Brookfield Surgery

Updated 8 August 2016

Brookfield Surgery is located in Lymm, Warrington, Cheshire. The practice was providing a service to approximately 9,000 patients at the time of our inspection.

The practice is part of Warrington Commissioning Group (CCG) and is situated in an area with low levels of deprivation when compared to other practices nationally. The percentage of patients with a long standing health condition is 56% which is similar to the local and national average.

The practice is run by four GP partners and there are an additional two salaried GPs (two male and four female). There are three practice nurses, a practice manager, a finance manager and a team of reception and administrative staff. The practice is open from 8am to 6.30pm Monday to Friday. The practice had signed up to providing longer surgery hours as part of the Government agenda to encourage greater patient access to GP services. As a result patients could access a GP at a Health and Wellbeing Centre in the centre of Warrington from 6.30pm until 8pm Monday to Friday, 8am to 8pm Saturday and Sunday mornings. This was by pre-booked appointment. Outside of practice hours patients can access the Bridgewater Trust for primary medical services. The practice is a training practice for trainee GPs.

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice has a General Medical Services (GMS) contract. The practice provides a range of enhanced services, for example: childhood vaccination and immunisation and avoiding unplanned hospital admissions.

Updated 8 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brookfield Surgery on 15 June 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• Significant events had been investigated and action had been taken as a result of the learning from events. However, the recording of significant events did not always clearly demonstrate this.

• Systems were in place to deal with medical emergencies and all staff were trained in basic life support.

• There were systems in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Feedback from patients about the care and treatment they received from clinicians was very positive.

• Data showed that outcomes for patients at this practice were similar to outcomes for patients locally and nationally.

• Staff felt well supported and they were kept up to date with appropriate training.

• Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• The appointment system was flexible and responsive to patients’ needs. Patients said they found it easy to make an appointment with a named GP and there was good continuity of care.

• The practice had good facilities, including disabled access and it was well equipped to treat patients and meet their needs. However, some patients raised a concern that the practice provided limited parking facilities.

• Information about the services provided and about how to make a complaint was available. Complaints had been investigated and responded to in a timely manner.

• The practice had a clear vision to provide a safe and high quality service.

• There was a clear leadership and staff structure and staff understood their roles and responsibilities.

• The practice provided a range of enhanced services to meet the needs of the local population.

The areas where the provider should make improvements are;

• Clearly demonstrate/document the actions taken following significant events.

• Review the chaperoning procedures to ensure these are in line with best practice.

• Consider a planned programme of full cycle audits and formalise a processes for sharing the outcome of audits and implementing changes to practise.

• Review and update the information provided to patients about making and escalating a complaint.

• Risk assess and plan to mitigate risks associated with the use of the annexe.

• Review staff files to ensure all required proof of identification is held by the provider.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 August 2016

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

• The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.

• Regular, structured health reviews were carried out for patients with long term conditions.

• Clinical leads had been designated to support patients with specific long term conditions.

• Patients were provided with advice and guidance about prevention and management of their health and were signposted to support services.

• Data from 2014 to 2015 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes. For example, the percentage of patients with diabetes, on the register, who had had an influenza immunisation was 97% compared to a national average of 94%.

• Longer appointments and home visits were available for patients with long term conditions when these were required.

• The practice provided an in house phlebotomy service which was convenient for patients especially those requiring regular blood monitoring.

• Regular clinical meetings were held to review the clinical care and treatment provided to patients who were seriously ill.

Updated 8 August 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 those who were at risk, for example, children and young people who had a high number of A&E attendances. A GP was the designated lead for child protection.

• Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

• Weekly antenatal and post natal clinics were held and the practice worked closely with the community midwife.

• Child immunisation rates were comparable to the national average for all standard childhood immunisations. Opportunistic immunisations were given to encourage uptake.

• The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.

• Family planning and contraceptive services were provided.

• Babies and young children were offered an appointment as priority and appointments were available outside of school hours.

• The premises were suitable for children and babies and baby changing facilities were available.

Updated 8 August 2016

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

• The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

• The practice provided a range of enhanced services, for example, the provision of care plans for patients over the age of 75 and those at the highest risk of unplanned hospital admission.

• There was a designated clinical lead for the care and assessment of patients aged 75 and over.

• Patients over the age of 65 were encouraged to have annual flu vaccines and pneumococcal and shingles vaccinations as required.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to or better than local and national averages. For example, 98% of patients with COPD had had a review undertaken including an assessment of breathlessness in the preceding 12 months compared to a national average of 89%.

• GPs carried out regular visits to local care homes to assess and review patients’ needs and to prevent unplanned hospital admissions.

• Home visits and urgent appointments were provided for patients with enhanced needs.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

Updated 8 August 2016

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

• The practice provided appointments in line with their core contract arrangements and patient feedback was that the appointment system was sufficiently flexible to meet their needs. However, in the national patient survey, the practice had scored lower than the national average for patient satisfaction with the surgery opening hours and the provider was considering how they would improve this.

• The practice was part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre up until 8pm in the evenings Monday to Friday, and from 8am to 8pm Saturdays and Sunday mornings, through a pre-booked appointment system.

• Telephone consultations were provided and patients therefore did not always have to attend the practice in person.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group. Screening uptake for people in this age range was comparable to or above national averages. For example 72% of females aged 50-70 had been screened for breast cancer in the last three years compared to a national average of 72%. The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 85% which was higher than the national average of 81%.

• The practice was proactive in offering online services including the booking of appointments and request for repeat prescriptions. Electronic prescribing was also provided.

Updated 8 August 2016

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

• The practice held a register of patients experiencing poor mental health and these patients were offered an annual review of their physical and mental health.

• The practice had a designated lead for mental health.

• A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

• Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they were prescribed.

• The practice referred patients to appropriate services such as psychiatry and counselling services.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

Updated 8 August 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 in order to provide the services patients required.

• The practice had a designated lead for patients with a learning disability.

• 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 was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available.

• Information and advice was available about how patients could access a range of support groups and voluntary organisations.