Bradford Student Health Service

Updated 17 August 2016

Bradford Student Health Service provides services for 9,577 patients. The surgery is situated within the Bradford City Clinical Commissioning group and is registered with Care Quality Commission (CQC) to provide primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

Bradford Student Health Service is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury, maternity and midwifery services and family planning. They offer a range of enhanced services such as childhood immunisations and improving patient access on line.

The majority of patients that are registered with the practice are students attending the local university. There is a higher than average number of patients aged between 15 and 34. With a higher than average number of male patients aged 35-39. There are fewer patients aged over 40 than the national average and very few children registered with the practice aged under 14. Public Health England data estimates that 49% of the practice population is from a south Asian background with a further 16% of the population originating from black, mixed or non-white ethnic groups. The practice has a high patient turnover with large numbers of students registering and leaving each year and estimates that over 70% of patients registered with them are from overseas. At busy periods the practice will register over 200 patients per day.

The practice is registered as a partnership of three GPs, one of whom is female, who work 18 sessions collectively. The practice also employs regular locum cover for 2 sessions per week. There is an advanced nurse practitioner and two practice nurses who are all part time and are supported by a part time health care assistant (HCA). The clinical team is supported by a practice manager and a team of administrative staff.

The practice catchment area is classed as being within one of the 20% most deprived areas in England. People living in more deprived areas tend to have a greater need for health services.

Bradford Student Health Service is situated within an older single storey building with limited car parking available. It has disabled facilities and a hearing amplifier. Access to the building is not disability friendly but staff are aware of this and assist when necessary. The practice has submitted plans to move from the current location over a period of years but have been unable to do so due to a lack of funding.

The practice is open for reception and consultations from 8.00am until 5.30pm Monday to Friday.

The practice does not offer an extended hours clinic.

When the surgery is closed patients can access the ‘Pharmacy First’ minor ailments scheme and are advised of the NHS 111 service for non –urgent medical advice. Patients can also access the walk-in centre at Hillside Bridge Health Centre.

Updated 17 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bradford Student Health Service on 27 July 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 thorough system in place for reporting, recording and reviewing significant events.

• 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. We saw that patients were contacted by the practice following complaints and that these were resolved in a timely manner.
• Risks to patients were assessed and well managed. However, reception staff were occasionally acting as chaperones without a Disclosure and Barring Service check (DBS). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they could get through easily to the practice by phone and they were satisfied with the practices’ opening hours. Patients also told us on the day that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 had good facilities and was well equipped to treat patients and meet their needs.
• The practice was an active member of a GP federation within Bradford City Clinical Commissioning Group (CCG). The federation had commissioned a number of services including a fertility service and a diagnostic and ultrasound service. Patients referred to these services would be reviewed within a week of being referred.
• There was a clear and supportive leadership structure and staff felt very supported by management. The practice proactively sought feedback from staff, patients and the patient participation group (PPG) using a range of social media, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

We saw that the practice had developed Information leaflets that were relevant to the patient group. These included bespoke leaflets on how to use NHS services, a self-care leaflet and a “z” card, credit card sized leaflet that gave advice on vaccinations, services, and who to contact for various services, such as sexual health, alcohol, drug and mental health advice.

The areas where the provider should make improvement are:

The practice should review the use of staff who act as chaperones for patients without a Disclosure and Barring Service check (DBS). DBS checks should be undertaken for staff performing this role or a risk assessment should be evidenced.

The infection prevention and control (IPC) audit should be actioned and completed. All actions taken should be documented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 August 2016

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.
• The percentage of patients with diabetes who had an influenza immunisation within the preceding 12 months was 94% which was comparable to CCG and national averages.
• Longer appointments were available when needed and for anyone who requested additional time.
• There was a named lead GP for those at high risk of an unplanned admission.
• The practice participated in the ‘Bradford Breathing Better’ and the’ Bradford Beating Diabetes’ CCG led initiatives.
• The practice offered a long term conditions pack to patients to assist them in the management of their condition and provided ECG, Spirometry and phlebotomy services in-house.
• Where appropriate the practice liaised with the university disabilities office to support patients and had a shared record system with out of hours services to enable continuity of care.
• 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 were involved in the “Aspire” research programme which aims to improve the care of people within general practice. The programme showed that the care given to diabetic patients within the practice had improved by 2% which was comparable to other practices in West Yorkshire.

