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Brooklyn Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 25 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brooklyn Medical Practice on 15 March 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. These were regularly discussed at practice meetings.
  • Risks to patients were assessed and well managed.
  • The premises were observed to be clean and tidy. Waiting areas were on two levels.
  • The practice had adequate facilities and was well equipped to treat patients and meet their needs. The treatment room had been refurbished to a good standard and new equipment had been purchased to facilitate storage and transportation of clinical items.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • 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.

  • The practice engaged with the clinical commissioning group and other practices in the locality to share learning.
  • This practice also operated a cross-referral process with local practices whereby GP specialities were utilised between practices to treat patients with specific conditions, for example dermatology clinics were provided by a GP at the practice with expertise in this field .

However, there was one area where the provider should make improvements;

  • The practice should be proactive in ensuring that all patients who are also carers are represented on the practice’s register of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 April 2016

The practice is rated as good for providing safe services.

  • The practice had effective systems in place to support the recording of events, incidents and near misses. Staff were encouraged to identify and report any areas of concern. Staff meetings and protected learning time sessions were used to learn from significant events and lessons learned were recorded and communicated. Information about safety was recorded, appropriately reviewed and addressed. When there were unexpected safety incidents, patients received an apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • Risks to patients were assessed and well managed. Infection prevention and control procedures were completed to a satisfactory standard. There were enough staff to keep people safe.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse and concerns were discussed at regular safeguarding meetings and also at other relevant meetings.

  • There were processes in place to manage safety issues such as patient safety alerts, medicines management and medical emergencies.

  • Risk assessment were in place to manage risks to staff and patients.

Effective

Good

Updated 25 April 2016

The practice is rated as good for providing effective services.

  • Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • Clinical audits were undertaken. For example, an audit was undertaken to identify whether patients taking a non steroidal anti-inflammatory (NSAID) medicine were also receiving a medicine to protect their stomach. The audit resulted in an alert being placed on patient’s notes.
  • Data showed most patient outcomes were similar to the locality. For example, the practice’s uptake for the cervical screening programme was 83% which was the same as the CCG average and 1% above national average.
  • There was evidence of appraisals and personal development plans for all staff and evidence that staff had attended development sessions and training
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 25 April 2016

The practice is rated as good for providing caring services.

  • Data from the National GP survey showed that patients rated the practice in line with others several aspects of care. For example, 88% of patients described their overall experience of this surgery as good compared to the CCG average of 87% and the national average which was 85%
  • Patients told us they were treated with care and concern by staff and that their privacy and dignity was respected. Feedback from comments cards aligned with these views.
  • The practice provided information for patients which was accessible in the waiting room and was easy to understand.
  • We observed that staff treated patients with kindness and respect, and maintained confidentiality.
  • The practice held a register for patients who were also carers and offered them additional support.

Responsive

Good

Updated 25 April 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
  • The practice offered flexible services to meet the needs of its patients. For example, extended appointments each evening, telephone consultations and same day appointments for urgent requests. Most of the patients we spoke with said they were able to get an appointment when they needed one.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 25 April 2016

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

  • The practice had a vision to deliver high quality care. Staff were clear about their responsibilities in relation to this and appeared motivated to deliver high quality care.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk through regular reviews, audits and risk assessments.
  • There was a clear leadership structure and staff felt supported by partners and management.
  • The practice had a wide range of policies and procedures to govern activity and these were regularly reviewed and updated.
  • The partners and practice manager encouraged a culture of openness and honesty, and staff felt supported to raise issues and concerns
  • The practice proactively sought feedback from staff and patients which it acted on. The patient participation group (PPG) met regularly with the practice manager. They worked with the practice to review issues such as appointment times
Checks on specific services

