Archived: Burton & Bransgore Medical Centres

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Burton and Bransgore Medical Centres on 18 October 2016. Overall the practice is rated as requires improvement

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. Lessons were shared and action was taken to improve safety in the practice. However, evidence showed that issues were discussed by clinicians at weekly meetings but records had not historically been kept of these meetings. Prior to the inspection the practice had already identified where they needed to improve in this area and were actively working through an action plan to do so.
• There had been inconsistent arrangements in how risks were assessed and managed. For example, risks relating to staff training, management of emergency equipment and medicines, the management of medicines that needed refrigeration, Disclosure and Barring Service checks on staff (DBS) and the monitoring of test results had not been fully considered. The practice had plans for improvements in these areas.
• The monitoring of high risk medicines was not completely effective as not all patients had received a blood test prior to being issued a repeat prescription to ensure they were receiving the correct dosage.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, mandatory training identified by the practice needed completing and records updating.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• One of the GPs had a special interest in patients with an ear, nose or throat complaint (ENT). Patients with these complaints were seen in the practice instead of having to attend an outpatient’s appointment at the local hospital and because of this the practice was the second lowest referrer of patients to the ENT consultant in the locality. Benefits to patients included swifter access to specialist care and treatment and receiving closer to home services.
• 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 practice had a number of policies and procedures to govern activity, but some of these policies were overdue a review.

We saw two areas of outstanding practice;

• Patients could be referred by their GP to an NHS physiotherapist. A physiotherapy clinic was held at the practice four times a week. Two of these weekly clinics were funded by the practice themselves to enhance patient access to re-ablement services and to promote faster recovery for patients. 60 patients had benefitted from these referrals in the last quarter. The clinics focussed on muscular-skeletal conditions and supported patients post operatively as well as patients with back and joint problems who would normally see a GP. Patients benefitted from these clinics through longer more detailed assessments, closely monitored recovery programmes and reduced waiting times to access physiotherapy services.
• The practice had employed two clinicians to work within the team to improve care for patients over 75 years of age. The clinicians provided a link between the practice and vulnerable people in their own homes. The team consisted of a registered nurse, a paramedic and a co-ordinator. They worked closely with the SMILE team (a team consisting of one registered nurse and two health care assistants who undertook memory assessments in the community which had been in place for over 5 years). About 2.3% of patients over the age of 75 years had benefitted directly from this service since April this year through faster access to support which helped them remain at home. Services also helped prevent them from needing hospital care and continuity of support through seeing the same support team. Six of these patients were regularly discussed and managed during multidisciplinary team meetings. The SMILE team was a joint initiative funded by the practice and its neighbouring practice.

The areas where the provider must make improvement are:

• Ensure governance arrangements are in place to improve the delivery of safe and effective services. This includes the systems for effective management of medicines that require refrigeration, the management of emergency medicines and equipment, staff recruitment and the management of those patients on high risk medicines.
• Ensure arrangements are in place for the effective management and monitoring of staff training.
• Ensure arrangements are implemented for the effective governance of the practice.

The areas where the provider should make improvements are:

• Continue to involve patients by using the NHS Friends and Family Test to obtain effective patient feedback.
• Continue to review policies and procedures to ensure staff work to the most up to date guidance.
• Review and improve the process of formally identifying patients who were carers.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice