Briton Street GP Surgery

We carried out an announced comprehensive inspection at Briton Street GP Surgery on 30 September 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall due to concerns in providing safe, effective and well-led services. However, the population groups were rated as good because patients were treated with kindness and respect and were able to access timely care and treatment; except for long-term conditions population group as well as families, children and young people and working age people (including those recently retired and students) population groups which were rated as requires improvement.

We rated the practice as inadequate for providing safe services because:

• The practice stocked emergency medicines which enabled clinicians to respond to most medical conditions they were likely to face and had most equipment to assess patients with possible sepsis. During our inspection, the provider ordered additional emergency medicines as well as equipment to assess possible sepsis.
• The practice had systems which promoted the delivery of high-quality, person-centre care in most areas. However, the system for managing blood monitoring results within the practice was not entirely safe and effective.
• The practice provided care in a way that mainly kept patients safe and protected them from most avoidable harm.

We rated the practice as requires improvement for providing effective and well-led services because:

• The 2017/18 Quality Outcomes Framework data showed areas of negative variation as well as significant negative variations compared to the local and national averages for the management of patient’s conditions.
• The practice demonstrated some awareness of their Quality Outcomes Framework performance and took action to improve the management of patients’ clinical care. At the time of our inspection, unpublished data from the 2018/19 QOF year did not demonstrate improvement in the management of patients diagnosed with a long-term condition.
• Since our inspection, the 2018/19 QOF data had been published. Data showed areas where performance had declined; and clinical indicators such as patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD) as well as mental health indicators showed significant decline in performance.
• There were clear responsibilities and roles of accountability to support governance and management in most areas. The practice operated a process for ensuring policies and procedures were reviewed and updated in line with local and national guidance updates. However, some clinical governance arrangements did not assure safe and effective care. The practice was unable to demonstrate that quality improvement activities systematically identified where actions should be taken to improve areas where performance was below local and national averages.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Completed Care Quality Commission comment cards were positive as well as feedback from the Patient Participation Group (PPG). The practice carried out their own internal patient survey which demonstrated improvement in patient satisfaction.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way. Patients as well as members of the PPG we spoke with during our inspection, felt they were able to access appointments when they needed one.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Ensure availability of equipment to carry out clinical assessments when patients present with an acute illness, or a deteriorating pre-existing condition, particularly where sepsis is suspected.
• Ensure availability of suggested emergency medicines to enable staff to respond to a wider range of medical conditions they might encounter.
• Continue taking action to improve the uptake of childhood immunisation as well as national screening programmes such as cervical screening.
• Continue taking action to improve the appropriate and safe use of antibacterial medicines.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care