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Brentford Family Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 20 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brentford Family Practice on 6 October 2016. The practice was rated as requires improvement for providing safe services as electrical equipment in the administrator’s room had not been tested for safety in the last annual review. The practice was rated as requires improvement for the care of people experiencing poor mental health (including people with dementia) as performance for mental health related indicators was below the local and national average and exception reporting was high. The practice was rated as good overall. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Brentford Family Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 25 January 2018 to confirm that the practice had addressed the concerns we identified at our previous inspection on 6 October 2016. This report covers our findings in relation to those recommendations made since our last inspection. The practice is now rated as good for providing safe services and good for the care of people experiencing poor mental health (including people with dementia).

Overall the practice remains rated as good.

Our key findings were as follows:

  • The practice had taken steps to ensure electrical equipment in the administrator’s room was safe to use.
  • The practice had demonstrated improvement in the care provided to people experiencing poor mental health (including people with dementia). For example:
  • The practice had appointed a member of staff as the mental health lead for the practice. Patients were recalled for an annual review of their condition with longer appointments allocated for these reviews.
  • The GPs had received recent training in the management and care of patients with mental health conditions.
  • Patients experiencing poor metal health were offered a joint review at the practice with their GP and the primary care plus mental health team, which included a consultant psychiatrist and mental health nurse.
  • The most recent published Quality Outcome Framework (QOF) results showed performance for mental health related indicators was comparable to the clinical commissioning group (CCG) and national averages. (QOF is a system intended to improve the quality of general practice and reward good practice).
  • Ninety one percent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months (CCG average 85%; national 84%).
  • Ninety one percent of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the previous 12 months (CCG 88%; national 90%).
  • Ninety one percent of patients experiencing poor mental health had received discussion and advice about alcohol consumption (CCG 93%; national 91%)
  • Ninety eight percent of patients experiencing poor mental health had received discussion and advice about smoking cessation (CCG 96%; national 95%).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 February 2018

Effective

Good

Updated 20 February 2018

Caring

Good

Updated 20 February 2018

Responsive

Good

Updated 20 February 2018

Well-led

Good

Updated 20 February 2018

Checks on specific services

People with long term conditions

Good

Updated 20 February 2017

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 patients at risk of hospital admission were identified as a priority.

  • 80% of patients diagnosed with asthma had an asthma review in the last 12 months; this was comparable to the local average of 74% and national average of 75%.The exception reporting rate was 24%

  • Performance for diabetes related indicators was comparable to the local and national average, for instance:

  • 81% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 77%, national average 77%). The exception reporting rate was 9% compared to the national average of 12%.
  • 71% of patients with diabetes on the register had their cholesterol measured as well controlled (local average 79%, national average 81%). The exception reporting rate was 11% compared to the national average of 12%.
  • 95% of patients with diabetes on the register had a recorded foot examination and risk classification (local average 91%, national average 88%). The exception reporting rate was 12% compared to the national average of 8%.
  • Longer appointments and home visits were available when needed.

  • 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 20 February 2017

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.

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.

  • 77% of women aged 25-64 had it recorded on their notes that a cervical screening test has been performed in the preceding five years; this was comparable to the local average of 77% and national average of 82%. The exception reporting rate was 3%.

  • 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.

Older people

Good

Updated 20 February 2017

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.

  • 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.

Working age people (including those recently retired and students)

Good

Updated 20 February 2017

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 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.

  • The practice offered extended opening hours on Monday evenings and Wednesday and Friday mornings.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 20 February 2017

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

  • Performance for mental health related indicators was comparable to the local and national average:

  • 73% of patients diagnosed with dementia had a recorded review in a face to face meeting in the last 12 months (local average 86%, national average 84%).The exception reporting rate was 21% compared to the local average of 18%.

  • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 92%, national average 90%). The exception reporting rate was 14% compared to the national average of 10%.

  • 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months (local average 94%, national average 88%). The exception reporting rate was 14% compared to the national average of 13%.

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

  • Patients experiencing poor metal health were offered access at the practice primary care and mental health teams on Tuesday and Thursday every week.

  • Patients with mobility issues were offered home visits.

  • The practice 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.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 20 February 2017

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 homeless people, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • 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.