Bromleag Care Practice

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We found the service was providing responsive care. The provider listened to and involved patients in decisions about their care. Leaders at the service understood the needs of its population and tailored services in response to those needs.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Care home staff told us healthcare professionals used a person-centred approach and had made a positive impact on patients

Leaders at the service understood the needs of its population and tailored services in response to those needs. They told us that different residential homes housed patients with different needs, and the time taken with each patient and the type of appointments offered were different depending on the site which they were visiting. Staff demonstrated an understanding of the needs of populations served by the practice.

Staff that we spoke to were aware of the need to share decisions with the patient and/or their family. The service had a large number of patients who had a DNACPR in place. Leaders at the service told us that there were detailed procedures in place where the practice worked with other providers as necessary, to put these in place, and to monitor them.

Partners did not raise any concerns regarding care provision, integration and continuity.

The service had a system in place that alerted staff to any specific safety or clinical needs of a person using the service, for example there were alerts about a person being on the end of life pathway. The service had systems and protocols to determine mental capacity, and involved the patient and/or their family as required.

We had no concerns regarding people’s information about providing information.

Staff told us that information was available to provide to patients, families of patients and care home staff as required. Leaders at the service said they made changes to its ways of work through both informal feedback from residential homes, and from complaints and incidents.

As part of the assessment a number of set clinical record searches were undertaken by a CQC GP specialist advisor. This record review showed that patients were provided with necessary information relevant to their care.

Care home staff told us the practice listened to and involved patients in decisions about their care.

Staff at the service were aware of the complaints process, the need to provide details of the system to complainants, and the escalation procedure. Leaders at the service told us that issues were investigated across relevant providers, and staff were able to feedback to other parts of the patient pathway where relevant. They told us that the service learned lessons from individual concerns and complaints and from analysis of trends. It acted as a result to improve the quality of care.

Information about how to make a complaint or raise concerns was available and it was easy to do. Staff treated patients who made complaints compassionately. The complaint policy and procedures were in line with recognised guidance. We reviewed a sample of the complaints received by the service and found that all were satisfactorily handled in a timely way. We saw that the electronic database had a record of every step of the process of handling the complaint from receipt through to resolution.

Most care homes told us there were sufficient ward rounds, however some staff reported that their ward rounds could be missed if their assigned GP was on leave, off sick, or the ward round fell on a bank holiday. In these cases, there were not always systems in place for a different GP to carry out the routine ward rounds.

Leaders at the service detailed the processes that had been put in place to determine the duration and frequency of “ward round” style care at individual care homes. Staff were aware of the booking process for any acute needs outside of routine appointments covered by ward rounds.

We did not have any concerns about the processes that supported equity of access.

We had no concerns regarding people’s experience regarding equity in experience and outcomes.

Leaders told us that the care provided included both regular “ward round” style care at the residential homes to which it provided services, plus acute conditions that needed more immediate review. They told us that this removed some of the barriers of access to care. Staff to whom we spoke were aware of the appointments system, and how to escalate any acute conditions.

We did not have any concerns about the processes that supported equity of experience and outcome.

We heard the practice involved patients in future plans and provided information so that patients could make informed decisions about their care.

Leaders at the provider told us that a practice of this kind which only sees patients in residential homes is new, and that they were the first service in the London area to provide this. They told us that the commissioning of the service had therefore been complex, as the average patient at the service would have a higher need for medical care than an average patient at a non-specialised GP service. They told us that they had worked closely with commissioners and other funding options to ensure that the complement of staff was correct.

We did not have any concerns about the processes that supported planning for the future.