Bevan House

Updated 30 March 2016

Bevan House provides services for homeless people, people in temporary or unstable accommodation, refugees or those seeking asylum and others who find it hard to access the health care and support they need. The practice works closely with other organisations and with the local community in ensuring bespoke services are provided to meet patients’ needs. Additional services that the practice provides are, the Bevan Pathway Team who attend regular meetings at the local hospital to review the patient group and any discharge plans. The Street Medicine Team hold outreach clinics in city centre locations to enhance access for vulnerable patients; this team also offers advice and healthcare to people who were not registered with the practice. Another service is the BRICCs team, a respite service developed with a social housing provider to offer accommodation for homeless patients who require medical care after they are discharged from hospital. The team also offer late night clinics for female sex workers.

Bevan Healthcare, which is responsible for running Bevan House, is a Community Interest Company. As a social enterprise, any financial surplus is spent on improving services for patients.

In 2015 there were 3,003 patients registered at Bevan House, the practice now has over 3,500 registered patients.

Bevan House is situated within the Bradford City Clinical Commissioning group and is registered with CQC to provide primary medical services under the terms of an alternative provider medical services contract, (APMS). This is a locally negotiated contract which allows NHS England to contract for services from non NHS bodies.

Bevan House is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services. They offer a range of enhanced services such as childhood immunisations. The practice offers drop in clinics for emergency cases and babies plus a range of advice, counselling and support services.

The practice offers services to almost twice as many male patients as female patients, with a higher than average number of patients aged between 20 to 49 years of age. Only 0.1% of registered patients are over the age of 75.

Bevan House has recently moved to a converted older building within a city centre location. It has disabled access and facilities. Baby changing facilities are also available.

There are eight part time GPs, two of whom are male and six are female. The practice is staffed by two practice nurses, a vulnerable migrants nurse and a mental health nurse. It also has one full time health care assistant (HCA) and a part time patient engagement lead. The practice also engages the services of a pharmacist one day per week. The clinical team is supported by a managing director, a practice manager and a team of administrative staff.

The practice is open between 9am and 6pm Monday, Tuesday and Friday with appointments available between these times.

On a Wednesday the surgery is open between 9am and 1.30pm when appointments are available and also between 3.30pm and 6pm for appointments. On a Thursday the practice is open between 9am and 8pm for reception assistance and extended hours appointments. In addition the practice also offers late night clinics for sex workers, 3 evenings per month and many services offered by the Street Medicine Team commence at 7am.

When the surgery is closed patients can use the local walk-in centre at Hillside Bridge, Bradford. Patients are also advised of the NHS 111 service.

Updated 30 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bevan House on 4 February 2016. Overall the practice is rated as outstanding.

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.
• Risks to patients were assessed and well managed.
• Feedback from patients about their care was consistently and strongly positive.
• Information about how to complain was available and easy to understand.
• The practice had introduced numerous ways to improve access to services including a walk-in triage service each morning for those without access to a telephone, or who due to language difficulties could not make a telephone appointment.
• An Arabic interpreter was available at the practice until 1pm each day to assist patients.
• Volunteers assisted patients with registration forms and accompanied people to appointments with other service providers for example housing agencies and multi-lingual volunteers were able to interpret for patients.
• The practice had trained Heath Champions who were or had been patients at the surgery, they offered help and advice to patients and organised healthy living and health promotion events.
• The practice had a clear pro-active vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed with them and the staff team.
• The Bevan House team were winners of the 2015 General Practice Awards for Innovators of the Year.

We observed numerous examples of outstanding practice.

