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Brace Street Health Centre Good Also known as 63 Brace Street

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 7 December 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Brace Street Health Centre on 7 March 2017. The overall rating for the practice was good with requires improvement for providing safe services. We found one breach of legal requirement and as a result we issued a requirement notice in relation to:

  • Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment

The full comprehensive report on the March 2017 inspection can be found by selecting the ‘all reports’ link for Brace Street Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 23 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 March 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The safe domain is now rated as good and overall the practice remains rated as good.

Our key findings were as follows:

  • The practice had improved the processes in place for handling repeat prescriptions which included the review of high risk medicines. We saw that appropriate monitoring of patients had taken place prior to prescriptions being issued.
  • The Patient Group Directions (PGDs) adopted by the practice to allow nurses to administer medicines in line with legislation had been signed by an appropriate person.
  • Although a system had been introduced to monitor the use of prescription stationery, the records did not include the serial numbers of prescriptions on receipt and when they were distributed through the practice. The practice rectified this issue during the inspection.
  • The practice had reviewed and increased the range of emergency medicines held at the practice.
  • The practice had reviewed and discussed the results from the national GP survey published in July 2017 during a team meeting in October 2017. The practice acknowledged that the results reflected the staffing situation at the time the survey was carried out (January to March 2017), when there was only one permanent GP being supported by locum GPs. Action taken included adding call waiting to the telephone system, aiming to answer the telephone within four rings, and encouraging patients to book double appointments when they had more than one issue to discuss to reduce delays in appointment times. The practice also promoted the use of on line booking and had increased the number of patients signed up for on line access to 14% with a target of 20% by the end of March 2018.
  • The practice had taken a more proactive approach to identifying and supporting carers. The number of carers identified had increased from 16 to 32 (1% of the patient list), and 15 of these patients had been offered an assessment. The new patient registration form asked if the patient was also a carer. Patients who identified themselves as carers were asked to provide additional information and were given the contact details for the carers association. They were also asked if they wished to be referred for an adult care assessment with the local authority. Information relating to carers was on display in the waiting area and leaflets were available.
  • Posters informing patients about national screening programmes (breast and bowel cancer) were on display in the waiting room.
  • The practice’s uptake for cervical screening (2016/17) had increased to 72% (up from 70% for 2015/16), although this was below the 80% coverage target for the national screening programme. We saw that the practice manager had altered the standard letter sent to patients to be more informative about the reason for having the test and the potential consequences of not being screened. The female GP and the practice nurse told us they carried out cervical screening tests opportunistically when patients attended the practice.
  • The practice was part of a local initiative to encourage participation in the bowel screening programme. This initiative involved following up patients who failed to respond or responded inappropriately to the screening kit. The practice identified these patients on a monthly basis, contacted them and encouraged participation and ordered a new screening kit if required.
  • The practice manager told us they were being supported by the breast screening team to encourage participation in national breast screening programme. The screening team were going to send letters out in different languages on behalf of the practice to patients who failed to attend their first appointment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 December 2017

The practice is rated as good for providing safe services.

  • The practice had reviewed and increased the range of emergency medicines held at the practice. The suggested list of emergency medicines was available.
  • The Patient Group Directions (PGDs) adopted by the practice to allow nurses to administer medicines in line with legislation had been signed by an appropriate person.
  • The practice had improved the processes in place for handling repeat prescriptions which included the review of high risk medicines. We saw that appropriate monitoring of patients had taken place prior to prescriptions being issued.
  • Although a system had been introduced to monitor the use of prescription stationery, the records did not include the serial numbers of prescriptions on receipt and when they were distributed through the practice. The practice rectified this issue during the inspection.

Effective

Good

Updated 30 May 2017

  • Data from the Quality and Outcomes Framework showed patient outcomes for some clinical areas were at or below average compared to the local and national average.

  • Although the practice was performing below local and national averages for the uptake of national screening programs such as breast and bowel cancer screening, staff we spoke with were able to demonstrate actions taken to increase patient uptake.

  • Staff were aware of their performance as well as current evidence based guidance; and used clinical audits to demonstrate whether quality improvements had been achieved as a result of new ways of working.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 30 May 2017

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
  • For example, the practice responded to areas of the July 2016 national GP patient survey where performance were below local and national averages. This involved discussions around the effective management of appointment times and training around communication skills.
  • Patient feedback from the comment cards we received showed that patients felt involved in decision making about the care and treatment they received.
  • Information for patients about the services available was accessible within the practice and also via the practice website.
  • There was a clinical lead responsible for identifying carers and keeping the carers list up to date. The practice had a comprehensive carers pack and offered pre and post bereavement support for families.
  • During the inspection we saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 30 May 2017

  • The practice understood its population profile and had used this understanding in most areas to meet the needs of its population. For example, reception staff were multilingual therefore able to speak and understand several languages.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • Results from the national GP patient survey, published in July 2016, showed that patient’s satisfaction with how they could access care and treatment was mainly comparable to local and national averages.

