Parklands Medical Practice

Updated 24 February 2017

Parklands Medical Practice provides services for 10,552 patients and is situated at 30 Buttershaw Lane, Bradford BD6 2DD. The practice also had a branch surgery at Park Road Medical Centre, Park Road, Bradford BD5 0SG. Only the main surgery was inspected on this occasion.

Parklands medical centre is situated within the Bradford District Clinical Commissioning Group (CCG) and provides primary medical services (PMS) services under contract.

They offer a range of enhanced services such as childhood immunisations, extended hours opening and facilitating timely diagnosis and support for people with dementia.

The National General Practice Profile shows that the age of the practice is very similar to the national average. The profile shows that 23% of the practice is from a south Asian background with a further 11% of the population originating from black or mixed or non-white ethnic groups.

There are six GP partners and one salaried GP, four of who are female and three female. Four of the GPs are part time. The practice is also supported by four part time nursing staff, two part time health care assistants (HCA’s). The practice is also supporting a full time trainee nurse practitioner. The practice also has the support of CCG pharmacist. The clinical team is supported by a business manager, a patient services manager and a team of administrative staff.

The main surgery is situated within an older building with car parking available. The surgery is accessed via a ramp and has limited disabled facilities. We observed the displaying of the CQC ratings from the inspection undertaken on 9 August 2016.

The practice is open between 8am and 6.30pm Monday to Fridays with a range of appointments available between these times. The practice closes on Wednesday afternoon.

Out of hours services are provided by Local Care Direct and can be accessed either by using the practice telephone number or through NHS111.

When we returned for this inspection we checked and saw that the previously awarded ratings were displayed as required in the premises and on the practice’s website.

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parklands Medical Practice on 09 August 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.

• 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.
• Patients said they were treated with care and concern and that the GPs and nursing staff were good at involving them in decisions about their care.
• 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. However, we found that a number of items of equipment which could be used to treat patients were out of date.
• Not all risks to patients were assessed and well managed. We saw that legionella checks had not been undertaken since August 2015 despite a six month renewal date being evidenced.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. However, not all the GPs at the practice were trained to the recommended level three.
• Nursing staff at the practice administered medicines under Patient Group Directions (PGDs). We saw that the PGDs in the practice had not been signed by an authorised person. PGDs are written instructions to administer medicines to patients, usually in planned circumstances.
• The practice could not evidence an infection prevention and control audit on the day of our visit and forwarded this after the inspection. We saw that the disposable curtains used in the practice were dated and last replaced in 2014.
• There was a clear leadership structure. We were told of open and honest communication throughout the team and staff said they felt supported by management. However, we saw evidence that the majority of staff had not received an annual appraisal.
• The practice proactively engaged the Patient Participation Group (PPG) and the Health Champions in the running of the practice. It 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.

The areas where the provider must make improvement are:

The provider must ensure that Patient Group Directions used in the practice are signed by an authorised person as dictated in legislation.

The areas where the provider should make improvement are:

The provider should review the Infection Prevention and Control audit for both sites and make this available for staff to refer to. The practice should also review the renewal regime of the disposable curtains used in the practice and follow best practice.

The provider should review the monitoring of equipment and the systems and processes which are in place and assure themselves that they are able to keep patients and staff safe.

The provider should evidence that all GPs are trained to Safeguarding level three as directed by “Safeguarding Children and Young People: roles and competences for health care staff (2014)”.

The provider should ensure that all staff are provided with an appraisal in a timely manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 September 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. Nursing staff were supported to develop additional skills in these areas.
• Outcomes for patients with diabetes were comparable to CCG and national averages. For example 95% of patients had received a flu vaccination in the preceding 12 months which was the same as the national average and similar to the CCG average of 96%.
• We were told that longer appointments and home visits were available when needed.
• On the day of inspection we saw examples of specific templates and care plans which were used with patients to deliver care and set goals.
• The practice participated in CCG led initiatives including the Bradford Beating diabetes programme and Bradford Healthy Hearts. They had been recognised by the CCG for their work in this area.
• An early recall system was in place whereby patients were reminded of their review three months before it was due. This enabled staff to make appointments to suit individual needs.
• Patients could access an anticoagulation clinic and a vascular clinic which reduced the need to travel for treatment.
• 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. Regular meetings and discussions took place to review individuals.

Updated 29 September 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• We saw that the practice encouraged young people to join the “Teen voice for health group” and valued their involvement in services. Sexual health services were accessible for young people. Young people were contacted on their fourteenth birthday and offered the opportunity to update practice records with their own mobile number and take more control over their personal health.
• The percentage of women whose notes recorded that a cervical screening test had been undertaken in the preceding five years was 67%. This was lower than the CCG average of 81% and the national average of 82%. The practice were aware of this and would offer opportunistic screening if necessary and send letters to patients in their preferred first language.
• Appointments were available outside of school hours with GPs and nursing staff and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses including a joint baby clinic with a GP and a health visitor.
• Urgent appointments were available for babies and young children.

Updated 29 September 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 practice allowed a small group of older people to continue to request their medications by telephone, as this was their preference. The practice managed the risks associated with this by ensuring that these requests were taken by experienced staff and any queries were followed up by the GP.
• The practice discussed all patients nearing the end of life at monthly Gold Standard Framework meetings (GSF). (GSF is a way of working that helps to provide the highest standard of care possible for patients and their families).Templates were also used to record the wishes of these patients.
• The practice had registered patients who were resident in nursing and care homes. They would liaise with the community matron regarding their care.

Updated 29 September 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.
• Patients could access a Saturday morning clinic to see a GP or a nurse.
• Following patient feedback, next day appointments were also available to book and patients were sent text message reminders.

Updated 29 September 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the CCG average of 87% and the national average of 84%.
• Data also showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption was recorded in the preceding 12 months was 100%. However, only 56% of the same patient group had a documented care plan in their records.
• 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.
• Patients diagnosed with serious mental illness were offered annual physical health reviews.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Nursing staff offered screening for depression if concerns were raised during appointments. These patients would then be booked in to see the GP if necessary.
• 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 staff had recently completed training in this topic.

Updated 29 September 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 told us they would liaise with social services and the health visiting team when concerns were raised.
• The practice had 67 people with a learning disability registered with them and offered longer appointments and annual health checks to these patients. Longer appointments were also available for those with mental health issues.
• The practice would refer vulnerable patients to various support groups and voluntary organisations. The practice Health Champions also offered a number of groups and social activities for patients including an epilepsy support group. We saw that there were leaflets and posters advertising these groups.
• Patients could access an alcohol worker who visited the practice once per week.
• There were 49 different languages spoken within the practice population. The practice told us that they would book longer appointments and an interpreter or use a telephone interpreting service to communicate with patients when necessary.
• 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.