Background to this inspection
Updated
16 May 2016
Brimington Surgery provides care to approximately 8,000 patients in the Brimington and Staveley areas within the borough of Chesterfield in North East Derbyshire. The surgery provides primary care medical services via a Personal Medical Services (PMS) contract commissioned by NHS England, and services commissioned by North Derbyshire Clinical Commissioning Group (CCG). The practice operates from a modern purpose-built building.
The practice is run by a partnership of four part-time GPs (two males and two females). The practice employ two part-time salaried GPs (one male and one female), and presently have a vacancy for a further part-time salaried GP. This equates to five whole time GPs working within the practice at the time of the inspection. The practice use winter pressure funding provided by the CCG to contract an additional part-time locum GP to increase capacity to see patients during the winter periods.
The Brimington Surgery is an established training and teaching practice and accommodates GP registrars (a qualified doctor who is completing training to become a GP); foundation training (F2) doctors (a two-year postgraduate medical training programme for newly qualified doctors); and both medical and nursing students.
The practice employs three part-time practice nurses (all female), and has recently appointed a community practice nurse. The nursing team is complemented by a part-time health care assistant and a phlebotomist. The clinical team is supported by a practice manager and assistant practice manager a team of twelve administrative and reception staff. The practice partially funds a care co-ordinator post to provide additional hours to enhance care planning and co-ordination for their patients.
The registered practice population are predominantly of white British background. The practice is ranked as the fourth highest in the CCG in terms of the deprivation status of their registered patients (and the third highest for income deprivation in older people). The practice age profile has higher numbers of patients aged over 65 (practice value 21.5%, compared against a national average of 16.7%), and this is more pronounced for patients aged 85 and over.
The practice opens from 8am until 6.30pm Monday to Friday. Scheduled GP morning appointments times are available from 8.30am to 11.30am approximately, and afternoon surgeries run from 3pm to 5.30pm, apart from one Wednesday afternoon each month when the practice closes for staff training. Extended hours opening is available on either a Wednesday or Thursday evening from 6.30pm until 8.30pm.
The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to Derbyshire Health United (DHU) via the 111 service.
Updated
16 May 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at the Brimington Surgery on 12 April 2016. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
- There was an active patient participation group which influenced practice developments. For example, introducing practice nurse appointments into the weekly extended hours’ surgery.
- Risks to patients were assessed and well managed, although the practice had not been formally assessed for the control and management of legionella on site.
We saw two areas of outstanding practice:
-
Brimington Surgery was the first GP practice in Chesterfield to receive the Derbyshire Dignity Campaign Award in February 2016, an initiative developed by the local County Council and CCG. This reflected the passion within the practice team to provide high quality care to their patients. The practice ensured this was maintained by reviewing one of the ten action points within the award in turn at each monthly staff meeting to review what they were doing, and agree what might be done to enhance this even further. We observed a strong and visible patient-centred culture in which staff were motivated and inspired to offer personalised care that promoted people’s dignity.
-
A ‘Village Friends Group’ had been established by the practice with support from their community matron, to support those patients who were bereaved. This had expanded to include patients who were socially isolated and also to include patients from other local GP practices. Activities including lunch clubs and theatre trips took place which provided an opportunity for social interaction and promoted a strong sense of local community.
The areas where the provider should make improvement are:
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
16 May 2016
-
QOF achievements for clinical indicators were higher than CCG and national averages. For example, the practice achieved 100% for diabetes related indicators, which was above the local and national averages of 96.7% and 89.2% respectively. However, exception reporting was higher in six of the ten indicators for diabetes, although practice-supplied data for the last 12 months showed that exception reporting levels had reduced.
-
The practice undertook annual reviews for patients on their long-term conditions registers. The review occurred in the patient’s birthday month and was monitored by the GPs who received lists of those due a medicines’ review, to indicate the type and length of appointment required, to update their individual needs as appropriate.
-
The annual reviews were co-ordinated to ensure that patients with more than one condition could be reviewed as part of one appointment.
-
There were nurse-led clinics available to support patients with diabetes, asthma and chronic obstructive airways disease.
-
The practice held in-house bi-monthly education sessions for new patients diagnosed with diabetes and for those identified as being at risk of developing the condition.
-
The practice provided insulin initiation (teaching patients how to inject and manage their insulin regime) for patients with type 2 diabetes (type 2 diabetes occurs when the body doesn't produce enough insulin to function properly).
-
The practice was committed in supporting the training of clinical staff to deliver excellent chronic disease management. For example, the practice was supporting a nurse to complete a nurse prescribing course, and the health care assistant had completed a course to enhance their skill set in supporting those patients with a long-term condition.
