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Archived: Brockwell Medical Group Good

Inspection Summary


Overall summary & rating

Good

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brockwell Medical Group on 5 February 2016. The overall rating for the practice was good. However, we rated the practice as requires improvement for providing safe services. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Brockwell Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 5 February 2016. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings from this inspection were as follows:

  • The provider had complied with the requirement notice we set following our last inspection visit. In particular, we found that required pre-employment checks had been completed for all newly employed clinical staff.

In addition, the provider had also addressed the improvements we asked them to make. In particular, the provider had:

  • Taken action to ensure the practice actively used the local clinical commissioning group’s (CCG) Safeguarding Incident and Risk Management System (SIRMS), to report concerning incidents. (The SIRMS system enables GPs to flag up any issues via their surgery computer to a central monitoring system, so that the local CCG can identify any trends and issues for improvement across its whole area.)

  • Improved the practice’s telephone system. In collaboration with their telephone provider, the provider had doubled their line capacity at all three locations. For example, at the Brockwell Surgery, 20 lines were provided rather than the previous ten. In addition, to help address continuing concerns raised by some patients about not being able to get through to the practice, the provider had further upgraded their telephone system. They had introduced a queuing system, which enabled more calls to be accepted and gave callers information about when they could expect their call to be answered. The provider told us that, since this latest system upgrade, introduced in September 2016, the practice had not received any further comments from patients about being unable to get through to the practice.

  • Taken action to ensure that all staff knew how to access the practice’s policies and procedures, and understood its business continuity plan and, whistle-blowing and medicine policies.

  • Taken significant action to help improve its Quality and Outcomes Framework (QOF) performance. For example, the practice had implemented a nurse-led, ‘Year of Care’ (YoC) approach to the carrying out of all long-term conditions (LTCs) reviews. To help implement the new approach, additional advanced nursing practitioners had been appointed, to manage these clinics. The patient recall system had been strengthened by aligning each patient’s recall with their birth month. The provider had also reviewed and improved their systems and processes for ensuring that information entered onto the QOF system was accurate. They had expanded their Clinical Quality Team (CQT), to help ensure that all patient related correspondence coming into the practice that included QOF related data, was appropriately documented and coded on patients’ medical records. The CQT had also been allocated the responsibility for monitoring the practice’s QOF performance and ensuring that appropriate steps were taken, to ensure patients attended for routine checks and LTCs reviews. Because the introduction of new care planning, patient recall and QOF monitoring systems and processes had not had sufficient time to have an impact on the practice’s QOF performance for 2015/16, we are repeating the area of improvement we previously asked the provider to consider.

However, there were also areas where the provider should make improvements. The provider should:

  • Continue to take action to build on the arrangements it has put in place since our previous inspection to improve the practice’s QOF performance.

  • Consider replacing the flooring covering in the corridors and patient waiting area.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 March 2017

The practice is rated as good for providing safe services.

Since our previous inspection, the provider had taken action to:

  • Address the breach of legal requirement we found during our previous inspection. Required pre-employment checks had been completed for newly employed clinical staff. Other improvements had also been made to help the management team maintain an effective overview of their compliance with the provider’s recruitment policy. For example,

  • Ensure the practice actively used the local clinical commissioning group’s (CCG) Safeguarding Incident and Risk Management System (SIRMS), to report incidents of concern. (The SIRMS system enables GPs to flag up any issues via their surgery computer to a central monitoring system, so that the local CCG can identify any trends and issues for improvement across its whole area.)

Effective

Good

Updated 24 March 2017

Caring

Good

Updated 24 March 2017

Responsive

Good

Updated 24 March 2017

Well-led

Good

Updated 24 March 2017

Checks on specific services

People with long term conditions

Good

Updated 31 May 2016

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

Overall, there were good arrangements in place for providing patients with common long-term conditions with an annual review, so their needs could be assessed, and appropriate care and advice given about how to manage their health. Staff were in the process of setting up a nurse-led model of providing care and support to patients with long-term conditions. Clinical staff were very good at working with other professionals to deliver a multi-disciplinary package of care to patients with complex needs.

Nationally reported QOF data, for 2014/15, showed the practice had performed well in relation to providing recommended care and treatment for the majority of conditions commonly associated with this population group. For example, the practice had obtained 100% of the total points available to them, for providing care and treatment to patients who had been diagnosed with asthma. This was 0.7% above the local CCG average and 2.6% above the England average.

However, there were also a small number of clinical indicators where the practice’s performance fell below the local CCG and England averages. The practice’s new management team had introduced measures to improve their QOF performance. This included, for example, the introduction of meetings, to identify and address shortfalls in the recording of QOF data.

