Brookside Surgery

Updated 20 July 2016

Brookside Surgery is located in the village of Stretton-on-Dunsmore, near Rugby. The practice is run as a partnership and provides primary medical services to patients in a rural area.

The practice was formed in the 1960s and is now housed in a modern, purpose built building. There were 3,700 patients registered with the practice at the time of the inspection. The practice has a high number of elderly patients. This included a large number of elderly patients who lived in three static caravan sites nearby and a large traveller community who primarily live in two nearby locations. There is little social deprivation within the area.

Brookside Surgery also has a dispensary which supplies medicines to patients over the counter and by a home delivery service.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities. It is part of a local GP federation, a group of practices that work together to improve services and outcomes for patients.

“The practice has two partner GPs (one male, one female) and one salaried GP (female), as well as trainee GP's. (At the time of the inspection, the practice had two full-time male and two part-time female trainee GP's.) Other clinical staff are two part-time practice nurses and a part time healthcare assistant. They are supported by dispensary staff and management, a practice manager and administrative and reception staff. The practice has appointed an additional salaried GP from August 2016.

The practice is open from 8.30am to 6.30pm during the week (closed on Thursday afternoons). Appointments are available from 8.30am to 12pm and from 2pm to 6pm. A duty GP is also available over the telephone from 8am to 8.30am and from 6pm to 6.30pm. An arrangement is in place with another local practice to provide emergency patient appointments on Thursday afternoons. Extended hours appointments are available until 7.30pm on Wednesdays. An open surgery is held on Monday mornings (or the Tuesday after a bank holiday Monday) when no appointments are needed.

When the practice is closed, patients can access out of hours care through NHS 111. The practice has a recorded message on its telephone system to advise patients. This information is also available on the practice’s website and in the patient practice leaflet.

Home visits are available for patients who are unable to attend the practice for appointments. There is also an on line service which allows patients to order repeat prescriptions and book appointments without having to telephone the practice.

The practice is an approved training practice for doctors who wish to become GPs. A GP trainee is a qualified doctor who is training to become a GP through a period of working and training in a practice. Only approved training practices can employ GP trainees and the practice must have at least one approved GP trainer.

The practice treats patients of all ages and provides a range of medical services. This includes minor surgery and disease management such as asthma, diabetes and heart disease. Other appointments are available for blood tests, maternity care, family planning and smoking cessation. A health visitor clinic is held at the practice every two weeks.

Updated 20 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brookside Surgery on 3 May 2016. Overall the practice is rated as good.

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

• The practice had an effective system in place for reporting and recording significant events. All such events were reviewed at a weekly staff meeting.

• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was delivered in line with current evidence based guidance. We saw that staff had the skills, knowledge and experience to deliver effective care and treatment.

• All patients we spoke with and those who completed comment cards before our inspection, said they found it easy to obtain an appointment, usually on the same day. Urgent appointments were always available the same day.

• Information about how to complain was available and easy to understand. The practice made improvements to the quality of care as a result of complaints and concerns.
• The practice had good purpose built facilities which were fully accessible. The building was well equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• The practice had recently introduced a revised system for monitoring the use of prescriptions and should continue to monitor this to ensure the improvements are sustained.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 20 July 2016

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

• The practice had a low rate of unplanned hospital admissions for patients with long term conditions. When patients were discharged from hospital following an unplanned hospital admission they were given a 30 minute appointment to assess their needs and complete a care plan. This was carried out at patients’ homes if they were unable to reach the practice.

• Nursing staff had lead roles in chronic disease management. They identified patients at risk of hospital admission as a priority.

• Patients with diabetes attended an annual clinic during a practice campaign held between August and November each year. This was publicised locally.

• Longer appointments and home visits were available when needed.

• Patients had a named GP and a structured annual review to check their health and medicines needs were being met.

Updated 20 July 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 above average (between 94% and 100%) for the Coventry and Rugby Clinical Commission Group.

• 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.

• Cervical screening tests had been carried out on 84% of eligible female patients. This was above the national average of 82%.

• Patients we spoke with told us appointments were available outside of school hours and we saw the premises were suitable for children and babies.

• The practice worked with midwives and health visitors.

A full range of family planning services were available and one GP was a family planning trainer which added to the expertise available at the practice.

Updated 20 July 2016

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

• The practice provided personalised care to meet the needs of the older people in its population. This included home visits and urgent appointments for those with enhanced needs.

• All patients aged over 75 who received four or more medicines (polypharmacy) had their medicines reviewed over the last nine months in a specific 20 minute appointment. This ensured they were receiving appropriate medicines.

• Multi-disciplinary team meetings were held every two weeks to review the most vulnerable older patients. This included district nurses and health visitors.

Updated 20 July 2016

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

• The practice had identified the needs of the working age population, those recently retired and students. It had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, by providing telephone consultations.

• Extended hours appointments and pre-bookable telephone consultations were available for patients who were unable to reach the practice during regular working hours.

• The practice was offered online services as well as a full range of health promotion and screening that reflects the needs for this age group. This included NHS health checks and travel vaccinations.

Updated 20 July 2016

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

• 91% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan in place. This was above the national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A multi-disciplinary team meeting was held every two weeks.

• The practice carried out advance care planning for patients with dementia. All such patients had their care reviewed within the last 12 months.

• 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 20 July 2016

The practice is rated as good for the care of people who circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice worked closely with the large local traveller community. This included close liaison with health visitors, the social work team attached to these patients and traveller site wardens. A weekly open surgery had been introduced which had improved their access to healthcare at the practice.

• Longer appointments were available for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. This included social workers and district nurses.

• A system to assess risk was in place to reduce unplanned hospital admissions amongst the most vulnerable patients. When patients were discharged from hospital following an unplanned hospital admission they were given a 30 minute appointment to assess their needs and complete a care plan which included a home visit when necessary.

• 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.