-
The practice provided INR monitoring at the practice and within patient’s homes. INR testing measures the length of time taken for the blood to clot to ensure that patients taking particular medicines were kept safe.
-
The practice had developed their own patient advice and information leaflets including diabetes, spirometry (a breathing test), and the application of ear drops.
- A pharmacist from the CCG’s medicines management team visited the practice weekly to assist with medicines audits, reviews of prescribed medicines, and offered prescribing advice and guidance.
Families, children and young people
Updated
16 May 2016
-
Regular meetings were held between the lead GP for child safeguarding and health visitors and midwives. The cases discussed were documented in patient records, and the meeting minutes were circulated to all GPs.
-
Telephone advice was offered to parents, and appointments were provided outside of standard school hours.
-
Six-week mother and baby post-natal appointments were provided by the practice. Although this was no longer part of the core GP contract, the practice continued to provide this service in recognition of the benefits provided for new mothers. Feedback provided by new mothers acknowledged their appreciation of this service.
-
A family planning and sexual health drop-in clinic run by the GP and practice nurse took place each week between 4pm and 6pm.
- The practice provided baby changing facilities, and there was a small play area for younger children. The practice welcomed mothers who wished to breastfeed on site, and provided a private room for them upon request.
Working age people (including those recently retired and students)
Updated
16 May 2016
-
The practice offered on-line booking for appointments and requests for repeat prescriptions. The practice provided electronic prescribing so that patients on repeat medicines could collect them directly from their preferred pharmacy.
-
Extended hours’ consultations were available one evening each week from 6.30pm to 8.30pm to accommodate the needs of working people.
-
The practice offered health checks for new patients and NHS health checks for patients aged 40-74.
-
The practice promoted health screening programmes to keep patients safe. For example, the practice had achieved a rate of 78.6% cervical screening for eligible women which was in line with the local average of 79.4%, and the national average of 81.8%.
- Health Trainer sessions were held each week for advice regarding diet, smoking, alcohol and exercise.
People experiencing poor mental health (including people with dementia)
Updated
16 May 2016
-
The practice achieved 100% for mental health related indicators in QOF, which was 1.9% above the CCG and 7.2% above the national averages, with exception reporting rates generally in line with averages.
-
93% of patients with ongoing active mental health problems had received an annual health check during 2014-15.
- 88.4% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was 4.5% higher than local an national averages, although it was noted that the exception reporting rate was almost 10% above the averages for this indicator.
-
The practice had completed ‘Dementia Friends’ training for all staff to improve their awareness of dementia and the support available to patients and their carers.
-
A visiting psychiatrist provided appointments at the surgery each week for practice patients.
-
A community psychiatrist nurse worked with the practice, and attended monthly multi-disciplinary meetings, to support patients experiencing poor mental health.
People whose circumstances may make them vulnerable
Updated
16 May 2016
-
The practice had undertaken an annual health review in the last 12 months for 65.5% of patients with a learning disability.
-
A bi-monthly ward round was undertaken at a local home for 32 adults with severe learning disabilities. Staff at this home described the practice’s input as excellent and being highly supportive and responsive.
-
The practice worked in–line with recognised standards of high quality end of life care. Palliative care was co-ordinated by a named GP working with the wider multi-disciplinary team. Bi-monthly palliative care meetings were in place between with GPs, district nurses and the Macmillan nurse. An analysis of patient deaths was undertaken for patients with cancer to ensure any learning points were considered, and ensure that best practice was shared with the whole team.
-
The practice adopted a co-ordinated approach to care by the use of care plans, which ensured key information was shared with other providers such as the out of hours service.
-
Longer appointments were offered to vulnerable patients when required
-
Homeless people were welcomed to register with the practice. The practice provided care for residents at a local facility providing accommodation for those with a history of substance misuse or mental health difficulties, and ex-offenders. A more flexible approach was taken to see these patients, in recognition of them not regularly engaging with health services. The practice also worked with a local women’s refuge team and facilitated meetings at the practice, for example, for victims of domestic abuse.
-
GPs prescribed for patients with substance misuse problems in conjunction with the local substance misuse team. At the time of the inspection, the practice were providing ongoing care for eight patients to help stabilise and monitor their condition.
-
The practice had recently undertaken a joint project with the local council to offer a free assessment of home heating for vulnerable patients, and consider how support could be provided to those who required it. This project recognised the impact that cold has on health for older people and children, and the impact upon an individual’s mental health.
- The practice was a recognised ‘safe haven’ for people with a learning disability. This Derbyshire partnership scheme aimed to protect people with learning disabilities from potential bullying or abuse. It helped them feel safe and confident when out in the community by having access to a place where they could be supported if required.