Archived: The Brownhill Surgery

Updated 19 December 2016

The Brownhill Surgery is located in the centre of Chandlers Ford a town north of Southampton, Hampshire. The practice is based in a converted residential building built in approximately 1900, and there are two floors. Three treatment rooms are on the ground floor and three treatment rooms are on the first floor. The practice provides services to patients living in the Chandlers Ford, Eastleigh and Otterbourne areas of Hampshire. The practice area has low deprivation and low unemployment compared to the averages for England.

The practice provides services under a NHS General Medical Services contract and is part of NHS West Hampshire Clinical Commissioning Group (CCG). The practice has approximately 7,000 patients registered. A total of 68% of patients at the practice are working or are in full-time education compared to the national average of 60%.The practice population has a similar number of patients with a long-standing health condition compared to the national average. A total of 51% of patients registered at the practice have a long-standing health condition compared to the national average of 54%.

The practice has two male GP partners, one female GP partner, and one female GP who is a long-term locum. Together, the GPs provide care equivalent to approximately three full-time GPs over approximately 23 sessions per week. The GPs are supported by one nurse practitioner, who is a non-medical prescriber and provides diagnosis, treatment and advice to patients. Two practice nurses and two health care assistants also provide a range of services to patients such as 24 hour heart monitoring and long-term condition reviews. Together the practice nurses are equivalent to just under two full time nurses. The clinical team are supported by a management team and a team of 10 support staff who share secretarial, administrative and reception duties.

The practice telephone lines and reception desk are open between 8am and 6.30pm. Appointments are available between 8.30am and 12pm and again from 3pm to 6.30pm daily. Extended hours appointments are offered every weekday between 7.20am and 8.30am and on Monday and Thursday evenings until 7.10pm. The Brownhill Surgery has opted out of providing out-of-hours services to their own patients and refers them to the out of hours service via the NHS 111 service.

The practice offers a range of additional in-house services to patients including antenatal care, midwifery, phlebotomy, travel advice, sexual health services and minor operations. The practice offers online facilities for booking of appointments and for requesting prescriptions.

We carried out our inspection at the practice’s only location which is situated at:

2 Brownhill Road, Eastleigh, Hampshire, SO53 2ZB

We previously inspected The Brownhill Surgery on 10 May 2016. Following this inspection, the practice was given a rating of good. The practice was rated as requires improvement for providing safe care. This was because the practice had not conducted a risk assessment for the prevention and control of Legionella. Appropriate pre-employment checks for staff had not consistently been undertaken. We also found that blank prescriptions were not stored securely at all times.

A copy of the report detailing our findings can be found at www.cqc.org.uk/

Updated 19 December 2016

Letter from the Chief Inspector of General Practice

We carried out a focused inspection of The Brownhill Surgery on 8 November 2016 to assess whether the practice had made the improvements required in providing safe care and services.

We had previously carried out an announced comprehensive inspection at The Brownhill Surgery on 10 May 2016 when we rated the practice as good overall. The practice was rated as requires improvement for providing safe care. This was because a risk assessment for the control and prevention of Legionella had not been completed, appropriate recruitment checks for staff were not consistently performed and blank prescriptions were not kept securely.

We asked the provider to send a report of the improvements they would make to comply with the regulations they were not meeting at that time. The practice is now able to demonstrate that they are meeting the regulations. The practice is now rated as good for providing safe care and the overall rating remains as good.

This report should be read in conjunction with the full inspection report dated 27 June 2016.

Our key finding across the area we inspected was as follows:

• Recruitment checks for staff had been appropriately completed and recorded.
• The security systems for clinical areas and blank prescription stationary were effective.
• The practice had an assessment to determine the risk from infection from Legionella and had taken action to ensure effective and safe water systems.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 June 2016

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

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

• Data for patients with long-term conditions compared well with national figures. For example, the percentage of patients with diabetes, on the register, who had a flu vaccination in the preceding 1 August to 31 March was 100%, compared to a national average of 94%.

• 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.

• The practice regularly hosted an external service to screen patients for retinopathy (an eye disorder). This meant patients did not have to travel large distances to receive this care.

Updated 27 June 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.

• 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.

• A total of 80% of eligible women attended for a cervical smear in 2014-2015. This is similar to the national average of 81%.

• 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 27 June 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 patients in its population.

• Performance indicators for conditions commonly found in older patients were comparable to national averages. For example, 100% percentage of patients with atrial fibrillation (an irregular heart beat) were treated with appropriate medication compared to a national average of 98%.

• The practice used an alerting system on the records of older patients who had limited mobility and provided appointments in a ground floor consulting room.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The practice’s computer system enabled clinical staff to access patient records directly when on home visits.

• Frail older patients were actively identified and supported by a dedicated team which the practice part-funded.

Updated 27 June 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 reflects the needs for this age group.

• A text messaging service for reminders to attend appointments and routine reviews was offered to patients.

Updated 27 June 2016

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

• A total of 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to 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 the preceding 12 months was 91% compared to a national average of 88%.

• 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 carried out advance care planning for patients living 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 27 June 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 homeless people and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.