Archived: Dr's Brear, Wimborne and Fleet Also known as York Bridge Surgery

Updated 14 January 2016

Dr’s Brear, Wimbourne and Fleet, also known as York Bridge Surgery, is part of the NHS Lancashire North Clinical Commissioning Group (CCG). Services are provided under a personal medical service (PMS) contract with NHS England. The practice has 7025 patients on their register. The practice is located in a residential area of Morecambe, Lancashire.

Information published by Public Health England rates the level of deprivation within the practice population group as four on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male and female life expectancy in the practice geographical area is below the England average for males at 78 years and 82 years for females (England average 79 and 83 respectively).

The patient population aged 65 years and over is 21.8%, higher than the national average of 16.7%. Patients aged over 75 years of age is also higher at 10%, compared with 7.6 % nationally. Patients in the age ranges 0-18 years are comparable with the national average.

The practice has two GP partners (one male and one female), one salaried GP (currently on maternity leave) and one long term locum (female). The practice employs a practice manager, an advanced nurse practitioner (who is also a salaried partner), one nurse practitioner, two practice nurses (including a specialist research nurse) two healthcare assistants, a phlebotomist and 12 reception and administrative staff. In addition, the practice has the support of a part time pharmacist who is jointly employed by the CCG.

The practice is a training practice for qualified doctors who are training to be a GP. The practice also provides clinical placements for student nurses in training.

The practice is open Monday to Friday between 08:00 - 18:30. Extended hours are available each Monday morning from 7am and a late evening until 8pm every two weeks. There is also a Saturday morning surgery each month.

Out of Hours services are provided by Bay Urgent Care, and contacted by ringing NHS 111.

The practice provides online access for patients to book appointments and order prescriptions.

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr’s Brear Wimbourne and Fleet, also known as York Bridge Surgery on 18 November 2015. We had previously visited the practice in October 2014, when the surgery was rated as requires improvement. We were able to check that the required actions had been undertaken.

Overall the practice is now 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.

• It was clear staff had a commitment to providing safe and effective care. The practice had a strong commitment to supporting staff training and development

• Risks to patients were assessed and well managed.

• 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.

• The practice had acted upon and improved recruitment and employment procedures

• 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.

• Feedback from patients about their care was positive. Patients commented that staff were brilliant and were described as caring and professional.

• Three comment cards completed by patients said they found it difficult to get through to the practice in the morning to make an appointment with a named GP, however when they did there were urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• 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 areas where the provider should make improvement are:

• Ensure more effective communication with the Patient Participation Group to obtain patient feedback to inform and improve services

• Improve signage to indicate wheelchair access at the rear of the building

• Ensure when reviewing policies that any reference to external organisations who no longer exist are removed

• Ensure that audit results are shared with all staff to consistently support improved outcomes

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 January 2016

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

• The practice had a team of nurse practitioners, practice nurses and health care assistants to meet the needs of the patients. Nursing staff had lead roles in chronic disease management. They were supported by GPs.

• The number of patients registered with the practice with a long term condition was similar to both the Clinical Commissioning Group (CCG) and national averages

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Patients were given email access to GPs and nurses when advice was needed to avoid unnecessary visits to the surgery

• Medication reviews were undertaken by the practice pharmacist, particularly for those patients onmultiple medications

Updated 14 January 2016

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

• There were effective 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 higher or comparable with local and national percentages for all standard childhood immunisations.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Evidence of joint working with midwives, health visitors and community nurse was available.

• Nurse led contraception clinics were provided every two weeks via a late night clinic session.

• Cervical screening data from 2013/14 for women aged 25-64 was 75.5%, which was comparable to the CCG 75.5% and England 76.9% averages. The practice’s exception rate was also lower at 4% compared with 5.2% and 6% respectively.

• The practice had a proactive chlamydia screening programme, with counselling available for those patients with a positive diagnosis

Updated 14 January 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.

• There was good uptake of influenza, pneumovax and shingles vaccinations, with visits arranged for patients who were housebound

• The practice had a dedicated phone line for easier access to support or advice for patients receiving palliative care, those in residential or nursing homes and for ambulance staff who could contact the GP directly and avoid admission to hospital

• Access to Age UK for advice and support was to be provided in the practice in the near future

Updated 14 January 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 were available each Monday morning from 7am and a late evening until 8pm every two weeks. There was also a Saturday morning surgery each month.

• The practice was participating in an extended 8 to 8 service with five other local practices.

• 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.

Updated 14 January 2016

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

• The practice maintained a register of patients with a mental health condition.

• Data showed the practice achieved a higher percentage than both the local CCG and nationally for all mental health indicators; for patients having a comprehensive care plan and receiving health promotion and prevention treatments and advice.

• < > of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, compared with 83.82% nationally

  The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support people with mental health needs and dementia

Updated 14 January 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 with a learning disability, with longer appointments offered. There was also a register of patients who were carers.

• The practice served a significant traveller population and had good levels of engagement

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• Vulnerable patients were told how to access various support groups and voluntary organisations.

• The practice worked closely with a local voluntary community group West End Impact supporting the homeless.

• 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.