Updated 17 August 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 accident and emergency (A&E) attendances.
• Immunisation rates were lower than CCG averages for all standard childhood immunisations. The practice was aware that is faced particular challenges in this area. Many parents were from overseas where immunisation regimes differ from those in the United Kingdom and the population was very transient with large numbers of patients leaving the practice each year. A comprehensive recall system was in place to encourage parents to attend with their child. The practice held additional clinics around registration time for children and gave patients the opportunity to update vaccinations missed earlier in childhood
• Similar challenges were evidenced in relation to the uptake of cervical screening. The percentage of women whose notes recorded that a cervical screening test had been performed in the preceding five years was 53%, compared to the CCG average of 77% and the national average of 82%. Many women registered with the practice were from overseas and reported not to be sexually active. The practice also used registration and open days to encourage the uptake of screening.
• Children were offered same day appointments or added to the emergency list for the GP to review. Appointments were available outside of school hours and the premises were suitable for children and babies.
• When families and young children failed to attend for appointments and screening the practice would check their registration records which included a probable date for completion of their university course. They would also liaise with the university who would contact the patient when possible and ask them to contact the surgery.

Updated 17 August 2016

This group includes patients within the population who are aged 75 and over. The practice does not have anyone registered with them at this current time in this age group.

Therefore the care given to this population group has not been rated.

• We saw evidence that the clinicians at the practice had the skills and abilities to manage patients in this age group should they choose to register with the practice.

Updated 17 August 2016

The practice is rated as outstanding 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 reflects the needs for this age group. Data showed that 38% of patients were signed up for on line services.
• The practice proactively used a range of social media to communicate with patients and the PPG, highlighting issues, health promotion and self-care advice and events.
• The practice offered a self-care area within the practice where patients could check their height, weight and blood pressure. Results could be placed in an envelope and handed to the receptionist. Relevant leaflets were also available. These items were also portable and were taken to the university when events were held.
• The practice was flexible and responsive to individual needs; staff at the practice had an excellent understanding of the issues faced by students who may be isolated and alone when joining the university. Services in the practice were tailored to meet the needs of students and the practice worked closely with representatives and services at the university and also at the local college.
• The practice would advertise their services and direct students to access appropriate health care with posters and leaflets in the halls of residence. The practice attended’ fresher’s week’ on the university campus and registration at the practice was encouraged at this point. The practice had also liaised with other health services such as the drug and alcohol team and arranged for them to attend.
• The practice was approximately half a mile away from the main campus; however a nurse held a general advice clinic on campus once per month in response to a suggestion by the PPG.
• At every point of contact with the surgery patients would be asked to give their telephone and address details. This enabled the practice to keep in touch with students when they moved accommodation.
• Bespoke information leaflets were available that were relevant to the patient group. These included leaflets on how to use NHS services, a self-care and an exam stress leaflet and a “z” card, credit card sized leaflet that gave advice on vaccinations, services, and who to contact for service such as sexual health, drug and mental health advice.

Updated 17 August 2016

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

• The practice did not have anyone registered with them who had a diagnosis of dementia.
• The practice worked with multi-disciplinary teams and student support services in the case management of patients experiencing poor mental health.
• The percentage of patients with schizophrenia, bipolar disorder or another psychoses whose alcohol consumption had been recorded in the preceding 12 months was 100% compared to the CCG average of 95% and the national average of 89%.
• Locally agreed targets for patients with mental health issues showed that the practice was performing well in this area. For example 100% of patients on the mental health register had been reviewed every six to eight weeks during the last 12 months.
• The practice supported patients experiencing poor mental health to access various support groups and voluntary organisations. They worked closely with the university counselling services and leaflets were available.
• 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. The practice had reviewed a patient who had repeatedly called an ambulance. A strategy was developed and put in place and the patient had not found it necessary to call for help since.
• Staff demonstrated a good understanding of how to support patients with mental health needs and the impact that leaving home for the first time might have on an individual’s mental health. Patients registering with the practice completed a mental health assessment and these were reviewed as necessary by the GP.
• The practice offers physical health checks to patients with a serious mental illness.

Updated 17 August 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability, those who requested them and a small number of patients who would automatically be allocated a longer appointment as the practice had identified that this met the person’s individual needs.
• Registration forms for the practice included an assessment of alcohol intake, smoking and a screening for depression. Concerns would be related to the GP who would follow up on any scores which indicated further assessment and support was needed.
• 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. Whilst the practice rarely had the need to refer to voluntary organisations in the public sector, they had a good understanding of the services offered by the university and referred to these as necessary, for example counselling services.
• 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. We saw that some staff had undertaken training in the area of female genital mutilation (FGM) which was relevant to the practice and they had a policy in place to support this.
• At every point of contact all patients registered with the practice were asked to provide up to date address details and telephone numbers. The practice stated that this had helped to recall patients and ensure that in a very transient population, people could be supported and contacted.