Archived: Millbrook GP Surgery

Updated 28 January 2016

Millbrook Surgery is located within a coastal village in Cornwall. The practice runs a branch surgery at Lodge House Surgery. There were 2621 patients on the practice list and the majority of patients are of British white background. There is a higher percentage of patients over 55 years registered at this practice. Social deprivation is in the lower-range in a coastal area.

Since 1 July 2015 Access Health Care Ltd , which also runs the Clock Tower GP surgery and Cranbrook Medical Centre, has been responsible for providing medical services and care to the patients registered at Millbrook Surgery. Access Health Care Ltd is part of the Devon Doctors Group, which has an executive board providing governance oversight for all policies, procedures, support and clinical leadership. The practice is four months into a 12 month contract term. A public consultation is currently underway and being managed by NHS England to obtain the views of the local community about their future healthcare needs.

The practice is run by a non-clinical registered manager and a business manager. They are supported by two female salaried GPs, two female practice nurses and an administrative team. The nursing team has been further increased to include a nurse with advanced qualifications to run clinics for patients with chronic and long term diseases.

Millbrook Surgery is open 8.30am – 6pm Monday to Friday except Tuesdays. On Tuesdays the practice opens for a half day from 8.30 am – 1pm. The branch practice Lodge House Surgery covers between 1pm and 6pm. Extended hours had just restarted in October 2015, with evening appointments being offered to working age patients on a Monday evening. Outside of these hours, Cornwall Health the Out of Hours service provider cover for patients in line with the agreed contract. The practice closes 4 half days a year for staff training and information about this is posted on the website. The practice has consulted with their patients about their needs regarding appointments via surveys. Recruitment is underway for members to reinstate the PPG (Patient Participation Group) so that they can help drive improvements forward.

The practice has an Alternative Medical Service (APMS) contract. Services provided at the practice are:

• Minor surgery

• Child health surveillance
• Influenza, pneumococcal, rotavirus and shingles immunisations for children and adults
• Patient participation in development of services.
• Learning Disability health check scheme
• Pertussis vaccinations for pregnant women
• Women's health – maternity medical care, cervical screening and contraceptive services

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Millbrook Surgery over two days on 18 and 25 November 2015. Since assuming responsibilities for the service 4 months ago, a comprehensive action plan had been put in place to ensure at systems and the premises were safe for patients and staff. 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.
• 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.
• 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.
• The practice had 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 provider should:

Audit patient record systems to provide assurance that data is continuously reliable for monitoring people with chronic health conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 January 2016

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

• All patients with a long term condition had a named GP who reviewed their healthcare needs with them.
• Patients at risk of hospital admission were identified as a priority. Community nursing teams reported that communication with them about vulnerable people was effective and proactive. A more formalised approach was in the process of being set up so that regular monthly meetings would be taking place.
• Patients diagnosed with long term conditions were supported for specific conditions such as, asthma, chronic obstructive pulmonary disease (COPD) and diabetes. A recently appointed nurse with chronic disease management qualifications was prioritising seeing these patients for reviews.
• Longer appointments and home visits were available when needed.

Updated 28 January 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 satisfactory 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:
• Women's health was promoted. For example, cervical cytology screening uptake was comparable with local and national averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Baby changing facilities were updated during the inspection as a result of identified infection control risks.

Updated 28 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 and had a range of enhanced services, for example emergency admission avoidance.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Specifically the GP’s were proactive in visiting older people without an acute medical need. We found integrated working arrangements with community teams.
• The practice worked closely with carers and liaised well with a Carers support worker to provide the support and advice they might need.

Updated 28 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.
• 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 such as health checks for men and women and flu clinics outside of working hours.

Updated 28 January 2016

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

• People diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The GPs were promoting advance care planning for patients with dementia and worked closely with adult social care providers and carers on this.
• The practice had systems in place to advise patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The new provider had begun an investigation into a complaint which highlighted potential areas for improvement regarding responding to patient needs at the weekend. It was too early to report the outcome of this at this inspection.
• It 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 people with mental health needs and dementia.

Updated 28 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 living in vulnerable circumstances including homeless people and those with a learning disability. No travellers were registered at the practice.
• It offered longer appointments for people with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. More formalised arrangements with regular monthly meetings were due to start within two months of the inspection.
• It had told 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.