Brownhill Surgery Also known as Dr T L & Mrs S K Phillips

Updated 12 September 2016

Brownhill surgery is part of the Blackburn with Darwen Clinical Commissioning Group (CCG). The practice provides services for 4196 patients under the terms of the NHS Personal Medical Services contract.

Information published by Public Health England rates the level of deprivation within the practice population as six on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). Male and female life expectancy is 78 and 83 which is better than the CCG average of 76 and 80 and comparable to the national average of 79 and 83 respectively.

The practice is located in a row of converted residential properties close to the town centre. There is easy access to the building and disabled facilities are provided. Consultations rooms are on the ground floor and are accessible for people with limited mobility. There is on street parking at the front of the building and on the nearby side streets.

The practice consists of two male GP partners, a male sessional GP and a male GP registrar. In addition there is a nurse practitioner, who is also a partner, two practice nurses and a team of eight administration/reception staff. The practice is a training practice and provides placements for medical students, trainee GPs and F2 trainees (qualified doctors in the second year of their foundation training).

The practice is open between 8am and 6pm Monday to Friday. Appointments times are available between 8am and 12.30pm and 2.30pm and 6pm. Extended hours appointments are offered on Mondays until 8.30pm. Outside of practice opening hours patients were directed to the out of hour’s service.

There is also a branch surgery located within Barbara Castle Way Health Centre, Simmons Street, Blackburn. We did not visit the branch as part of this inspection.

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brownhill Surgery on 27 July 2016. 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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 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.

We saw three areas of outstanding practice:

One staff member was a trained Carer’s champion who offered face to face and telephone support to patients and the local community, advising them on the available avenues of support.

The patient participation group (PPG – Friends of Brownhill Surgery) held community events to raise awareness of various medical conditions and relevant support organisations, for example; they had organised a dementia awareness event to provide advice about the different types of dementia, the treatments and support available. More recently there was a cancer awareness event and patients can access the presentation slides on the practice web site. These events were held in the Parish hall and were also open to people who were not patients at Brownhill surgery.

There were two nurse prescribers at the practice who helped to free up GP time and improved patient access. The practice submitted evidence to demonstrate for the period 2014-2015 Brownhill Surgery had the lowest non-elective emergency hospital admissions and the lowest accident and emergency attendance for both adults and children within the Blackburn with Darwen CCG area.

The areas where the provider should:

• Ensure the decision made not to hold Benzylpenicillin on site is appropriately risk assessed.

• Ensure audit activity is formally documented to clearly demonstrate improvements in governance arrangements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015), was 83.61% which was above the CCG and National average of 78.44% and 77.54% respectively.
• The percentage of patients with hypertension in whom the last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 88.68% compared with the CCG and national averages of 85.28% and 83.65% respectively.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and 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.

Updated 12 September 2016

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

• 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.

• Immunisation rates were relatively low for all standard childhood immunisations. For example, rates for 68.3% 43.8% with the CCG average 93.5% to 96.3% and 72.5% to 94.1% respectively. The practice informed us that there had been issues with the submission of data to Public Health England , which was being investigated. Following the inspection the practice provided evidence from Public Health NHS England that the current immunisations rates were in fact better than the CCG average The children’s immunisation clinics were flexible and the practice had in-house anti- natal and post-natal clinics.

• 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.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 84.1% comparable to the CCG and National average of 80.44% and 81.83% respectively.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 12 September 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 12 September 2016

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

• The needs of the working age population, those recently retired and students 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, the 2016 national GP survey indicated that 95.34% of patients were able to get an appointment to see or speak to someone the last time they tried which was higher than the CCG average of 74.52% and a national average of 76.06%.

• 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.

Updated 12 September 2016

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

• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is above the CCG and national average of 87.53% and 84.01% respectively.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months which is above the CCG and national average of 92.17% and 88.47% respectively.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice 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 patients with mental health needs and dementia.

Updated 12 September 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 homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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 had a dedicated carers champion and there was an information folder in the waiting room that provided information and contact details for local carers groups.