Archived: Bull Farm Branch of Oakwood Surgery

Updated 30 January 2017

Bull Farm Surgery is a single handed practice supported by a salaried GP which provides primary care services to approximately 2770 under an Alternative Provider Medical Services (APMS) contract.

• The practice is situated close to public transport and has parking facilities, including disabled bays.
• Services are provided from Concorde Way, Millenium Business Park , Mansfield, Nottinghamshire, NG19 7JZ
• The practice consists of one lead GP (male) with a part time salaried GP (female).
• The nursing team consists of one advanced nurse practitioner, one practice nurse, one health care assistant (HCA) and one phlebotomist (who had a dual role as a receptionist).
• The practice has a practice manager and office manager who is supported by five clerical and administrative staff to support the day to day running of the practice.
• The practice has a sister practice locally. Some of the staff work at both practices. Any emergency situations meant that the practice could easily relocate.
• When the practice is closed patients are able to use the NHS 111 out of hours service.
• The practice has high deprivation and sits in the third most deprived centile.
• The practice is registered to provide the following regulated activities; surgical procedures;, diagnostic and screening procedures, maternity and midwifery services; and treatment of disease, disorder or injury.
• The practice lies within the NHS Mansfield and Ashfield Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.
• The practice is open between 7.30am and 6.30pm Monday to Friday (Monday and Wednesday 8am). Nurse appointments are available Tuesday, Thursday and Friday from 7.30am.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bull Farm Surgery on 22 December 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 an effective system in place for reporting and recording significant events. Lessons were shared to make sure action was taken to improve safety in the practice.

• Risks to patients were assessed and well managed.

• 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.

• Patient survey figures showed patients rated the practice higher than others for most aspects of care. Comments about the practice and staff were positive.

• 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. Improvements were made to the quality of care as a result of complaints and concerns.

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

• The practice had employed an advanced nurse practitioner so that the GP’s were able to spend more time with more complex patients.

• 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.

• Safety alerts and alerts from Medicines and Healthcare products Regulatory Agency (MHRA) were reviewed and cascaded to the appropriate persons. However we did not see these discussed in clinical meeting minutes.

• There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular meetings. Meetings did not show standing agenda items such as complaints, patient safety alerts and NICE guidance.

• The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

• The practice had identified 39 patients as carers (1.4% of the practice list).

The areas where the provider should make improvement are:

• Review process and methods for identification of carers and the system for recording this. To enable support and advice to be offered to those that require it.

• Implement a continuous programme of quality improvement including clinical audit.

• Update action plans accordingly to evidence completed actions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 January 2017

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

• Staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nurse appointments were available three mornings per week from 7.30am.
• Performance for diabetes related indicators was comparable to CCG and national averages. (100% compared to 83% CCG average and 90% national average).
• Longer appointments and home visits were available when needed.
• The practice worked with community specialist nurses for heart failure, complex diabetic patients and chronic obstructive pulmonary disease patients.

Updated 30 January 2017

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 above CCG averages 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.
• The practice’s uptake for the cervical screening programme was 85%, which was above the CCG average of 80% and the national average of 76%.
• We saw positive examples of joint working with midwives and health visitors.

Updated 30 January 2017

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.
• Patients had a named accountable GP to enable continuity of care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs from either the GP or advanced nurse practitioner.
• Reviews were completed in patients home were required.
• The practice worked with the multi-disciplinary teams in the care of older vulnerable patients.
• The practice had close links with local pharmacies to arrange delievery of medicines if necessary.

Updated 30 January 2017

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 and flexible.
• Appointments were available on the day and there were options to book an appointment with a GP up to two weeks in advance.
• Nurse appointments were available three mornings per week from 7.30am.
• Telephone consultations were available.
• 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 30 January 2017

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

• 78% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG average of 87% and the national average of 84%.
• 98% of patients experiencing poor mental health were involved in developing their care plan in last 12 months which was better than the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Staff had completed dementia awareness training.

Updated 30 January 2017

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.
• The register was monitored to ensure patients were attending for their annual reviews.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.