Brentford Group Practice

Updated 28 September 2017

Brentford Group Practice provides NHS primary medical services to approximately 8,000 patients living in the surrounding area of Brentford. The practice has a General Medical Services (GMS) contract (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS Hounslow Clinical Commissioning Group (CCG).

The practice team consists of three GP partners (one male and two female) and four salaried GPs (one male and three female). The number of sessions offered by the GPs equates to 4.75 whole time equivalent (WTE) staff. The GPs are supported by two practice nurses (1.2 WTE); a health care assistant (0.45 WTE); a practice manager; and seven administrators / receptionists.

The practice is located on the ground floor of a health centre, and shares the premises with other health care providers. The premises are accessible by wheelchair.

The practice is open from 6.45am to 7.45pm on Monday, and 8.30am to 6.30pm Tuesday to Friday. Pre-booked appointments are from 8.30am-10.30am on Monday, 8.30am to 11am Tuesday to Friday, and 3pm to 5pm every weekday afternoon. Extended hours appointments are available on Monday from 7.10am to 7.50am and 6.30pm to 7.10pm. Same day appointments are available for patients with complex or more urgent needs. An out of hours provider handles telephone calls from 8am to 8.30am and 6pm to 6.30pm, with urgent calls being transferred to the on-call doctor at the practice. When the practice is closed, patients are advised to use the local out-of-hours provider or attend the local 'hub' primary care service.

The practice population is characterised by average levels of income deprivation, employment rates and life expectancy. The practice has a higher percentage of patients aged 25 to 39 compared to the English average. The population is ethnically diverse.

The practice service is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder and injury; family planning services; surgical procedures; and maternity and midwifery services.

Updated 28 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brentford Group Practice on 21 October 2015. The practice was rated as requires improvement for providing safe and well-led services and the overall rating for the practice was requires improvement. The full comprehensive report on the October 2015 inspection can be found by selecting the ‘all reports’ link for Brentford Group Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 21 August 2017 to check for improvements since our previous inspection. Overall the practice is now 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 a system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed, with the exception of those relating to testing electrical equipment, checking medical supplies and tracking blank prescription forms.
• Staff were aware of current evidence based guidance. Most staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, not all had received training in the Mental Capacity Act 2005.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• 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 sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Implement a system to ensure risks to patients are assessed and well managed. For example, the safe use of equipment and medical supplies, tracking blank prescriptions, and updating the business continuity plan.
• Implement a system to ensure clinical audits are recorded in a consistent format to demonstrate effectiveness.
• Provide staff with access to appropriate training and review the protected learning time for nursing staff.
• Implement a system to ensure results are received for samples sent for the cervical screening programme.
• Continue to identify and support patients who are carers.
• Review ways to improve patient satisfaction with the convenience and punctuality of appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 September 2017

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

• GPs and nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice had performed well on the Quality and Outcomes Framework (QOF) for managing long-term conditions.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for 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.
• New patients on regular medicines were required to be reviewed by a GP on registration.
• The practice offered a monthly diabetic clinic with a diabetes specialist nurse, consultant and dietician.

Updated 28 September 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were comparable to CCG and national averages for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children.

Updated 28 September 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. For example, with the district nurses, social workers, palliative care nurse and patient co-ordinator.

Updated 28 September 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended hours appointments on Monday from 7.10am to 7.50am and 6.30pm to 7.10pm, and pre-booked appointments in the evening and at weekends at the local primary care ‘hub’.
• 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.

Updated 28 September 2017

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

• Patients at risk of dementia were identified and offered an assessment. The practice carried out advance care planning for patients living with dementia.
• In 2015/16, 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 86% and national average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, there were joint consultations with consultants to improve communication and patient care.
• In 2015/16, 97% of patients with a diagnosed psychosis had a comprehensive care plan in their records, which was comparable to the CCG and national averages of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. Although, not all staff had received training in the Mental Capacity Act 2005.

Updated 28 September 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 those with a learning disability and homeless people.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability, and these patients had a named GP.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, patients could be referred to the care navigator who worked with the GP to support vulnerable patients in accessing the services they need, self-manage their conditions and proactively ask for help, and ensure their carers are supported.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.