Brinnington Surgery

Updated 22 November 2016

Brinnington Surgery is part of the NHS Stockport Clinical Commissioning Group (CCG). Services are provided under a personal medical services (PMS) contract with NHS England. The practice told us that they had 8759 patients on their register.

Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 74 years and female life expectancy is 78 years in the practice geographical area, which is significantly below the England and CCG averages of 79 years and 83 years respectively.

The practice’s patient population for the under 18 years of age at 26% is much larger than the local and England average of 20%. Further, the practice is located in an area that has a patient population with a higher rate of long standing health conditions (59% compared to 53% locally and 54% nationally) and there is a significantly higher rate of unemployment at 19% compared to 5% locally and nationally.

The practice is located within a NHS property service health centre. The district nursing and health visitors’ teams, podiatry, two dental practices and one independent pharmacy are also located in the building. The community midwives team run a weekly antenatal clinic at the practice and a blood anti-coagulation clinic is held at the centre each week. The building provides 13 consultations rooms all with ground level access, which is suitable for people with mobility issues. Car parking is available at the practice and a range of local shops are available close by.

The practice is a partnership between six GPs (four male and two female) and one non clinical partner who is the practice manager. Six partners are registered with CQC and the seventh partner has attempted to complete their application for inclusion on the CQC register. In addition to the partners, the practice employs four salaried GPs (three female and one male), four practice nurses, two assistant practitioners, a pharmacist, a mental health care navigator and a number of reception and admin staff. The practice is a GP training practice.

The practice is open between 8am to 6.30pm Monday to Friday, with extended hours for GP, practice nurse and assistant practitioner appointments on a Monday evening until 7.30pm and Friday mornings from 7am. Appointments were available in the mornings Mondays to Thursday from 8.30 am to 12pm and Fridays from 7.10am to 12pm . Afternoon appointments were available Mondays from 2pm until 7.30pm and from 2pm until 6pm Tuesday to Friday.

When the practice is closed patients are asked to contact NHS 111 for Out of Hours GP care.

The practice provides online access that allows patients to order prescriptions and request and cancel an appointment.

Updated 22 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brinnington Surgery on 6 October 2016. Overall the practice is rated as outstanding.

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. All opportunities for learning from internal and external incidents were maximised.
• The practice had a strong vision, which put quality, effective care and treatment as its top priority. The partnership was structured with distinct roles and responsibilities, utilising the experience and skills of partners to the full. As a result, all business and clinical matters were delivered effectively at the practice.
• The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• Patients described the GP practice as excellent; staff were described as caring and professional.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services in response to feedback from patients. For example, the appointment system following a review in 2015 was changed to provide a minimum of 12 minutes per appointment and schedule a GP telephone appointment for every fifth appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

We saw some areas of outstanding practice including:

• The practice was committed to safeguarding children and vulnerable adults. Safeguarding referrals were reviewed as significant events and learning from these shared within the Clinical Commissioning Group (CCG) and the local NHS trust. For example, one child safeguarding incident resulted in changes to the practice’s postnatal baby check template to include more information about the family situation. The adapted template was shared with the CCG. The changes to the postnatal template enabled the practice to identify two incidents where young children were considered at potential risk and safeguarding procedures were implemented.
• The practice sent out ‘case finding’ questionnaires to patients over 65 years to identify any unmet health care needs.
• The practice had a designated ‘Speaking Up Guardian’ who was independent of the practice partnership. This provided staff with someone they could raise concerns to under the practice whistleblowing policy.

