Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Broadmead Medical Centre on 8 December 2014. Overall the practice is rated as good.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with 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 both in the practice and walk-in centre.
• People who were of no fixed abode and those who were unable to make a same day appointment with their own GP were able to be seen in the walk-in centre.
• 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.

We saw several areas of outstanding practice including:

• The practice held a register of patients living in vulnerable circumstances including people with no fixed abode and those with a learning disability. It had carried out annual health checks for people with a learning disability and offered longer appointments for them.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.
• The practice liaised with substance misuse services and a refuge to provide outreach services for patients who were reluctant to visit the practice.

• Some patients lived in hostels for the homeless and failed to access health care so the practice nurses held clinics in the hostel.

• The practice provided Saturday support to the Criminal Justice Intervention Team. When people were released from prison on a Friday they could be seen at appointments if their own GP practice was closed on Saturday. This enabled them to be given support with medicines for the weekend.

• The walk-in centre provided opportunities people whose circumstances may make them vulnerable to have same day appointments and appointments at weekends.
• Some reception staff could speak other languages such as Somalian which provided assistant to patients from Somalia and an interpreting service was available.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 12/2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Broadmead Medical Centre on 10 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw some areas of outstanding practice which had been identified on our previous visit were continuing and in addition we found:

• The nurse team from the practice had a programme of regular visits to local hostels to offer health screening and support people to access local health services.
• Transgender patients were supported by the practice. Specifically the practice ensured that patients’ record reflected the gender they identified with, and the nurse team liaised closely with the local treatment centres so that they had knowledge and could provide guidance to patients about their treatment and potential side effects.
• The practice had designated appointments on Saturday for patients who had been discharged from prison who required primary care services. This was pre-booked in liaison with the Criminal Justice Intervention team and allowed for continuity for treatment and prescribing.
• The practice temporarily registered relatives of patients at the local children’s hospital who were staying away from home. The practice temporarily registered relatives of patients at the local children’s hospital who were staying away from home.
• The practice had a pro-active approach to managing new born babies and their mothers and routinely sent a birth card with a pre-booked appointment date to encourage attendance for checks and immunisations which resulted in national targets being met.

The areas where the provider should make improvements are:

• The practice should review use of consent forms for any minor surgery or contraceptive insertions to ensure the details of any decisions or discussions are fully recorded.
• The practice should ensure that the procedure for use of stock medicines records is fully implemented by clinical staff.
• The practice should ensure there was a protocol in place for maintaining the security and integrity of content of the consulting rooms.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice