has been supported by the practice to complete training to become a health care assistant. The clinical staff are supported by a practice manager (who has recently been appointed to manage the second practice) as well as a team of five reception and support staff.

The practice is open from 8am until 6.30pm on Mondays, Wednesday from 8am until 1pm, Tuesdays and Thursdays 8 am until 8pm as well as offering Saturday morning appointments. Dr Bello is providing additional extended hours temporarily whilst the CCG completes work to introduce a new extended hours contact locally.

On Wednesday afternoons when the practice is closed, the GP is available by mobile phone. Out of hours services are provided by East Lancashire Medical Services Ltd. The practice works closely with two other principal GPs, who cover each other for holidays and provide locum cover for each other.

Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). The life expectancy rate is below national and CCG averages (75 for men, 80 for women) and there are fewer under 45 year old patients than the national average, with comparatively more over 65 year olds. 15% of the practice population are 66 years old or over. East Lancashire has a higher prevalence of chronic obstructive pulmonary disease (COPD, a lung condition), smoking and smoking related ill-health, cancer, mental health and dementia than national averages.

Updated 12 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Gladstone Bello’s Surgery on 14 June 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 a system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt 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.

The areas where the provider should make improvement are:

• Review the threshold of events which are reported as significant events to ensure that all opportunities for shared learning are maximised
• Introduce a system to update patient medical records with relevant information following multi-disciplinary review meetings.
• Conduct a risk assessment on provision of emergency drugs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 July 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice nurse lead in chronic disease management and worked closely with the GP. Patients at risk of hospital admission were identified as a priority.
• The practice achieved higher than average outcomes for all five diabetes indicators. For example, 87% of patients with diabetes had a recent blood sugar test result which was within a normal range, compared with the national average of 77%.
• 94% of patients with chronic obstructive pulmonary disease (COPD, a lung condition) had a full review undertaken in the previous 12 months, higher than the national average of 90%.
• Longer appointments and home visits were available when needed.
• All patients had a named GP and those with long term conditions were offered 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 and practice nurse worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 12 July 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 living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. We noted that some childhood immunisations for under 24 months olds were very low, compared to the clinical commission group (CCG) averages. The practice was aware of this and explained there had been an error in CCG wide data. The practice manager provided recent data showing that over 95% of two year old children were currently fully immunised and the CCG was working to resolve a data quality issue. Immunisation rates for five year olds were in line with CCG averages.
• 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.
• 86% of eligible women had a cervical screening test recorded in their notes in the preceding 3 years, above the national average of 82%.
• 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.

Updated 12 July 2016

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 and urgent appointments for those with enhanced needs.
• The practice had identified that 15% of the patient population was over 66 years old and the community matron provided additional care for patients aged 75 and over, coordinating care and making referrals to partners including local and national charitable organisations and social services where appropriate.
• The practice discussed anecdotal evidence that this role was having a positive impact on the care for this patient group, although data was not yet available to demonstrate the impact of this role.
• Housebound patients were offered regular reviews in their own home.
• Figures from the Quality and Outcomes Framework for 2015-2016 shared by the practice with the inspection team showed that 76% of patients aged over 65 had received a flu immunisation and 81% a pneumonia vaccination, although these figures had not been validated nationally at the time of our visit.

Updated 12 July 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.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Since the introduction of electronic prescription services (EPS) in the local area, the practice had processed one or more prescriptions for 2,100 patients through EPS. This equated to 82% of the practice population.
• The practice currently offered evening appointments on Tuesdays and Thursdays as well as additional Saturday morning surgeries.
• The practice provided emergency contraception where requested and referred patients to local family planning services where appropriate.

Updated 12 July 2016

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

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
• 91% of patients with schizophrenia, bipolar effective disorder or other psychoses had a review in the previous 12 months, also higher than the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 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.
• Several staff had attended dementia friend training and all staff had a good understanding of how to support patients with mental health needs and dementia.
• The principal GP had prior training in psychiatry and offered early care and intervention to patients experiencing mild mental health problems.

Updated 12 July 2016

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 those with a learning disability and a range of patients living in temporary rented accommodation close to the practice.
• The practice offered longer appointments for patients with a learning disability and worked closely with the local learning disability nursing team.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people, for example the integrated neighbourhood team (INT) for patients with complex medical and social needs.
• Patients could attend a local counselling service which was held in the practice premises three days per week.
• 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.
• The practice referred patients with drug and alcohol problems to the local substance misuse support service.
• The practice offered good continuity of care, with one principal GP, one practice nurse and a working agreement with two local GPs who provided all locum GP cover within the practice.