The areas where the provider should make improvement are:

• Implement a system to ensure patient medicine reviews that are undertaken are recorded in the patient records as being completed.
• To support the current risk assessment and to further mitigate any potential risk to patients, staff undertaking the role of chaperone should have a Disclosure and Barring Service (DBS) check.
• Extend patient participation at the practice by implementing ways for patients who do not have access to the internet or social media applications to contribute to the development of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 November 2016

The practice is rated as outstanding 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 practice performed better than the national average in all five of the diabetes indicators outlined in the Quality of Outcomes Framework (QOF). The practice carried out insulin initiation and they also initiated GLP-1 (glucagon-like peptide 1) treatments which were normally initiated within a hospital setting. 
• A recent drive to review patients at risk of developing pre-diabetes identified additional 250 patients as being at risk. The practice consulted with Public Health England to bring the pre diabetes awareness and education course into the local community (DESMOND -Diabetes Education and Self Management for Ongoing and Diagnosed). The first meeting was arranged for the 1 December 2016.
• Longer appointments and home visits were available when needed. All housebound patients with a long term condition were visited regularly to ensure the appropriate screening was undertaken. All these patients also had a self-management or an advanced care plan in place.
• All 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 22 November 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.
• Safeguarding children and young people was a priority and the practice was proactive in identifying people at potential risk. Safeguarding referrals were reviewed as significant events to identify learning and improvements. This had led to improvements in the eight week postnatal baby check template, which was shared with the Clinical Commissioning Group.
• Immunisation rates were comparable to the locality for all standard childhood immunisations.
• 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 practice provided a full range contraceptive services including long-acting reversible contraception, such as coils and implants.
• Quality and Outcome Framework (QOF) 2014/15 data showed that practice performance reflected the Clinical Commissioning Group and the England averages. For example, 75% of patients with asthma, on the register, had received an asthma review in the preceding 12 months (CCG 76% and national data 75%).
• The practice’s uptake for the cervical screening programme was 82%, and reflected the CCG and the England average,
• 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 and health visitors with regular meetings and electronic contact. There was a weekly antenatal clinic at the practice.
• A consultant led, attention deficit hyperactivity disorder (ADHD) clinic was held once every two months from the practice enabling patients to access the service without having to travel.

Updated 22 November 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 routinely visited all housebound patients to review their health care needs. Care plans were place for all these patients.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Case finding questionnaires were sent to patients aged over 65 to help identify any unmet needs.
• GPs and practice nurses were allocated a specific care home and carried out regular planned visits to each home. The practice met every second month with the care home managers at meetings to discuss a range of issues.
• Care plans were in place for those patients considered at risk of unplanned admission to hospital.
• Palliative care and neighbourhood multi-disciplinary meeting were held regularly with community health care professionals. Patients on the palliative care register had care plans in place.
• In 2015/16 influenza immunisation uptake was 80% compared with the CCG average of 75%.
• The practice has a designated cancer champion who has tried to encourage patients to attend breast screening appointments or complete bowel screening kits.
• The practice was implementing a programme of patient pulse checks for those over 65 years of age to identify those with an irregular pulse (atrial fibrillation).

Updated 22 November 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.
• Telephone consultations were available each day and extended hours for GP, practice nurse and assistant practitioner appointments were available on a Monday evening until 7.30pm and Friday mornings from 7am.
• 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 22 November 2016

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

• The practice provided in house a Mental HealthCare Navigator to provide guidance and support to patients with low-level depression and anxiety.
• The practice facilitated and supported the provision of additional medical services for example a consultant psychiatrist worked from the practice one day per month.
• The practice carried out six monthly dementia reviews and these patients had care plans in place. Data from 2014/15 showed that 91% of patients had had a face to face review compared to the average of 87% for the Clinical Commissioning Group (CCG) and England average of 84%.
• Data from 2014/15 showed 87% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months, which was slightly below the CCG and England average of 90%.
• 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 22 November 2016

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

• The staff team were well trained in recognising and responding to patients at risk of abuse.
• 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. Care plans were recorded for patients with a learning disability.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• One GP partner supervised a weekly shared care drug misuse clinic in the practice.
• The practice facilitated in house supportive initiatives for the practice’s patient population. This included weekly visits by Healthy Stockport, which provided an open door drop in service at the practice where patients could get advice and signposting to support for social issues, lifestyle choices including diet, alcohol and drugs use.
• Telephone and face-to-face language and sign language interpreters were provided as required.