Families, children and young people

Good

Updated 31 May 2016

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

There were good systems in place to protect children who were at risk and living in disadvantaged circumstances. For example, the practice maintained a register of vulnerable children and contacted families where a child had failed to attend a planned appointment. Appointments were available outside of school hours and the practice’s premises were suitable for children and babies. The practice offered contraceptive and sexual health advice. The practice offered a full range of immunisations for children. Publicly available information showed they had performed very well in delivering childhood immunisations. For example, most of the immunisation rates were above 90%, and one immunisation rate was 100%. Nationally reported data also showed the practice had performed very well in the delivery of their cervical screening programme, with an uptake of 83.91% in comparison with the national average of 81.83%.

Older people

Good

Updated 31 May 2016

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

Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed well in relation to providing care and treatment for the clinical conditions commonly associated with this population group. For example, the practice had obtained 100% of the total points available to them, for providing care and treatment to patients who had heart failure. This was 1.1% above the local clinical commissioning group (CCG) average and 2.1% above the England average. The practice offered proactive, personalised care which met the needs of the older patients. For example, all patients over 75 years of age had a named GP who was responsible for their care. The practice held weekly GP clinics at local care homes. These clinics offered regular opportunities for medication reviews, the assessment of acute problems as they arose, and the continued monitoring of older patients with long-term conditions. The adoption of the local high-risk patient pathway had resulted in care plans being put in place to meet the needs of frail and vulnerable older patients. Annual nurse-led clinics for influenza, shingles and pneumococcal vaccinations were provided, to help promote access to this service.

Working age people (including those recently retired and students)

Good

Updated 31 May 2016

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

The practice had put flexible arrangements in place to meet the needs of working age patients. For example, early morning and late appointments were offered as part of the Doctor First appointment system that had recently been introduced. (Doctor First is a demand led system where patients contacting a practice are assessed by a doctor on a clinical priority basis, and then given an appointment where this is judged appropriate.) One of the GPs ran a clinic which enabled women to access long-acting reversible contraception. Plans were underway to introduce a nurse-led family planning clinic to enable women to book in advance for pill checks and contraceptive injections. An open access family clinic operated at one of the branch surgeries, and could be accessed by patients from other practices. The practice was proactive in offering online services, such as for booking routine appointments and ordering repeat prescriptions. Staff provided a full range of health promotion and screening that reflected the needs of this group of patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 May 2016

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

Patients with mental health needs were provided with advice about how to access various support groups and voluntary organisations. Information included on the practice’s website also provided good information about how to access ‘talking therapies’. Nationally reported QOF data, for 2014/15, showed the practice had performed less well with regards to providing recommended care and treatment to this group of patients. The practice had obtained 72% of the total points available to them for providing recommended care and treatment to patients with mental health needs. This was 24.5% below the local CCG average and 20.8% below the England average. The practice’s new management team had introduced measures to improve their QOF performance. This included, for example, the introduction of meetings, to identify and address shortfalls in the recording of QOF data.

There were good arrangements for meeting the needs of patients who had dementia. Nationally reported QOF data, for 2014/15, showed the practice had performed well in obtaining 100% of the total points available to them, for providing recommended care and treatment to this group of patients. This was above the local CCG average, by 0.9%, and above the England average, by 5.5%. Staff kept a register of patients who had dementia, and the practice’s clinical IT system clearly identified them to help make sure clinical staff were aware of their specific needs. Clinical staff actively carried out opportunistic dementia screening during long-term conditions clinics, to help ensure their patients were receiving the care and support they needed to stay healthy and safe. GP-led clinics were carried out at local care homes for patients with mental health needs to help make sure they received proactive care and treatment. All staff had attended Dementia Awareness training to help them understand the needs of these patients, and this had resulted in staff taking steps to improve access for such patients.

People whose circumstances may make them vulnerable

Good

Updated 31 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

There were good arrangements for meeting the needs of vulnerable patients. For example, steps were being taken to reduce unplanned emergency admissions into hospital. Staff had developed a high risk patient register, which they were actively using to provide personalised care planning. Patients admitted into hospital following an emergency had their care plans reviewed by practice staff after being discharged. The needs of vulnerable patients, including those with end-of-life needs, and those who had had contact with the local out-of-hours service during the preceding month, were discussed at monthly multi-disciplinary meetings. The practice maintained a register of patients with learning disabilities which they used to ensure they received an annual healthcare review. Extended appointments were offered to enable this to happen. Systems were in place to protect vulnerable children from harm. Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns. Arrangements had been made to meet the needs of patients who were also carers.