18 May 2017
Dr N Sivanesan & Partners, known locally as Brereton Surgery, is registered with the Care Quality Commission (CQC) as a GP partnership provider in Rugeley, Staffordshire. The practice holds a Personal Medical Services (PMS) contract with NHS England. A PMS contract is a locally agreed contract between NHS England and the general practice and offers variation in the range of service which may be provided by the practice. At the time of our inspection the practice had 4,270 patients.
The provider has amended their registration since the inspection in August 2016. Dr Sivanesan has retired from the partnership and Dr Davis is now the main partner.
The practice staffing comprises of:
- Two GP partners (one male and one female).
- One female nurse prescriber, one female practice nurse and a female phlebotomist (who takes blood samples).
- A practice manager, office manager, clinical administrator, secretary and three reception staff.
The practice is open between 8am and 6.30pm Monday to Friday. The practice offers routine pre-bookable and on the day appointments. Pre-bookable 15 minute appointments are bookable up to four weeks in advance. Ten minute on the day appointments are either GP specific or added to the pool list to be seen by the next available GP. The practice also offers appointments with a nurse practitioner, a practice nurse and a phlebotomist (person who takes blood samples). The practice does not offer any extended hours appointments.
Patients requiring a GP outside of normal working hours are advised to call the practice, where the call is automatically diverted to the out of hours service, which is Staffordshire Doctors Urgent Care.
18 May 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr N Sivanesan & Partners (known as Brereton Surgery) on 18 August 2016. The overall rating for the practice was good, and the well led domain rated as Requires Improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Dr N Sivanesan & Partners on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 25 April 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 18 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Our key findings were as follows:
- The practice had developed a system to demonstrate that the medicines and equipment alerts issued by external agencies were acted upon. We saw for the two alerts received post April 2017 appropriate action had been taken.
- The practice had improved the systems in place for assessing and monitoring. A range of risk assessments had been completed and action plans in place to manage the identified risks.
- The practice had strengthened the governance procedures in place. A meetings schedule had been developed, set agendas were used and meetings minuted and the information shared with all staff.
- The leadership structure was being updated due the changes in the partnership. The partners had designated managerial and clinical roles and met regularly to discuss the practice strategy.
- The practice continued to develop the role of the patient participation group and the group now met in person.
- Systems were in place to check the continued registration of nurses with their professional body. However, the practice did not ask for information relating to any physical or mental health conditions that the person may have, or whether they were up to date with their routine immunisations.
One area for improvement remained outstanding from the previous inspection:
- Record information regarding any physical or mental health conditions that applicants may have.
Two additional areas for improvement have been identified. The provider should:
- Ensure the practice are in receipt of all appropriate safety alerts and take appropriate action on any gaps noted in receipt.
- Review whether staff are up to date with their routine immunisations and take appropriate action as required.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
4 October 2016
The practice is rated as good for the care of people with long-term conditions.
- The GPs and the nursing team were involved in chronic disease management and patients at risk of hospital admission were identified as a priority.
- The practice maintained registers of patients with long term conditions. Patients were offered a structured annual review to check their health and medicines needs were being met.
- Performance in four of the five diabetes related indicators was comparable to the national average. For example: The percentage of patients with diabetes, on the register, in whom a specific blood test was recorded was 77%, the same as the national average.
- Longer appointments and home visits were available when needed.
- 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.
4 October 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 who were at risk, for example families with children in need or on children protection plans.
- Appointments were available outside of school hours and the premises were suitable for children and babies. Same day emergency appointments were available for children.
- There were screening and vaccination programmes in place and the practice’s immunisation rates
- Data from the Quality and Outcomes Framework (QOF) for 2014/2015 showed that 77% of women aged 25-64 had received a cervical screening test in the preceding five years. This was below the national average of 82%.
- The practice offered routine contraception services including implant and coil insertion.
4 October 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.
- The practice participated in the hospital admission avoidance scheme. The care of these patients was proactively managed using care plans and there was a follow up procedure in place for discharge from hospital.
4 October 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.
- The practice offered on the day and pre-bookable appointments, as well as telephone consultation.
- The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
4 October 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- Ninety four percent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.
- Performance for mental health related indicators was comparable to or above the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95% compared to the national average of 88%.
- The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
4 October 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 those with a learning disability.
- The practice offered longer appointments for patients with a learning disability.
- The staff knew how to recognise signs of abuse in vulnerable adults and children. The 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.