Archived: Hillside Bridge Health Centre

Updated 12 December 2016

Hillside Bridge Health Centre comprises a GP practice for registered patients and a walk-in service for non-registered patients. The centre is operated by Local Care Direct Limited which is a community owned healthcare provider which delivers a range of health services including 111 services across West Yorkshire. The practice has been open since 2007 and is located on the upper floor of a building located at:

4 Butler Street West

Bradford

BD3 0BS.

At the time of inspection the surgery had a registered patient population of around 4,750. The building is accessible to those with a disability and is served by a staircase and passenger lift. Being located in the centre of Bradford there is ample on-site parking. The practice is a member of the NHS Bradford City Clinical Commissioning Group (CCG).

The population age profile shows that it is significantly below the CCG and England averages for those over 65 years old (5% of the practice population is aged over 65 as compared to the CCG and England averages of 17%). Correspondingly, the practice has a high number of patients aged under 18 years at 29% compared to CCG and England averages of 20%. Average life expectancy for the practice population is 73 years for males and 77 years for females (England average is 79 years and 83 years respectively). The practice has higher than average numbers of patients with long term conditions such as diabetes, chronic obstructive pulmonary disease and dementia. The practice has higher numbers of non-white British patients and those who are transient. Deprivation in the area served by the practice is relatively high, being ranked in the second most deprived decile.

The practice provides services under the terms of Alternative Practice Medical Services (APMS) contracts for the surgery and the walk-in service. The practice and walk-in service are registered with the Care Quality Commission (CQC) to provide treatment of disease, disorder or injury, diagnostic and screening procedures.

The practice surgery offers a range of enhanced local services including those in relation to;

• Alcohol
• Childhood vaccination and immunisation
• Dementia
• Improving online access
• Influenza and Pneumococcal immunisation
• Rotavirus and Shingles immunisation
• Minor surgery
• Learning disability support
• Avoiding unplanned admissions
• Risk profiling and care management

As well as these enhanced services the practice surgery also offers additional services such as those supporting chronic disease management including asthma, chronic obstructive pulmonary disease, heart disease and hypertension.

Additionally the practice delivers services in conjunction with health visitors, midwives and district nurses.

The walk-in centre delivers services for minor illness in relation to acute episodes and does not provide ongoingcare for pre-existing conditions.

The practice staff consists of one salaried GP (male), one advanced nurse practitioner (female), one practice nurse (female) and three healthcare assistants (female). Clinical staff are supported by a practice manager and an administration/reception team. Wider support is available from Local Care Direct Limited. The practice utilised locum staff to meet operational need.

The practice offers a range of appointments, these include:

• Routine pre-bookable appointments up to four weeks in advance
• Urgent appointments/on the day appointments
• Telephone appointments/consultations

Appointments could be made in person, via the telephone or online.

The walk-in centre is accessed via presentation by patients on the day and is staffed by an advanced nurse practitioner ANP (there is currently a vacancy being advertised for another full-time ANP)and GPs from the practice.

The practice surgery is open Monday to Friday 8am to 6.30pm, Saturday 11am to 1.30pm and the walk-in service operates from 2pm to 8pm seven days a week over every day of the year.

Out of hours care is provided by the parent company, Local Care Direct Limited, and this can be accessed via the practice telephone number or via NHS 111.

Updated 12 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hillside Bridge Health Centre on 13 September 2016. Overall the practice is rated as requires improvement.

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.
• Risks to patients were assessed and well managed.

• Results from the national GP patient survey showed the practice was rated below average for its satisfaction scores on consultations with GPs and nurses.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. We saw that development and learning was prioritised by the practice and staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment during consultations with their GP.
• 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 GP and there was continuity of care, with urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by management. Staff told us that they would feel confident to raise any concerns with the lead GP or practice manager.
• The provider was aware of and complied with the requirements of the duty of candour.
• Overall the practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice ensured that every locum always completed an ‘End of Shift Check Out Form’ which ensured continuity of care for patients.
• All patients who attended accident and emergency (A&E) or had an unplanned hospital admission were reviewed and their needs assessed.

The areas where the provider should make improvements are

• The provider should develop an action plan to address low patient satisfaction scores.
• Put systems in place to improve and monitor patient satisfaction so that it is in line with national survey results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 December 2016

The practice was rated as requires improvement for the care of people with long-term conditions. The issues identified as requiring improvement affected all patients, including this population group.

• Nursing staff had lead roles in chronic disease management, which included diabetes, chronic obstructive pulmonary disease (COPD) and asthma, and patients at risk of hospital admission were identified as a priority.

• Longer appointments and home visits were available when needed.
• 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 multidisciplinary packages of care.
• The practice offered 24 hour blood pressure monitoring and in-house spirometry.

Updated 12 December 2016

The practice was rated as requires improvement for the care of families, children and young people. The issues identified as requiring improvement affected all patients, including this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

• We were told by the practice 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 uptake for the cervical screening programme was 64%, which was below the CCG average of 76% and the national average of 81%.
• Immunisation rates were relatively low for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Additionally, patients could access the walk-in centre out of the practice core hours.
• All staff had received safeguarding training and were aware how to follow up concerns.

Updated 12 December 2016

The practice was rated as requires improvement for the care of older people. The issues identified as requiring improvement affected all patients, including this population group.

• 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. For example, practice nurses made home visits to administer flu vaccinations to older patients who struggled to attend the surgery.
• Care plans had been developed for older patients who were identified as being at risk.

Updated 12 December 2016

The practice was rated as requires improvement for the care of working age people (including those recently retired and students). The issues identified as requiring improvement affected all patients, including this population group.

• The practice was proactive in offering online services, which included appointment booking and repeat prescription requests.
• A range of health promotion and screening was offered that reflected the needs for this age group, this included weight management advice and smoking cessation support.
• Telephone consultations were available to those unable to attend the surgery.

Updated 12 December 2016

The practice was rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The issues identified as requiring improvement affected all patients, including this population group.

• The most recently published QOF results showed that 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG and national average of 84%.
• The practice regularly worked closely with other health professionals in the case management of patients experiencing poor mental health, including those with dementia
• Practice staff told us they also worked closely with relatives of patients who had poor mental health including dementia when this was appropriate.
• The practice had a system in place to follow up patients who had attended accident and emergency when they may have been experiencing poor mental health.
• The practice 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.

Updated 12 December 2016

The practice was rated as requires improvement for the care of people whose circumstances may make them vulnerable. The issues identified as requiring improvement affected all patients, including this population group.

• The practice held a register of patients living in vulnerable circumstances and used this information to coordinate services. For example, it used the mental health register to recall patients for regular reviews and a carers register to offer winter flu immunisations.

• The practice and walk-in centre provided regular services for members of the nearby traveller community.
• The practice offered longer appointments for patients with enhanced needs such as those with a learning disability or the frail elderly, and offered health checks and care planning.
• The practice 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. 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.
• Staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, the surgery and walk-in service met the health needs of a significant number of the local transgender community.