Archived: The New Brewery Lane Surgery

Updated 29 September 2016

The New Brewery Lane Surgery delivers primary care services to 7,546 patients in Thornhill, Thornhill Lees, Savile Town and surrounding areas in Dewsbury, West Yorkshire under a personal medical services (PMS) contract.

• The GP partners self-funded new premises and the service relocated the main surgery in March 2016 to a brand new purpose built medical centre at The Sidings Healthcare Centre, The Sidings, Savile Town Dewsbury, WF12 9QU. There is a branch practice located at The New Brewery Lane Surgery, Brewery Lane, Thornhill Lees, Dewsbury, WF12 9DU.
• Both locations provide full disabled access and all services are at ground floor level. Each surgery has an adjoining pharmacy. The surgeries have car parking and are accessible by bus.
• The area is on the third most deprived decile on the scale of deprivation. Sixty per cent of the patient population is aged under 65 (national average 38%). Sixty four per cent of patients are from black minority ethnic populations.

• There are three GPs, two male and one female and three regular locum GPs who provide four to five surgeries per week. There are three female practice nurses, two female health care assistants and a clinical pharmacist. The clinical team are supported by a practice manager and a team of administrative and reception staff.
• At the time of the inspection the practice had a vacancy for one WTE GP and were hoping a new recruit would be joining the practice in October 2016.

• The main surgery is open between 8am and 6.30pm Monday to Friday. The branch practice is open 8.30am to 1pm Monday to Friday. Extended hours appointments are offered at the New Brewery Lane location  between 8am to 12pm on Saturdays for pre-bookable appointments only. All telephone calls are answered at The Sidings location.
• Appointments are available at The Sidings from 8.30am to 6pm and are staggered throughout the day. Appointments with a GP or health care assistant are available from 8.30am to 12.30pm at the New Brewery Lane site. Patients can attend either location but all long term condition reviews are carried out at the main surgery.
• Out of hours care is provided by Local Care Direct which is accessed by calling the surgery telephone number or by calling the NHS 111 service.

The practice had not informed the Care Quality Commission (CQC) that the location of the main surgery had changed in March 2016. The practice manager took immediate action after the inspection to submit an application to the CQC to update the registered locations. The practice’s website also displayed the previous location details. We were informed the practice manager had submitted the new information to the health informatics company who had not updated the changes at the time of the inspection.

Updated 29 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The New Brewery Lane Surgery on 20 July 2016. Overall the practice is rated as good. The address shown above is for the branch practice which is the address registered with the CQC. The main surgery is located at The Sidings Health Centre, The Sidings, Savile Town, Dewsbury,WF12 9QU.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. We discussed events that had been dealt with successfully but not recorded as a significant event. We also noted that minor administrative errors were not recorded in an incident log.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an arrangement in place with local mosques to ensure that death certificates were issued quickly and to provide support to bereaved families.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care. In response to patient feedback the practice had improved access to appointments for both urgent and non-urgent care.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice provided services in line with the local Clinical Commissioning Group (CCG) ‘care closer to home’ policy. For example, phlebotomy, spirometry, 24 hour blood pressure monitoring and electrocardiograms (ECGs).

The areas where the provider should make improvements are:

• Improve significant event reporting to include events that are dealt with successfully and minor administrative errors.
• The practice should review the process to identify and review high risk medicines in collaboration with the pharmacist.
• Review the availability of clinical waste bins in all consulting and treatment rooms.
• Improve their systems to ensure they inform the CQC of any changes to the registered details of the service in a timely manner.
• Review their systems to ensure all GPs can readily access and contribute to shared care plans on the clinical system.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 September 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. Staff followed long term condition templates to carry out structured annual reviews.
• Staff worked closely with the community matron in the management of housebound patients who had complex long term conditions, to ensure they received care and support.
• Patients with long term conditions at risk of unplanned hospital admission were included on the admissions avoidance register which gave patients priority access to same day appointments.
• Performance for diabetes related indicators was similar to the national average, for example, 93% of patients with diabetes, on the register, had a record of a foot examination and risk classification (CCG average 89%, national average 88%).
• 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.
• Staff used online consultations where available, with hospital consultants to discuss cases and carry out shared care planning.

Updated 29 September 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.
• The practice’s uptake for the cervical screening programme was 72%, which was lower than the CCG and national average of 82%. Data showed that they had increased the uptake of cervical screening by 12% since 2013/14.
• Appointments were available outside of school hours and the premises were suitable for children and babies. All children who required an urgent appointment were seen on the same day as requested.
• The practice worked with midwives, health visitors and school nurses to support the needs of this population group.

Updated 29 September 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.
• The practice worked closely with other health and social care professionals, such as the district nursing team and community matron to ensure housebound and elderly patients received the care and support they needed.
• The practice encouraged older people to attend for screening. Uptake rates were lower than local and national averages. For example, 36% of patients aged 60 to 69 had been were screened for bowel cancer in the preceding 30 months (CCG average 55%, national average 58%).
• Older people with frequent hospital accident and emergency (A&E) or out-of-hours contact were included on the avoiding unplanned admissions register. This provided patients with priority for appointments and an individual care plan which enhanced GP awareness of any specific needs.
• Health checks were offered for all patients over the age of 75 who had not seen a clinician in the previous 12 months.

Updated 29 September 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.
• Extended hours appointments were offered at the New Brewery Lane location between 8am to 12pm on Saturdays.
• The practice offered telephone consultations to patients who were unable to attend the surgery.
• There was a practice ‘pod’ where patients could take their blood pressure at any time during opening hours.
• Text messages were used to remind patients of review appointments.
• Health checks were offered to patients aged between 40 and 74 who had not seen a GP in the last three years.

Updated 29 September 2016

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

• The practice provided care to 33 patients who resided in a specialist nursing care home for people with long term mental health problems. We saw evidence of good communication between the practice and staff at the home.
• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• Performance for mental health related indicators was better than the national average. For example, 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record (CCG average 89%, national average 88%).
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• The practice supported patients on shared care for opiate and alcohol dependency with a local support service.

Updated 29 September 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, travellers 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.
• Information was displayed in different languages about domestic violence and sensitive female related health and support services were displayed privately in the ladies toilet cubicle.