Bracondale Medical Centre

Updated 18 January 2017

Bracondale Medical Centre, 141 Buxton Road, Heaviley, Stockport, SK2 6EQ is part of the NHS Stockport Clinical Commissioning Group (CCG). Services are provided under a general medical services (GMS) contract with NHS England. The practice confirmed they had 5082 patients on their register.

The practice is a registered partnership between one female and two male GPs. The practice employs a salaried GP, a practice manager, an assistant practice manager, a reception manager two practice nurses and one health care assistant as well as reception and admin staff. The practice also employs two cleaners. The practice is a GP training practice and at the time of our visit there were two GP registrars and one foundation year one GP based at the practice.

Information published by Public Health England rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 79 years, which reflects both the local CCG and England average. Female life expectancy is 82 years, slightly below the CCG and England average of 83 years.

Bracondale Medical Centre is located on a busy main road in Stockport. Entrance to the practice is at the rear where there is ramped access and automated doors to assist patients with mobility issues. The practice provides five consultation rooms on the ground floor. There is also a training room on the first floor, which is used on occasion to see patients who do not have mobility problems.

The practice reception is open from 8.00am until 6.30pm Monday to Friday. Open access surgeries are available Monday mornings and Thursday afternoons, daily open access surgeries for children are available Monday to Friday and pre-bookable appointments, daily urgent and telephone appointments are available Monday to Friday. Later evening appointments are provided Mondays until 7.30pm and early morning appointments on Friday mornings from 7am.

Pre-bookable appointments are also available at weekends at the Out of Hours provider Mastercall located in Hazel Grove.

When the practice is closed patients are asked to contact NHS 111 for Out of Hours GP care.

The practice provides online access that allows patients to book and cancel appointments and order prescriptions.

Updated 18 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bracondale Medical Centre on 16 November 2016. Overall the practice is rated as good.

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

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with staff and stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• 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. The practice had a strong commitment to supporting staff training and development.
• Feedback from patients about their care was consistently and strongly positive. Patients described the GPs and staff as caring and professional.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met people’s needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients for example one patient was developing an information leaflet for patients to explain about the different intrauterine devices (coils) and the fitting of these.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• Evidence was available that demonstrated the practice complied with the Duty of Candour requirement.

We saw one area of outstanding practice:

• The practice had developed a care coordinator role to monitor and respond to patients attending A&E and/or admitted to hospital as an emergency. This involved liaising with the hospital ward staff to understand the reasons for admission and identify the discharge date so that appropriate care and support was in place at the point of discharge for the patient. The practice had established productive communication links with the neighbourhood advanced nurse practitioner and worked in coordination to ensure these patients receipt appropriate care and support. This model of care and support was being monitored with a view to rolling out to other GP practices within the Clinical Commissioning Group.

The areas where the provider should make improvement are:

• Strengthen existing pre-employment checks for locum GPs by obtaining references and copies of indemnity insurance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 January 2017

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

• The practice performed similarly or slightly below the local and national averages in the diabetes indicators outlined in the Quality and Outcomes Framework (QOF) for 2015/16.
• The practice encouraged patients to self refer to education programmes for the management of diabetes and other long term conditions.
• Longer appointments and home visits were available when needed.
• All 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.

Updated 18 January 2017

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.
• The practice held regular meetings to review patients considered at risk or with a child protection plan in place.
• The practice also held a log of all young people between the ages of 18 and 21 who were identified at risk from behaviours such as self harming.
• Immunisation rates were comparable to the Clinical Commissioning Group (CCG) rates for all standard childhood immunisations. The practice held children’s flu parties to encourage uptake of the vaccine.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The practice offered an open access surgery Monday to Friday between 12pm and 1pm for children and young people up to the age of 18. Appointments were also available outside of school hours.
• Quality and Outcome Framework (QOF) 2015/16 data showed that 77% of patients with asthma on the register had an asthma review in the preceding 12 months compared to the CCG and England average of 75%.
• The practice’s uptake for the cervical screening programme was 81%, which reflected the CCG and the national average of 81%. 

Updated 18 January 2017

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.
• It was responsive to the needs of older people, and offered a mixture of pre-bookable, on the day urgent appointments and open access surgeries.
• Home visits were available for those with enhanced needs.
• Planned weekly visits to a local care homes were undertaken by the GPs. This provided continuity of care.
• The practice had developed a care coordinator role to monitor and respond to patients attending A&E and or admitted to hospital as an emergency. This involved liaising with the hospital ward staff to understand the reasons for admission and identify the discharge date so that appropriate care and support was in place at the point of discharge for the patient. The practice had established productive communication links with the neighbourhood advanced nurse practitioner and worked in coordination to ensure these patients received appropriate care and support. This model of care and support was being monitored by the Clinical Commissioning Group (CCG) with a view to rolling out to other GP practices within the CCG area.
• Palliative care meetings were held every month and community health care professionals such as the district nurse and Macmillan nurse attended these.

Updated 18 January 2017

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 offered flexible surgery times including later evening appointments until 7.30pm on Mondays and early morning appointments from 7am on Fridays. The practice also provided a messaging service so that all requests for contact with a GP were actioned through the day. The electronic messaging board highlighted urgent call back requests so that GPs could prioritise these.
• The practice was proactive in offering online services such as booking and cancelling appointments and ordering prescriptions.
• The practice website also offered information on health promotion and screening.

Updated 18 January 2017

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

• Data from 2015/16 showed that 76% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the Clinical Commissioning Group (CCG) average of 85% and the England average of 84%. The practice had recently designated a lead to support patients with a diagnosis of dementia. Responsibilities included ensuring these patients attended their health care reviews and assisting them with any issues.
• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months, which was higher than the CCG average of 92% and the England 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.
• The practice facilitated a patient support service, which assisted patients experiencing poor mental health and provided guidance 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.

Updated 18 January 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.
• One reception staff team member was the designated lead to support patients with a learning disability.
• The practice offered longer appointments for patients who were vulnerable and those with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice worked closely with a local hostel to provide care and treatment to patients accommodated there.
• 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.