What is the Quality of Facilities at Bowburn Medical Centre

Positive

"The practice nurse had Are services effective?"

Positive

"• The practice provided an enhanced nursing service; a nurse carried out daily visits to patients who lived at the neighbouring care home."

Positive

"The nurse had dedicated access to a GP if they required assistance."

Positive

"• The enhanced service nurse also coordinated care for the frail elderly patients in the community."

Positive

"The nurse was the named lead clinician and carried out regular reviews to ensure the plans were still relevant."

Neutral

"The GP and practice nurse also accommodated home visits for those who had difficulties getting to the practice."

Neutral

"For example in many cases the nurse practitioner was able to treat many patients who would have otherwise needed an appointment with a GP."

Neutral

"On the day of the inspection the next routine appointment with a GP was available for the following day; appointments with a nurse practitioner were available on the afternoon of the inspection day."

Neutral

"The nurse had carried out several pilots on new ways of working in those areas."

Neutral

"The nurse carried out the initial work and developed an approach which was then rolled out to other practices in the area."

Positive

"• Spoke with a range of staff the lead GP a practice nurse the practice clinical pharmacist and the operations manager and • Looked at information the practice used to deliver care and treatment."

Positive

"The practice has: • two GP partners both male although only one is active in the practice • one nurse practitioner and two practice nurses all female • a clinical pharmacist • a practice administrator and • four staff who carry out reception and administrative duties."

Neutral

"The practice nurse was in the process of contacting the other patients to arrange a time for them to attend in line with the patients’ preferences."

Positive

"• Where a patient’s mental capacity to consent to care or treatment was unclear the GP or nurse assessed the patient’s capacity and recorded the outcome of the assessment."

Positive

"• The practice employed an enhanced service nurse to provide care for vulnerable patients including housebound frail elderly those with dementia and patients requiring palliative care."

Positive

"• The practice had employed an enhanced service nurse to provide care for vulnerable patients including housebound frail elderly those with dementia and patients requiring palliative care."

Positive

"The practice has: • two GP partners both male although only one is active in the practice • one nurse practitioner and two practice nurses all female • a clinical pharmacist • a practice administrator and • four staff who carry out reception and administrative duties."

Positive

"• Separate clinical and nurse meetings were held but there were no full team meetings."

Neutral

"The practice employed an enhanced service nurse to provide care for vulnerable patients."

Neutral

"During our visit we: • Spoke with a range of staff a GP a practice nurse the practice clinical pharmacist the practice administrator and three members of the administrative team and • Spoke with patients who used the service."

Neutral

"The GP and nurse practitioner were trained to child safeguarding level three and the nurses to level two."

Neutral

"• The only permanent GP at the practice was male; however patients were able to make an appointment with a female nurse practitioner or if necessary one of the female salaried GPs who provided cover at times."

Positive

"• Staff encouraged and supported patients to be involved in monitoring and managing their health."

Positive

"• The practice had been monitoring progress against delivery of the strategy."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"There were arrangements for planning and monitoring the number and mix of staff needed."

Neutral

"• One of the practice nurses specialised in diabetes; foot screening checks and insulin initiation and monitoring were available at the practice; rather than patients having to attend further appointments elsewhere."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Positive

"Management monitoring and improving outcomes for people The practice used the information collected for the Quality and Outcomes Framework QOF and performance against national screening programmes to monitor outcomes for patients."

Positive

"The practice appeared clean and hygienic but monitoring arrangements were not satisfactory."

Positive

"However at the time of the inspection there were no cleaning schedules or monitoring systems in place."

Positive

"Monitoring risks to patients There were some procedures for assessing monitoring and managing risks to patient and staff safety but these were not always effectively followed."

Neutral

"It is based on a combination of what we found when we inspected information from our ongoing monitoring of data about services and information given to us from the provider patients the public and other organisations."

Neutral

"This included implementing a monitoring programme training staff and maintaining a log of checks carried out."

Neutral

"• Arrangements were in place for planning and monitoring the number and mix of staff needed to meet patients’ needs."

Positive

"There is onsite parking accessible parking an accessible WC wheelchair and stepfree access."

Positive

"There is onsite parking accessible parking an accessible WC wheelchair and stepfree access."

Positive

"There is onsite parking accessible parking an accessible WC wheelchair and stepfree access."

Positive

"There is onsite parking accessible parking an accessible WC wheelchair and stepfree access."

Positive

"There is onsite parking accessible parking an accessible WC wheelchair and stepfree access."

Positive

"There is onsite parking accessible parking an accessible WC wheelchair and stepfree access."

Positive

"Over the past six years they had undertaken a number of projects including palliative care and support for frail elderly and dementia patients."

Positive

"• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life and involved those patients in planning and making decisions about their care."

Positive

"• The practice employed an enhanced service nurse to provide care for vulnerable patients including housebound frail elderly those with dementia and patients requiring palliative care."

Positive

"• The practice had employed an enhanced service nurse to provide care for vulnerable patients including housebound frail elderly those with dementia and patients requiring palliative care."

Positive

"• Practice leaders had established proper policies procedures and activities to ensure safety and assured themselves that they were operating as intended."

Neutral

"• The practice ensured that end of life care was delivered in a coordinated way which took into account the needs of different patients including those who may be vulnerable because of their circumstances."

Positive

"There were early and ongoing conversations with these patients about their end of life care as part of their wider treatment and care planning."

Neutral

"The practice ensured that end of life care was delivered in a coordinated way which took into account the needs of different patients including those who may be vulnerable because of their circumstances."

Neutral

"For example: • Patients receiving end of life care carers those at risk of developing a longterm condition and those with a mental health condition."

Positive

"Staff were aware of this and were considering how best to approach quality improvement over the coming months: • There had been one clinical audit over the past two years where the improvements made were implemented and monitored."

Positive

"• There was evidence of some quality improvement including clinical audit although this was at an early stage which we were informed was due to workload pressures."

Positive

"There was evidence of some quality improvement including clinical audit although this was at an early stage which we were informed was due to workload pressures."

Positive

"This included an induction process onetoone meetings appraisals coaching and mentoring clinical supervision and support for revalidation."

Positive

"• During a former scheme to help avoid unnecessary admissions to hospital the practice had reviewed elderly patients at risk and offered them more personalised support to help them better manage their health within a community setting."

Positive

"Over the past six years they had undertaken a number of projects including palliative care and support for frail elderly and dementia patients."

Positive

"For example the practice had been approached by the local clinical commissioning group CCG to ask them to support a pilot project on care for frail elderly patients."

Positive

"• The enhanced service nurse also coordinated care for the frail elderly patients in the community."

Positive

"• The practice employed an enhanced service nurse to provide care for vulnerable patients including housebound frail elderly those with dementia and patients requiring palliative care."

Positive

"• The practice had employed an enhanced service nurse to provide care for vulnerable patients including housebound frail elderly those with dementia and patients requiring palliative care."

Positive

"The practice learned from external safety events as well as patient and medicine safety alerts."

Positive

"Exception reporting is the removal of patients from QOF calculations where for example the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate."

Positive

"• There was a health and safety policy available."

Neutral

"This covered such topics as safeguarding fire safety health and safety and confidentiality."

Positive

"However at the time of the inspection there were no cleaning schedules or monitoring systems in place."

Positive

"Staff told us they had prepared cleaning schedules and were going to implement a checking system in the following week."

Positive

"For example following a complaint about a delay in taking action from a hospital discharge letter staff received further training."