  • CQC comment cards we received were also aligned with this feedback. However, some less positive comments related to

    access to appointments.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and evidence from five examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 30 May 2017

  • Although the practice had an overarching governance framework, we saw areas where systems and processes were not effectively operated.

  • For example, the practice did not operate an effective system to ensure Patient Group Directions were authorised for their use, track the use of prescription pads; establish effective arrangements to identify, monitor or manage risks.

  • The provider was aware of and complied with the requirements of the duty of candour. The management team encouraged a culture of openness and honesty.

  • The practice had a vision and strategy to deliver high quality care and promote good outcomes for patients. Staff we spoke with as part of the inspection were clear about the vision and their responsibilities in relation to it.

  • Staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular practice meetings.

  • The practice sought feedback from staff. The practice had an active patient participation group (PPG) and we saw measures in place in order to seek feedback from patients, which it acted on.

Checks on specific services

Older people

Good

Updated 30 May 2017

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. For example, patients who were prone to recurrent falls and those with

    fragile bones which made them more likely to break

    were referred to the local falls services, referred for bone density scans and referred to secondary care when required.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice had a named lead who identified at an early stage older patients who might need specialist care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, patients were sign posted to Age UK.

People with long term conditions

Good

Updated 30 May 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • The percentage of patients diagnosed with diabetes who had a blood sugar reading which showed that the condition was being controlled appropriately was 76%, compared to the CCG average of 79% and national average of 78%.

  • Patients had access to a diabetic nurse who attended the health centre once a fortnight. There was a clear referral processes were in place.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • The practice offered a range of services in-house to support the diagnosis and monitoring of patients with long term conditions including spirometry, phlebotomy and followed recognised asthma pathways.

  • All these patients had a named GP and there was a system to recall patients for 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.

Families, children and young people

Good

Updated 30 May 2017

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

  • The practice was able to demonstrate systems 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.

  • Staff we spoke with were able to describe how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

  • The practice’s uptake for the cervical screening programme was 70%, which was lower than the CCG and national average of 81%.

  • The practice provided support for premature babies and their families following discharge from hospital. GPs and practice nurse operated a weekly baby clinic where immunisations were given and GPs carried out health checks. Immunisation rates were relatively high for most standard childhood immunisations.

  • The premises were suitable for children and babies. Appointments with GPs were available outside of school hours. However, nurse appointments were not available before 9am or after 3pm.

    Rooms were available for breast feeding and there were baby changing facilities.

  • The practice worked with midwives, health visitors and school nurses where possible to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

  • The practice implemented new diabetes management protocols and provided information to raise awareness in young patients. As a result we were told that clinicians were able to identify young patients with diabetes at an early stage.   

Working age people (including those recently retired and students)

Good

Updated 30 May 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted some services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours were available with GPs. However, access to a practice nurse appointments were more limited.

  • The practice was proactive in offering online services, telephone consultations; test results were available online for those with patient access as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice offered travel vaccinations available on the NHS and staff sign posted patients to other services for travel vaccinations only available privately such as yellow fever centre (able to provide vaccination for a tropical virus disease transmitted by mosquitoes which affects the liver and kidneys).

  • The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.

People whose circumstances may make them vulnerable

Good

Updated 30 May 2017

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.

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

  • The practice offered longer appointments for patients with a learning disability. Data provided by the practice showed that annual reviews were carried out.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice had clear referral processes for patients with opiate and alcohol dependency allowing them to access the local addiction service.

  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.

  • The practice held a carers list. Carers of patients registered with the practice had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Data provided by the practice showed that 0.6% of the practice list were carers.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 May 2017

  • The practice carried out advance care planning for patients living with dementia.

  • 100% of patients diagnosed with dementia had their care plans reviewed in a face-to-face review in the preceding 12 months; however, 33% were exception reported, compared to the CCG and national average of 7%.

  • The practice specifically considered the physical health needs of patients with poor mental health and dementia.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs; data provided by the practice showed that 84% received a medicines review in the past 12 months.

  • The percentage of patients diagnosed with mental health who had a comprehensive, agreed care plan documented in their record in the preceding 12 months was 92%, which was comparable to the CCG average of 92% and national average of 89%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff we spoke with during the inspection had a good understanding of how to support patients with mental health needs and dementia.