Blackburn Road Medical Centre

Updated 9 December 2016

Blackburn Road Medical Centre delivers primary medical care to 11,559 patients in Birstall, Batley and Birkenshaw under a Personal Medical Service (PMS) contract with NHS England. The practice is located in a purpose built property at Blackburn Road, Birstall, Batley, WF17 9PL. The property has been extended several times to accommodate the service. There is a branch practice which is located at Birkenshaw Health Centre, Town Street, Birkenshaw, BD11 2HX. Both locations are accessible for patients with disabilities and have parking available.

• There are four male GP partners, and three salaried GPs (two male and one female); four female practice nurses and three female healthcare assistants. A female advanced care practitioner was joining the team in September 2016.
• The service is a teaching and training practice. At the time of the inspection the practice had one registrar, one medical student and one FY2 GP trainee.
• The practice is open between 8am and 6pm Monday to Friday at the Blackburn Road site. The branch practice at Birkenshaw is open from 8am every morning and closed at 6pm on Mondays and Thursdays, 1pm on Tuesday and Wednesday and 1.30pm on Fridays. Appointments were available throughout the day, in between these times, and patients could be seen at either location. Extended hours appointments were offered on Thursday evenings until 8pm and Wednesday mornings from 7.30am at the Blackburn Road location for working patients.
• When the practice is closed calls are transferred to the NHS 111 service who will triage the call and pass the details to Local Care Direct who is the out of hours provider for North Kirklees.
• The majority of patients are of White British origin, with 3% of patients being from black minority ethnic populations.
• The practice offer enhanced services which include minor surgery, the management of diabetes, phlebotomy, 24 hour blood pressure monitoring and ECG fitting and monitoring.

Updated 9 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Blackburn Road Medical Centre on 15 September 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. We saw how the analysis of significant events led to additional training and changes in policy and procedure
• 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.
• We saw how the business continuity and contingency plans had been reviewed and improved in response to a major incident in Birstall, where the practice was used as an emergency refuge for staff, patients and members of the public.
• 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.
• 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.

• 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 practice had strong and visible clinical and managerial leadership and governance arrangements. Staff appreciated the learning ethos of the practice and gave examples of where they had received additional training to improve their knowledge or expand their role.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

• The practice took every opportunity to learn from safety concerns raised by staff to improve services. We reviewed many incidents that had been reported and reviewed. Staff were also encouraged to report positive events, record their reflections and suggest improvements. We saw how the analysis of significant events led to additional training and changes in policy and procedure. The practice also fed into the North Kirklees Clinical Commissioning Group quality issues log to improve safety in the locality.

• This practice was an outlier for dementia on the primary care assessment tool in 2015. Three healthcare assistants had received additional training to enable them to carry out mental health physical assessments. Data from 2015/16 showed that 93% of patients had received a health check. This was a 28% improvement from 2014/15 where 65% of patients received their health check (CCG average 83%, national average 84%).

The areas where the provider should make improvement are:

• Review the process for checking emergency equipment.
• Review the storage of vaccinations in line with Public Health England guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 December 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.
• Performance for diabetes related indicators was similar to the national average. The practice initiated diabetic treatment. Data showed that 87% of patients with diabetes, on the register, had a record of a foot examination and risk classification in the preceding 12 months (CCG average 89%, national average of 88%).
• Performance for hypertension related indicators was better than the national average. Data showed the last blood pressure reading for patients in the preceding 12 months was within normal parameters for 89% of patients with hypertension (CCG average 85%, national average 84%).
• The GPs and nursing team worked together to manage patients with long term conditions. Staff followed the ‘Year of Care’ to provide personalised care planning for people with long term conditions by working in partnership with patients and care professionals. The practice used a diabetic record card which had been developed by a patient.
• Longer appointments and home visits were available when needed.
• 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.

Updated 9 December 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 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.
• Data from 2014/15 showed the practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG and national average of 82%. The practice nurses had identified approximately 300 patients who had not attended and contacted them by telephone. Over 200 of these patients had subsequently attended for screening; the latest unverified data showed the uptake rate had increased to 84%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There was a joint baby clinic with a GP, nurse and healthcare assistant and a drop-in clinic on Friday mornings.
• Same day appointments were available for children and those patients with medical problems that require same day consultation. The practice had a duty doctor each day to review and manage requests for same day demand.

Updated 9 December 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The addition of an advanced care practitioner meant that the practice could offer additional home visits for older and vulnerable patients.
• The practice had a nursing bed gap scheme in place for patients who resided in care facilities. The community care provision only included patients who did not require nursing care. The practice worked with the community care provider and set up an alert system to identify when patients moved from a care bed to requiring nursing care provision to enable continuity of care.
• The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. Data showed that uptake rates were high. For example, 64% of patients aged 60 to 69 had been screened for bowel cancer in the preceding 30 months. (CCG average 55%, national average 58%).

Updated 9 December 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, 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.
• Extended hours appointments were offered on Thursday evenings until 8pm and Wednesday mornings from 7.30am at the Blackburn Road location for working patients.
• The practice regularly reviewed the availability of appointments and promoted the use of online services including ordering prescriptions and booking appointments.

Updated 9 December 2016

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

• This practice was an outlier for dementia on the primary care assessment tool. Three healthcare assistants had received additional training to enable them to carry out mental health physical assessments. Data from 2015/16 showed that 93% of patients had received a health check. This was a 28% improvement from 2014/15 where 65% of patients received their health check (CCG average 83%, national average 84%).
• Data for 2014/15 showed that 57% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months (CCG average 89%, national average 88%). The practice reviewed the process to improve the number of patients attending for their review. A lead clinician was identified to drive improvement and invitation letters were changed to invite patients to attend. Unverified data for the first six months of the 2016/17 QOF year showed that the practice had already achieved 85%.
• 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.
• The practice referred patients taking benzodiazepines to the North Kirklees Clarity project which provides a structured programme to reduce the overall prescribing of these medicines.
• 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.
• Staff had received Dementia Friends training and had a good understanding of how to support patients with mental health needs or dementia.

Updated 9 December 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. There was an alert on the record of those patients who were known to be vulnerable or have complex needs to identify the need for a longer appointment.
• The practice identified and recorded the communication needs of patients with a disability, impairment or sensory loss in line with the Accessible Information Standard.
• The practice had invited a local carer support organisation to attend a clinical meeting to enable staff to identify carers more effectively and offer appropriate support. A member of staff was identified as patient liaison officer who received additional training and proactively encouraged patients to inform the practice if they either had or were a carer. This resulted in the number of carers increasing from 54 to 81.
• 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.
• 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.