Archived: Victoria Road Medical Practice

Updated 19 March 2015

Victoria Road Medical Practice provides a range of primary medical services to a population of approximately 5,800 patients in the Bedford centre, Kempston, Elstow, and Shortown area. The practice population is predominantly Asian but also includes patients from ethnic minority groups such as those originating from Eastern Europe and Asia. It serves a significantly higher than average number of people in the age groups of 0-10years and 25-39 years.

The practice has undergone an ownership change in October 2012 and delivers services under an alternative provider medical services contract (APMS) from Phoenix Primary Care Limited. They have been working since that time to put systems and processes in place, increase and establish a stable workforce, and develop services and improve outcomes for patients. The practice have an additional contract which requires them to provide appointments for patients who attend A&E and who are redirected if their care is deemed appropriate to be delivered at a GP surgery.

The practice employs three GPs, two females, one of whom is the medical director and one male GP. There are two advanced nurse practitioners, a practice nurse, a health care assistant and a practice manager who is supported by a number of reception and administrative staff.

The CQC intelligent monitoring placed the practice in band 1. The intelligent monitoring tool draws on existing national data sources and includes indicators covering a range of GP practice activity and patient experience including the Quality Outcomes Framework (QOF) and the National Patient Survey. Based on the indicators, each GP practice has been categorised into one of six priority bands, with band six representing the best performance band. This banding is not a judgement on the quality of care being given by the GP practice; this only comes after a CQC inspection has taken place. The latest data available to us prior to inspection showed some areas of higher than average risk relating to conditions such as diabetes, mental health and chronic obstructive pulmonary disease.

Out of hours care when the surgery was closed was accessed via the NHS 111 service.

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Victoria Road Medical Practice on 15 January 2015. We have provided an overall rating of good for this practice. However, there are areas which require improvement in effectiveness, specifically for the population groups where patients were experiencing mental health problems and for patients whose circumstances make them vulnerable. The practice was taken over by the current provider in October 2012 and have recently been working to put plans in place to improve the service which was experiencing difficulties in meeting people’s needs. However, they were not able to demonstrate effectiveness in all areas at the time of our inspection.

A medical director was appointed only three months ago to lead and develop the practice. This has resulted in many changes and plans being developed to improve the service overall. As a result, whilst we saw evidence of improvements in all areas, we were unable to assess the effects of some of these after such a short time. We saw that the practice had plans for future developments in all areas but were focusing on establishing robust systems and processes in all areas to facilitate good clinical care.

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

• There was a clear leadership structure and staff felt supported by management.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice were actively seeking feedback from staff and patients and trying to widen the membership of the patient participation group.

However there were areas of practice where the provider needs to make improvements. The practice should:

• Fully personalise the business continuity plan to ensure it contains all details specific to the practice.

• Introduce systems to ensure that staff are up to date with mandatory training such as fire and Mental Capacity Act (2005) training.

• Provide more comprehensive information regarding methods of booking appointments, out of hours arrangements and the complaints procedure to patients in the practice leaflet.

• Introduce more robust methods to ensure that difficult cases and review of elective and urgent referrals are formally discussed and documented to facilitate learning and ensure all staff delivering care are aware of any changes.

• Progress the establishment of multi-disciplinary meetings for palliative and end of life care and patients with complex conditions.

• Continue to develop and establish robust systematic processes to manage patients’ care from vulnerable groups and those with mental health problems.

• Ensure that a policy is developed to ensure consistency in medication reviews and the coding.

• Ensure that the legionella testing is completed as soon as possible and a more robust system for future checking is introduced.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 19 March 2015

The practice has been 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. Longer appointments and home visits were available when needed. Since the appointment of more qualified suitably skilled staff, we saw that processes were being implemented to manage long term conditions effectively.

Updated 19 March 2015

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

Updated 19 March 2015

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 and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and opportunistic treatments when appropriate.

Updated 19 March 2015

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 reflects the needs for this age group.

Updated 19 March 2015

The practice has been rated as good overall for the care of people experiencing poor mental health (including people with dementia. They were working towards offering people experiencing poor mental health an annual physical health check but this was opportunistic and no systematic process was in place. The practice was in the early stages of implementing meetings with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. They were also starting to complete advance care plans for patients with dementia and had committed to the enhanced service for dementia care. However, we could not evidence that this was established and effective at the time of our inspection.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and SANE. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had had not yet accessed training in the Mental Capacity Act 2005.

Updated 19 March 2015

The practice has been rated as good overall for the care of people whose circumstances may make them vulnerable. It had carried out annual health checks for people with a learning disability and offered longer appointments for those patients.

The practice had told 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.

They were starting to establish links with the multi-disciplinary teams in the case management of vulnerable people but this was in its early stages and had not yet become established and there were currently no written protocols regarding end of life or palliative care.