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Brentford Group Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 28 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brentford Group Practice on 21 October 2015. The practice was rated as requires improvement for providing safe and well-led services and the overall rating for the practice was requires improvement. The full comprehensive report on the October 2015 inspection can be found by selecting the ‘all reports’ link for Brentford Group Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 21 August 2017 to check for improvements since our previous inspection. Overall the practice is now 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 a system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed, with the exception of those relating to testing electrical equipment, checking medical supplies and tracking blank prescription forms.
  • Staff were aware of current evidence based guidance. Most staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, not all had received training in the Mental Capacity Act 2005.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments 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 sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

  • Implement a system to ensure risks to patients are assessed and well managed. For example, the safe use of equipment and medical supplies, tracking blank prescriptions, and updating the business continuity plan.
  • Implement a system to ensure clinical audits are recorded in a consistent format to demonstrate effectiveness.
  • Provide staff with access to appropriate training and review the protected learning time for nursing staff.
  • Implement a system to ensure results are received for samples sent for the cervical screening programme.
  • Continue to identify and support patients who are carers.
  • Review ways to improve patient satisfaction with the convenience and punctuality of appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 September 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written or verbal apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • Most risks to patients were assessed and well managed, with the exception of those relating to the testing of electrical equipment, checking medical supplies, and tracking blank prescriptions. Following our inspection the practice made arrangements for electrical equipment to be tested to ensure they were safe to use.
  • The practice had adequate arrangements to respond to emergencies and major incidents. However, the business continuity plan did not describe action to take in the event of loss of access to the premises.

Effective

Good

Updated 28 September 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.
  • Staff were aware of current evidence based guidance.
  • There was evidence of quality improvement and completed audits were carried out. However, the records we reviewed did not clearly set out the objectives of the audit or the criteria / standards used to measure compliance to confirm that improvements had been effective.
  • Staff had the skills and knowledge to deliver effective care and treatment. However, some staff had not received training in the Mental Capacity Act 2005.
  • 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. However, the practice did not have a system to ensure results were received for samples sent for the cervical screening programme.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 28 September 2017

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was accessible.
  • The practice held a register for patients identified as carers, although the current number of patients identified was low.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 28 September 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population.
  • 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.
  • Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. However, data from the national GP patient survey showed that patients rated the practice lower than average on the convenience and punctuality of 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 examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 28 September 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities. However, some nursing staff told us they had limited time to carry out administrative duties and training.
  • The provider was aware of the requirements of the duty of candour. In examples we reviewed we saw evidence the practice complied with these requirements.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice sought feedback from staff and patients and we saw examples where feedback had been acted on.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.
Checks on specific services

People with long term conditions

Good

Updated 28 September 2017

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

  • GPs and nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • The practice had performed well on the Quality and Outcomes Framework (QOF) for managing long-term conditions.
  • 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.
  • 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.
  • New patients on regular medicines were required to be reviewed by a GP on registration.
  • The practice offered a monthly diabetic clinic with a diabetes specialist nurse, consultant and dietician.

Families, children and young people

Good

Updated 28 September 2017

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

  • From the sample of documented examples we reviewed we found there were 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.
  • Immunisation rates were comparable to CCG and national averages for all standard childhood immunisations.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses 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.

Older people

Good

Updated 28 September 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.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative 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.
  • Where older patients had complex needs, the practice shared summary care records with local care services. For example, with the district nurses, social workers, palliative care nurse and patient co-ordinator.

Working age people (including those recently retired and students)

Good

Updated 28 September 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 the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended hours appointments on Monday from 7.10am to 7.50am and 6.30pm to 7.10pm, and pre-booked appointments in the evening and at weekends at the local primary care ‘hub’.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 September 2017

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

  • Patients at risk of dementia were identified and offered an assessment. The practice carried out advance care planning for patients living with dementia.
  • In 2015/16, 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 86% and national average of 84%.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, there were joint consultations with consultants to improve communication and patient care.
  • In 2015/16, 97% of patients with a diagnosed psychosis had a comprehensive care plan in their records, which was comparable to the CCG and national averages 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.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. Although, not all staff had received training in the Mental Capacity Act 2005.

People whose circumstances may make them vulnerable

Good

Updated 28 September 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 those with a learning disability and homeless people.
  • 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, and these patients had a named GP.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, patients could be referred to the care navigator who worked with the GP to support vulnerable patients in accessing the services they need, self-manage their conditions and proactively ask for help, and ensure their carers are supported.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed 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.