Archived: Broughton Gate Health Centre

Updated 24 February 2017

Broughton Gate Health Centre provides primary medical services to approximately 10,158 patients in an area of Milton Keynes. Services are provided on a Personal Medical Services (PMS) contract (a PMS contract is a locally agreed contract).

Services are delivered to patients from one registered location, Glyn Valley Place, Milton Keynes, MK10 7EF. 

The practice forms part of The Practice Group, a corporate group which provides primary medical services at a number of locations across England. Executive management oversight is provided by The Practice Group which includes corporate business planning, performance monitoring and central functions such as human resource management, payroll and regular review and update of policies and processes.

Broughton Gate Health Centre is one of five hubs in the Milton Keynes area offering appointments using funding available from the Prime Ministers GP Access Fund (PMGPAF). The PMGPAF was created to offer patients more flexibility in GP appointment availability. Additional appointments are available on Tuesday and Friday evenings and at weekends. In Milton Keynes there are five GP Hubs signed up to the PMGPAF campaign.

The practice at Broughton Gate Health Centre serves a population group with a noticeably different profile to the England average. For example, the practice had almost double the number of young children aged 0 - 4 years than the local and national average, with 12% at the practice, compared to 7% locally and 6% nationally.

Similarly, at the time of our inspection the practice had 29% of its practice population less than 18 years of age, compared to the local CCG average of 24% and the national average of 21%.

For patients in other age ranges, the practice had 4% of patients over 65 years of age, compared to the local average of 12% and the national average of 17%.

The area is recorded as being in the’ second least deprived decile’ and falls in an area of low deprivation According to national data, life expectancy for male patients at the practice is 77 years, which was lower than the CCG average of 78 years and the national England average of 79 years. For female patients life expectancy is 80 years, compared to the local CCG average of 82 years and the England average of 83 years.

The on-site practice team consists of eight GPs (five male GPs and three female GPs), two practice nurses, two nurse practitioners and one health care assistant (all nursing staff were female). The practice manager is supported by a team of staff who provide reception and administrative functions.

The practice is open between 8am and 8pm seven days a week, 365 days a year, and appointments with a GP, nurse or health care assistant are available during those times. Appointments are bookable up to six weeks in advance.

The practice also offers a limited number of walk-in appointments each day. This service operates on a first come first served basis for immediate and necessary treatment only. Emergency appointments are available daily. A telephone consultation and call-back service is also available for those who need urgent advice. Home visits are available to those patients who are unable to attend the surgery.

Out-of-hours service can be accessed via the NHS 111 service. Information about the out-of-hours services was available in the practice waiting area, on the practice website and on the practice telephone answering service.

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Broughton Gate Health Centre on 21 July 2016. Overall the practice is rated as good.

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

• The practice had a clear vision and had recognised the particular needs of patients in the community it served.
• The practice had worked to create an open and transparent approach to safety. A clear system, which was made known to all staff, was in place for reporting and recording significant events.
• Risks to patients were identified, assessed and appropriately managed. For example, the practice implemented appropriate recruitment checks for new staff, undertook regular clinical reviews and followed up-to-date medicines management protocols.
• We saw that the staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff were supported to access development learning and routine training was provided to ensure they had the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients was positive. Patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Comments from patients on the 31 completed CQC comment cards confirmed these views.
• Results from the GP Patient Survey published in July 2016 showed the practice to be in line with, or below, most local and national performance averages. However, some improvement from previous results, published January 2016, was noted.
• Information about services and how to complain or provide feedback was available in the waiting area and published on the practice website. The practice had a comprehensive and thorough process dealing with patient feedback. Outcomes from complaints were shared and learning opportunities identified as appropriate.
• Appointments were readily available. Urgent appointments were available the same day, although not always with the patients named or usual GP.
• The practice had access to good facilities and modern equipment in order to treat patients and meet their needs.
• There was a clear leadership structure and we noted there was a positive outlook among the staff, with good levels of moral in the practice. Staff said they felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are as follows:

• Continue work to identify and support patients with caring responsibilities.
• Continue development work to ensure improvement to national patient survey outcomes.
• Continue to ensure patients with a long term condition are monitored appropriately, including implementation of revised exception reporting policy.
• Records of attendance and discussion at staff meetings to be maintained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 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.
• 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 constructively with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had clear protocols in place to support the treatment of patients with long term conditions. The practice held records of the number of patients with long term conditions. These patients were seen at the surgery on a regular basis and invited to attend specialist, nurse-led clinics.
• The practice offered longer appointments to these patients and home visits were available when needed.
• 98% of the patients on the diabetes register had influenza immunization in the preceding 01 August 2015 to 31 March 2016, compared to local CCG average of 97% and national average of 95%. Effective arrangements were in place to ensure patients with diabetes were invited for a review of their condition.
• Nurse led clinics ensured annual reviews and regular checks for patients with asthma and chronic obstructive pulmonary disorder (COPD) were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions. All patients who were admitted to hospital were reviewed by the practice after discharge.
• The practice delivers the gold standard framework (GSF) for patients receiving palliative care and needing additional support at the end of their lives.

Updated 24 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.
• 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.
• 81% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was in line with the local CCG average and the national average of 82%.
• The practice provided appointments outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Immunisation rates for all standard childhood immunisations were broadly similar to local CCG performance averages. The practice provided flexible immunisation appointments.
• The practice supported a number of initiatives for families with children and young people, for example the practice offered a range of family planning services. Baby vaccination clinics and ante-natal clinics were held at the practice on a regular basis. Positive links with the community midwife team and liaison with health visitors formed a positive and collaborative approach.

Updated 24 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. GPs were able to offer home visits to those patients who are unable to travel into the surgery. On-the-day or emergency appointments were available to those patients with complex or urgent needs.
• The practice had clear objectives to avoid hospital admissions where possible. For example, when GPs visited patients who lived in residential care homes they ensured that patient medication was reviewed regularly and other routine tests were undertaken without the need for patient admission to hospital.
• These patients had a dedicated telephone number at the practice, for use in an emergency.

Updated 24 February 2017

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

• As the practice had a high percentage of working age patients, they focused on their needs through analysis of patient surveys and feedback from the Patient Participation Group (PPG). The practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• Data showed 54% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to 56% locally and 58% nationally.
• Data showed 69% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 74% locally and 72% nationally.
• The practice offered easy access to telephone appointments and telephone consultations.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40 - 74 years.
• The practice was proactive in offering on line services such as appointment booking, an appointment reminder text messaging service and repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs of this age group.

Updated 24 February 2017

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

• 97% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, compared to the local CCG average and the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia. For patients on the dementia register, the practice had a lead GP with responsibility for developing and improving delivery of services for patients with mental health and health promotion.
• The practice had supported patients experiencing poor mental health about how to access support groups and voluntary organisations, with links with support services, such as counselling and referrals to the Improving Access to Psychological Therapies service (IAPT).
• The practice had a system in place to follow up patients who had attended A&E 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 24 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, such as homeless people, travellers and those with a learning disability. The practice had 19 homeless patients on its register.
• The practice actively encourages patients with no fixed abode to register at the practice and provides food vouchers for those found to be in most need.
• The practice offered longer appointments for patients with a learning disability. GPs also visited patients who lived at local care homes when they were unable to travel to the practice for an appointment.
• The practice had recorded 29 carers on their register.
• The practice regularly worked positively and collaboratively with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access support groups and voluntary organisations. The practice told us that a dedicated member of the administration team contacts these patients once a week to enquire about their welfare, if any concerns are identified these are referred to a doctor.
• 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.