East Bridgford Medical Centre Also known as Drs Scaffardi, Stewart & Cope

Updated 22 June 2016

East Bridgford Medical Centre provides a range of services to 6755 patients living in an area that covers 20 villages with furthest points of Elston, Lowdham, Radcliffe on Trent, Bingham and Whatton.

The practice is in the Rushcliffe Clinical Commissioning Group (CCG) area. The practice serves an area where income deprivation affecting children and older people is significantly lower than the England average. Additionally, the area has a lower than average number of patients living with a long standing health condition and with health related problems affecting their daily life. The practice also has significantly fewer patients claiming disability allowance. The practice has a comparable average for patients in paid work or full time education and a significantly lower number of patient’s unemployed than the England average.

The practice holds a GMS contract, has a dispensary, and is a training practice with one GP trainer. A training practice has trainee GPs working in the practice; a trainee GP is a qualified doctor who is undertaking further training to become a GP. A trainer is a GP who is qualified to teach, support, and assess trainee GPs. There are currently three trainee GPs working in the practice. The practice offers a range of services including sexual health, long term conditions, and travel advice. In addition the practice holds a contract to offer anti coagulation services. An anticoagulant is a medicine that stops blood from clotting.

The practice has a dispensary and we included this in our inspection.

The practice team consists of three GP partners, two male and one female, one salaried GP and two GP registrars, three female nurses, and two health care assistants. The non-clinical team consists of one practice manager, five reception staff, and three administrative staff. The practice employs eight dispensary staff.

The practice is open between 8am and 6.30pm Monday to Friday. Late surgeries are offered on some Mondays, Tuesdays, or Thursdays with appointments from 6.30 to 7.30pm.

Nottingham Emergency Medical Services provide out of hours cover when the practice is closed.

We previously inspected this practice on 25 August 2015. We found that the practice required improvement.

Updated 22 June 2016

Letter from the Chief Inspector of General Practice

On 25 August 2015, we carried out a comprehensive inspection of East Bridgford Medical Centre. The practice was rated as requires improvement overall and rated as inadequate for providing safe services, good for effective, caring and responsive services and requires improvement for well led services.

As a result of the findings on the day of the inspection the practice was issued with requirement notices for regulation 12 (Safe care and Treatment) and regulation 18 (Staffing).

Specifically we found that

There were systems and processes that were not sufficiently robust to ensure that patients were kept safe from harm. The storage and management of medicines did not meet the required standards and some staff had not received appropriate training to fulfil their role.

The practice sent us an action plan that outlined the steps they were taking to improve and we then carried out an announced comprehensive inspection of East Bridgford Medical Centre on 6 May 2016.

We undertook this inspection to check that they had followed their action plan to address the shortfalls and to confirm that they now met legal requirements.

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

• Improvements had been made that addressed the findings of our inspection on 25 August 2015. These included the proper and safe management of medicines, doing all that is reasonably practicable to mitigate any risks, and ensuring that staff received appropriate support and training.

• The appointment system was flexible and ensured that patients who requested to be seen on the same day were able to obtain an appointment.
• The practice had good facilities including access for those with limited mobility. A hearing loop was available for those patients who needed it. Patients that were particularly unwell were asked to wait in areas where reception staff could observe them, in case their condition changed.
• Information about the services and how to complain was available. The practice sought patient views about improvements that could be made to the service and some of these discussions occurred through the patient participation group (PPG).
• The practice proactively managed care plans for vulnerable patients and had effective management strategies for patients at the end of their life. This enabled 78% of patients to die in their preferred place of care.
• There were systems, policies and procedures to keep patients safe and to govern activity for example, infection control.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 22 June 2016

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

Nursing staff had roles in chronic disease management and data reviewed showed patient outcomes were similar when compared with other practices in the locality. Patients that had attended appointments had a structured annual review to check that their health and medication needs were being met.

The practice held regular meetings attended by GPs, nurse and administration staff to ensure that patients received appropriate re-calls and follow up for their long term conditions.

Home visits were available to those patients who could not attend the surgery.

Longer appointments were available if required. Practice staff followed up patients who did not attend their appointments by telephone.

Updated 22 June 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 patients who had a high number of accident and emergency (A&E) attendances. Immunisation rates were in line with local averages for all standard childhood immunisations. Young children were given priority appointments for urgent needs.

The practice proactively offered routine contraceptive services and was a centre for the C-card scheme. This scheme provides young people with free condoms. The school nurse liaised directly with a GP when it was identified that a young person needed advice regarding their health and well-being.

Appointments were available outside of school hours and the premises were suitable for children and babies.

The practice had identified five young carers and was proactive in supporting these young people.

We saw examples of joint working with midwives, health visitors, and school nurses.

Updated 22 June 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. Home visits were available for those unable to attend the practice. Continuity of care was maintained for older people through a stable GP workforce and personalised patient centred care. The practice provided visits to local care homes.

The practice regularly reviewed attendances at the accident and emergency department to ensure patients identified as vulnerable to admission were reviewed.

Updated 22 June 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, including 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. Patients were able to book appointments at times that were convenient to them for their annual reviews. Telephone consultations were available for those patients who wished to seek advice from a GP.

NHS health checks were available and appropriate follow up arranged, promoting health prevention and healthy lifestyles.

The practice’s uptake for cervical screening was above the CCG and national average. The percentage of patients who had been screened for breast and bowel cancer was above the CCG and national average.

Updated 22 June 2016

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

The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Staff told us that 91% of patients with dementia had received advance care planning and appropriate reviews. These patients had a named GP and continuity of care was prioritised for them.

Same day appointments and telephone triage with a GP was offered to ensure that any health needs were quickly assessed for this group of patients.

The practice told patients experiencing poor mental health how to access various support groups and voluntary organisations. Staff had knowledge on how to care for patients with mental health needs and dementia.

Updated 22 June 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. It offered longer appointments and carried out annual health checks.

There were 30 patients on the register for patients with learning disabilities, 14 of these had received an annual review, and two had declined. We discussed this with the practice who had recognised that this needed to be improved and we saw that a robust system had been put into place to ensure that all patients received an annual review. The GP lead attended an annual meeting with the community learning disability team to review patients’ health needs and agree management plans.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. We saw the practice provided vulnerable patients with information about how to access various support groups and voluntary organisations.

We saw evidence that the practice had worked to the Gold Standards Framework for those patients with end of life care needs. Co-ordinated care for patients at the end of their lives ensured that 78% died in their preferred place of care.

Staff knew how to recognise signs of abuse or neglect 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.

Practice staff were intuitive to the needs of this group of patients and demonstrated that they had a personalised approach to helping them. Phlebotomy appointments were available at the practice.