Archived: Brunswick House Medical Group

Updated 14 January 2016

Brunswick House Medical Group is registered with the Care Quality Commission to provide primary care services. The practice provides services to approximately 14,700 patients from two locations:

• Main Surgery: Brunswick House Medical Group, 1 Brunswick Street, Carlisle, Cumbria, CA1 1ED
• Branch: 1 Eastern Way, Carlisle, Cumbria, CA1 3QZ

We visited both locations as a part of this inspection.

Brunswick House Medical Group is a large practice providing care and treatment to patients of all ages, based on a General Medical Services (GMS) contract. The practice is situated in the centre of Carlisle and is part of the NHS Cumbria clinical commissioning group (CCG).

Information taken from Public Health England placed the area in which the practice was located in the fourth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. There was a slightly higher proportion of people in the area in paid work or full time employment at 67.77% (compared to an England average of 60.2%). The unemployment rate in the area is lower than the national average at 2.6% compared to the national average at 6.2%). There were a higher proportion of disability allowance claimants (at 66.9 per 1000 population, compared to an England average of 50.3 per 1000 population).

The age distribution in the practice areas reflected the national average. The average male life expectancy is 79 years, which is the same as the England average. The average female life expectancy is 82 years, which is slightly lower than the England average of 83 years.

The percentage of patients reporting with a long-standing health condition is slightly lower than the national average (practice population is 51.1% compared to a national average of 54.0%). The percentage of patients with health-related problems in daily life is slightly higher than the national average (52.2% compared to 48.8% nationally). There are a lower percentage of patients with caring responsibilities at 16.6% compared to 18.2% nationally.

The practice has nine GP partners, of which six are male and three are female. There is also a female salaried GP and two GP registrars. There are also two nurse practitioners and six practice nurses, four healthcare assistants and a team of administrative support staff.

The opening times for the practice are as follows:

Brunswick Street Surgery:

• Monday 08:00 - 20.30
• Tuesday 08:00 - 18:00
• Wednesday 08:00 - 20.30
• Thursday 08:00 - 18:00
• Friday 08:00 - 18:00

Monday to Friday appointments are available between 8:30am and 5:50pm. During the extended hours on a Monday and Wednesday appointments are also available between 6.30pm and 7.50pm.

Branch Surgery at Harraby:

• Monday 08:30 - 18:00
• Tuesday 08:30 - 18:00
• Wednesday 08:30 - 18:00
• Thursday 08:30 - 18:00
• Friday 08:30 - 18:00

Appointments are available from 8:30 to 5:50 daily.

The service for patients requiring urgent medical attention out of hours is provided by the 111 service and Cumbria Health on Call (CHOC).

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brunswick House Medical Group on 12 November 2015. 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. 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.
• Information about services and how to complain was available and easy to understand.
• The practice had made improvements to make it easier for patients to make an appointment with a named GP and provide continuity of care. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively 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 should make improvement are:

• Change consultation rooms curtains at intervals in line with good practice guidelines.
• Review and seek to improve their performance across a number of indicators relating to mental health within the Quality and Outcomes Framework (QOF).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 2016

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

• Effective systems were in place which helped ensure patients with long-term conditions received an appropriate service which met their needs. These patients all had a named GP and received an annual review to check that their needs were being met. For those people with the most complex needs, the named GP worked with other relevant health and care professionals to deliver a multidisciplinary package of care.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group. For example, 90.1% of patients on the diabetes register had a recording of an albumin : creatinine ratio test in the preceding 12 months, which was higher than the national average of 85.9%. The percentage of patients on the diabetes register, whose last measured total cholesterol (measured within the preceding 12 months) was 5mmol/l or less was 84.4%. This was higher than the England average of 81.6%.
• Longer appointments and home visits were available when needed.
• Patients at risk of hospital admission were identified as a priority, and steps were taken to manage their needs.
• Staff had completed the training they needed to provide patients with safe care.

Updated 14 January 2016

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

• Regular antenatal clinics and weekly baby clinics were held by midwifes attached to the practice. The GP partners provided support to the baby clinics. We saw good examples of joint working with midwives, health visitors and school nurses.
• 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.
• Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 82.6% to 96.8% and five year olds from 59.3% to 96.1%. This compared to the CCG average of between 83.3% and 96.0% for vaccinations given to under two year olds and 72.5% and 97.9% for those given to five year olds.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice held a nurse practitioner led paediatric clinic each day.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Younger patients were able to access contraceptive and sexual health services, and appointments were available outside of school hours.
• Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients.

Updated 14 January 2016

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

• Staff provided proactive, personalised care which met the needs of older patients. Patients aged 75 and over had been allocated a named GP to help ensure their needs were met.
• Good arrangements had been made to meet the needs of ‘end of life’ patients. Staff held regular palliative care meetings with other healthcare professionals to review the needs of these patients and ensure they were met.
• The practice offered home visits and longer appointment times where these were needed by older patients.
• Nationally reported data showed the practice had performed well in providing recommended care and treatment for the clinical conditions commonly associated with this population group.
• 78.2% of patients aged 65 years or over received a seasonal influenza vaccination which was better than the national average (of 73.2%).

Updated 14 January 2016

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

• The practice had assessed the needs of this group of patients and developed their services to help ensure they received a service which was accessible, flexible and provided 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.
• Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, the QOF data for 2014/15 showed the practice had obtained 100% of the overall points available to them for providing services for patients with hypertension. This was above the CCG average of 98.9% and the national average of 97.8%.

Updated 14 January 2016

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

• Nationally reported data showed the practice had performed lower than comparators in providing recommended care and treatment to patients with mental health needs. For example,
• 73.1% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months (compared to a national average of 83.8%). The practice was looking at how they could improve their performance in this area.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• They 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 people with mental health needs and dementia.

Updated 14 January 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 patients with learning disabilities.
• Staff carried out annual health checks for patients who had a learning disability and offered longer appointments.
• Nationally reported data showed the practice had performed well in providing recommended care and treatment for this group of patients. For example, t
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• Staff provided vulnerable patients with information about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff understood their responsibilities regarding information sharing, the documentation of safeguarding concerns and contacting relevant agencies.