People with long term conditions

Good

Updated 25 April 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 provided dedicated clinics to assist in the management of chronic diseases.
  • The percentage of patients with diabetes, on the register, in whom the last blood test for HbA1c was 59 mmol/mol or less in the preceding 12 months was 70%, which was 0.5% above CCG average and 0.6% below national average. (By measuring HbA1c, clinicians are able to get an overall picture of a patient’s average blood sugar levels over a period of weeks or months).
  • The practice had provided an asthma review for 91% of the patients on their register in the last 12 months. This was 12% above CCG average and 15% above national average.
  • A total of 96% of patients diagnosed with diabetes had received an influenza immunisation
  • Longer appointments and home visits were available when needed. Patients who required anticoagulant therapy were monitored weekly and patients who were housebound received this at home.
  • The practice worked closely with the community matron and and district nurses to provide continuity of care where home visits were required.
  • The practices computer system alerted GPs when patients were due for a review of their medicines or when patients were overusing their medicines.
  • The CCG medicines management pharmacist regularly monitored and reviewed patients medicines and discussed any concerns or changes required with the GPs.
  • 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.

Families, children and young people

Good

Updated 25 April 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 high for all standard childhood immunisations. For example; rates for children under 24 months was between 94% and 98% except for meningitis C which was 1.2%. These were comparable with the CCG average of between 94% and 96% and higher than the CCG rate for meningitis C which was 0.7%
  • 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice liaised with community midwives, health visitors and school nurses where required.

Older people

Good

Updated 25 April 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. Individualised care plans were used where required and updated annually or more often if required.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Telephone consultations were provided by the advanced nurse practitioner who liaised with GPs and the community team
  • The practice provided abdominal aortic aneurism (AAA) screening at the practice on a regular basis.
  • The practice worked closely with the community matron and district nursing team to maintain continuity of care when visiting housebound patients
  • The practice made twice-weekly visits to two care homes where they provided regular reviews for patients and attended at other times when needed.

Working age people (including those recently retired and students)

Good

Updated 25 April 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. Extended hours appointments were available every day for patients who worked during the day.
  • The practice offered online services for patients to book routine appointments and request repeat prescriptions.There was a full range of health promotion and screening that reflects the needs for this age group.
  • They had provided cervical screening for 83% of eligible patients which was comparable with the CCG average and national average.
  • The practice provided information about long acting reversible methods of contraception for 100% of women who had requested emergency contraception in the preceding 12 months. This was 6% more than the CCG average and 7% more than the national average for providing this information.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 April 2016

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

  • 92% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is 7% higher than the CCG average and 8% higher than the national average.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan documented in the record, in the preceding 12 months was 93%. This is 1% higher than the CCG average and 5% above the national average. 95% of these patients also had a face to face review in the last 12 months including a blood pressure check. This is 3% higher than the CCG average and 6% higher than the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia and 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 and provided leaflets and information in the waiting area.
  • 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.
  • There were GP leads for patients with poor mental health and for dementia.

People whose circumstances may make them vulnerable

Good

Updated 25 April 2016

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

  • The practice held a register for patients with a learning disability and had 32 patients on their register. They had provided an annual health check for 28 of the patients on the register in the preceding 12 months. Longer appointments were also offered.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and informed vulnerable patients about how to access various support groups and voluntary organisations.
  • A care-coordinator worked with the practice and community team to plan care and avoid unnecessary admissions to hospital. They made use of the Single Point of Access service to enable timely care for patients when required. (The Single Point of Access is a service provided by Derby teaching hospital for people in the locality who are not in need of emergency care but could benefit from urgent multi-disciplinary support)
  • Regular meetings took place with the palliative care team, including Macmillan nurses to plan and coordinate care for people at the end of their lives.
  • 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. Health visitors were included in monthly safeguarding meetings for children at risk of harm.
  • Alerts were used on the practice’s computer system to highlight important information. For example if a patient was receiving palliative care or had a care plan identifying specific needs.
  • Women from a local womens domestic violence refuge centre were encouraged to register with the practice and provision was made for them to complete this online if required to preserve privacy.