Archived: Browney House Surgery

Updated 25 January 2017

Browney House Surgery is a purpose built GP premises in Langley Park. They have a Personal Medical Services (PMS) contract and also offer enhanced services for example; extended hours. The practice covers the village of Langley Park, which is an ex-mining community. There is also a branch surgery at Lanchester (Croft View) which was also visited during the inspection. There are 2700 patients on the practice list and the majority of patients are of white British background.

The practice is a partnership with two partners, one clinical and one non clinical. It is a single handed GP practice. There is one Practice Nurse, a Business Manager and a Practice Manager. There is a team of dispensing, reception and administration staff. The practice use regular locums who they employ as they have struggled to recruit new salaried GPs.

The practice is open between 8am and 5.30pm Mondays, Wednesdays and Fridays and between 8am and 6pm on Tuesdays and Thursdays. The branch surgery at Lanchester is open on Mondays, Wednesdays and Fridays between 4.30pm and 6.30pm and on Tuesdays and Thursdays between 11am and 12pm. Extended hours are offered at  the branch surgery until 6.30pm on Mondays, Wednesdays and Fridays. The practice has an agreement with North Durham CCG if patients require a GP outside of their opening hours.

Patients requiring a GP outside of normal working hours (after 6.30pm) are advised to contact the GP out of hour’s service provided by North Durham CCG.

Updated 25 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 1 March 2016. A breach of legal requirements was found. After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

Regulation 19 HSCA (RA) Regulations 2014 Fit and proper persons employed Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Fit and proper persons employed

How the regulation was not being met:

Recruitment arrangements did not include all necessary employment checks for all staff.

Regulation 19(3)(a) schedule 3

Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment

Regulation 12 of the Health and Social Care Act 2008

(Regulated Activities) Regulations 2014: Safe care and treatment

How the regulation was not being met:

The registered person did not do all that was reasonably practicable in managing medicines safely; medicines, including controlled drugs, were not stored safely and securely or disposed of appropriately in accordance with the relevant legislation.

Appropriate systems and processes were not in place to assess, monitor, and improve the quality of services in relation to the dispensing of medicines.

Guidance for the security of blank prescriptions was not being followed.

Regulation 12(2)(g)

Care and treatment was not provided in a safe way for service users because some aspects of the management of medicines and recruitment checks were unsafe.

Specifically:

The arrangements for storing controlled drugs did not ensure that medicines, including controlled drugs, were stored safely and securely (including checking fridge temperatures daily), and disposed of appropriately in accordance with the relevant legislation.

The practice did not keep a ‘near-miss’ record (a record of dispensing errors that have been identified before medicines have left the dispensary) and there were no records of dispensing errors that had reached patients. This meant errors could not be analysed, and learning shared to prevent reoccurrence.

No procedure was in place to track prescription forms after they had been received into the practice, which would identify if any were missing.

Recruitment arrangements did not include all necessary employment checks for all staff.

We undertook this focused inspection on 6 December 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Browney House Surgery on our website at www.cqc.org.uk

Our key findings were as follows:

Care and treatment was provided in a safe way for service users through the proper and safe management of medicines for the purposes of the regulated activity.

Recruitment arrangements now included all necessary employment checks for staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 April 2016

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

• Nursing staff and the GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice nurse was in the process of undertaking extra training in chronic disease management to enable them to do annual reviews for these patients. The community respiratory nurses and the GPs were doing these reviews at present.
• 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.

• Nationally reported data for 2014/2015 showed that outcomes for patients with long term conditions were good. For example;

  The percentage of patients with diabetes, on the register, in whom the last HbA1cwas 64 mmol/mol or less in the preceding 12 months (01/04/2014 to31/03/2015) was 83% compared to a national figure of 78%.

Updated 15 April 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 relatively high for all standard childhood immunisations.
• The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months that included an assessment of asthma control was 76% compared to a national average of 75%.
• 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.
• The percentage of women aged 25-64 whose notes record that a cervical screening test had been performed in the preceding 5 years was 85% compared to a national average of 82%.
• 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, health visitors and school nurses.

Updated 15 April 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.

• As part of the ‘Improving outcomes scheme’ in conjunction with the CCG, the practice held a register of patients who were at risk of unplanned emergency admission to hospital.

Updated 15 April 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 reflected the needs for this age group.

Updated 15 April 2016

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

• Nationally reported data from 2014-2015 showed 95% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 95% compared to a national average of 88%

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

• 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.

Updated 15 April 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 those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.