• Dedicated teams within the practice worked closely with other organisations in ensuring bespoke services were provided to meet patients’ needs. For example, the Bevan Pathway Team attended regular meetings at the local hospital to review its patient group and improve patient discharge and the provision of care and support.
• The Street Medicine Team held mobile outreach clinics in city centre locations to enhance access for vulnerable patients and also offered advice and healthcare to people who were not registered with the practice.
• The Bradford Respite and Intermediate Care Support Service (BRICCS) is a respite service that has been developed, where the Bevan team work with a social housing provider to offer respite accommodation for homeless patients who require medical care after they are discharged from hospital. These initiatives led to an increase in the number of homeless people registering with the practice, a reduction in the use of acute healthcare, A&E admissions and days spent in hospital. The intervention of these teams with homeless patients has shown significant cost savings in acute care of 62%.
• The practice had organised a Christmas celebration for vulnerable children who were registered with them. The staff team had donated presents for the children which were distributed by a member of the team dressed as Santa Claus.
• Feedback from the Patient Participation Group called the Experts by Experience (ExE), was integral to the running of the practice. Their views were actively sought and valued. The practice held numerous patient focus groups to find out their views on topics such as diabetes care. The group had been involved in the design, build and decoration of the new premises.
• A late evening clinic ran for three evenings per month from 8pm to 11pm for female sex workers and one early morning clinic, in liaison with a local women’s support team. Over 70% of the women who attended the late night sex workers’ clinic had registered with the practice and were accessing extended services.
• The practice had recruited a mental health nurse and a vulnerable migrants nurse, to work alongside a practice nurse, to effectively support patients. This had enabled the practice to be prepared to meet the needs of new patients, conduct structured assessments and refer as necessary to relevant services, prior to the persons arrival in the country.
• The practice had moved to new premises that allowed it to host other services and provide a “one stop shop” for patients. The teams located in the practice included the homeless team, benefits services, refugee support workers, rape crisis, legal, housing, midwifery and health visiting teams.
• Staff were clearly motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Clothing, food, oral and personal hygiene packs and ‘cold weather packs’ (consisting of gloves, socks, a hat, scarf, water and a bar of chocolate) were offered to those patients who were in urgent need.
• All staff had been given the opportunity to participate in individual Life Coaching sessions, to provide guidance and support as needed.
• The practice patient liaison lead and the ExE group held a weekly Chat and Craft group where patients, refugees and homeless people could meet new people and learn about services. Participants also knitted small articles for the homeless.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 March 2016

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

• Systems had been developed to offer patients in this group support through nurse led chronic disease management. Patients at risk of hospital admission were identified as a priority. There had recently been an increase in nursing and GP hours and clinics to assist the practice to target those patients with long term conditions.
• The practice had a high prevalence of HIV and viral hepatitis. Audits had been carried out into both these conditions. As a result the accuracy of recording and knowledge of medication regimes in the HIV group had improved. All the patients in these groups were being offered support through a nurse led review programme and a referral to a local specialist if appropriate.
• Longer appointments and home visits were available when needed. Patients were offered a one stop shop for long term conditions.
• 814 homeless patients had registered and received care with the Bradford Bevan Pathway and the Street Medicine Team since 2013; improved outcomes for this group had been shown following audit. 
• All these patients had a named GP and were offered an 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.
• Wherever possible, face to face interpreters were used in long term condition reviews to increase engagement which was noted to be poor, due to low rates of engagement and literacy, poor self-management, homelessness, destitution and drug or alcohol dependence.
• Following a review of diabetic clinics with the ExE group, individual care plans could be hand written to meet needs if required and patients were reminded by telephone in their own language to attend their reviews following receipt of a letter.

Updated 30 March 2016

The practice is rated as outstanding for the care of families, children and young people.

• There were clear 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 and in line with the CCG in the under two age group. The rates were lower for children aged five years, however, 38% of the practice population had registered within the last year and many of the children had an incomplete immunisation status at that point. The practice had recently implemented plans to improve this and were reviewing individual children and commencing a tailored programme of immunisations.
• Following audit, 103 children at the practice were identified with chronic health conditions, 52 of which were noted to be significant. The practice was pro-actively offering these children individual care plans and reviews.
• The number of patients diagnosed with asthma who had an asthma review in the last 12 months patients was 63% compared with the CCG average of 75% and a national average of 69.7%.
• 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 number of women attending for cervical screening at the practice was 55%, compared to the CCG average of 63% and a national average of 74%. The practice had increased nursing capacity to encourage uptake and had trialled opportunistically speaking to female patients, who were waiting in the reception area, about the benefits of cervical screening. Cervical screening uptake for patients on the mental health register had increased by 6% in the last year and was comparable to the CCG average. Over 70% of the women who attended the late night sex workers clinic have now registered with the practice and were accessing extended services.
• Appointments were available outside of school hours and the premises were suitable for children and babies. We found evidence that children who required medical attention were seen on the same day.
• We saw positive examples of joint working with midwives, health visitors, safeguarding, support workers, voluntary groups and school nurses.
• The practice told us of an occasion where they had liaised directly with a refugee camp in Syria to arrange referrals to hospital services for a sick child prior to their arrival in the country.

Updated 30 March 2016

The practice is rated as outstanding 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 whilst liaising with community matrons.
• There was a named GP who was aware of the individual needs of this group and reviews were offered.
• The issues and management of the vulnerable patients registered with this practice were also relevant to the older people registered.
• End of life care could be offered to individuals accessing the BRICCs service in liaison with the palliative care team.

Updated 30 March 2016

The practice is rated as outstanding 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.
• 80% of the practice population was noted to be of working age but with very high unemployment. This group included the homeless, asylum seekers and sex workers.
• The practice was proactive in using the Street Medicine Team to engage with this age group. The team also supported people who were sleeping rough and were offered shelter in various churches throughout Bradford in the winter. The Street Medicine Team visited whichever church was hosting on the day and offered health care to individuals regardless of whether they were registered with the practice.
• The practice offered online services as well as a full range of health promotion and screening that reflected the needs for this age group. Volunteers were available to assist patients with forms, registration and queries about their health and social wellbeing.
• Late night clinics, three Thursdays per month, were available for female sex workers and an additional clinic was held in the early morning.
• Following an audit which identified high rates of non-attendance, there had been a greater focus on same day appointments being available. An additional clinic had been made available on a Wednesday afternoon.
• The practice e-mailed job opportunities to patients which they knew were looking for work.

Updated 30 March 2016

The practice is rated as outstanding for the care of people experiencing poor mental health

• The practice has exceptionally low numbers of patients diagnosed with dementia. Reviews were regularly undertaken and each patient had a named GP.

• Public Health England, national general practice profile figures, show that 30% of patients registered at the practice were diagnosed with a long term mental health condition. CCG and England average is 5%. Of these patients, 75% had a comprehensive care plan compared with an England average of 77%.
• The practice consistently worked closely with multi-disciplinary teams in the case management of people experiencing poor and complex mental health needs. They also worked closely with teams providing support in drug and alcohol services, counselling, rape crisis teams and psychological therapies including support for those with the vulnerable persons relocation scheme. Some of these teams were located within the practice.
• The practice actively assisted and supported patients experiencing poor mental health to access various support groups and voluntary organisations including social and housing support.
• The practice had recruited a full time mental health nurse who had professional experience of working with patients with substance misuse issues. The practice had developed a mental health template which linked to local referral pathways, a physical health template and local safeguarding.
• 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 a good understanding of how to support patients with mental health needs and dementia and facilitated regular education sessions on mental health issues including Post-traumatic stress disorder (PTSD).
• In the last year the Bevan team had hosted an evening to bring together support teams to network and discuss best referral mechanisms for those experiencing poor mental health. This included primary care mental health teams, the new arrivals team, counselling services, rape crisis teams and the drug and alcohol team.

Updated 30 March 2016

The practice is rated as outstanding 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, asylum seekers, refugees. They had identified 19 patients with a learning disability.
• The practice offered 15 minute appointments to all patients and longer appointments for patients with a learning disability or those who needed them.
• The practice worked consistently, pro-actively and sensitively with multi-disciplinary teams in the case management of vulnerable people.
• The Street Medicine Team consisted of GPs, nurses and a mental health nurse, who offered sessions in areas where homeless people were known to gather. This service provided health care and support for vulnerable groups beyond the registered list of the practice.
• The practice had moved to new premises which allowed it to host other services and provide a “one stop shop” for patients. These teams located within the practice included the homeless team, benefits services, refugee support workers, rape crisis, legal, housing, midwifery and health visiting teams. Patients told us they found the city centre location easy to access.
• A GP and mental health nurse supported the clinical needs of patients at BRICCS, which is a residential 14 bed temporary accommodation unit. The housing service reported that service users’ needs were being met and communication between the teams was very good.
• The Bevan Pathway team is a multi-disciplinary team which works with the local hospital and the temporary accommodation unit for the timely and safe discharge of patients with complex health and social needs. Reductions in A&E attendances and admissions and cost savings of up to 62% have been evidenced.
• The practice had links to and worked with psychologists within the Vulnerable Persons Relocation Scheme (VPRS).
• 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. There was a comprehensive safeguarding policy in place for children and vulnerable adults which included a Prevent strategy (a duty introduced as part of the Counter-Terrorism and Security Act 2015 with regard to preventing people from being drawn into terrorism’). Multi Agency Risk Assessment Conference (MARAC) guidelines for those at the highest risk of domestic abuse were included and also details of other agencies where concerns could be raised and discussed. Staff were also aware of and had attended education sessions which had been held regarding female genital mutilation (FGM), we saw that safeguarding referrals had been made when patients had experienced this or were at risk.
• Waiting areas and rooms were colour coded and numbered to assist patients who could not read English.