Brierley Park Medical Group

Updated 12 November 2015

Brierley Park Medical Centre is a well-established practice caring for 8,655 patients in Huthwaite and Sutton in Ashfield, together with the surrounding Derbyshire villages. The practice is located within the Ashfield District Council area and levels of deprivation for the practice population are above the national average. The practice has extended opening hours and is open from 7am to 6.30pm, Monday to Friday. The practice closes on one Wednesday afternoon a month to allow for staff protected learning time.

Brierley Park Medical Centre holds a General Medical Services Contract to provide primary medical services. This is a contract between NHS England and general practices for delivering general primary care medical services including minor surgical procedures. The practice has opted out of providing out of hours services, which is provided by Central Nottinghamshire Clinical Services (CNCS) and Primary Care 24 (PC24).

There are five GP partners working at the practice, working various hours, which in total provide a service for patients which equates to 3.88 whole time equivalent GPs. The practice has three female and two male GPs. The practice is a training practice and provides work placements for doctors in training (GP registrars) and Foundation Year Two (FY2) doctors. GP registrars are qualified doctors who undertake additional training to gain experience and higher qualifications in general practice and family medicine. FY2 doctors are qualified medical graduates who are undertaking the Foundation Programme – a two-year, general postgraduate medical training programme which forms the bridge between medical school and specialist/general practice training. Currently, there are two GP registrars and one FY2 doctor at the practice. The practice team included two practice nurses, one nurse practitioner (non-medical prescriber) and two healthcare assistants. The practice management includes a practice manager and a deputy practice manager.

Updated 12 November 2015

We carried out an announced comprehensive inspection at Brierley Park Medical Centre on 13 July 2015. Overall the practice is rated as good

Specifically, we found the practice to be good for providing well-led, safe, effective, caring and responsive services. The practice was also good for providing services for older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• Staff knew how to report significant events and we found that action had been taken in response to safety alerts. Actions were taken following investigations into significant events and these were assessed to consider the impact they had on patients and staff.
• The practice worked with other agencies to help ensure the care and support provided to vulnerable children and adults was coordinated and effective.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Clinicians introduced the use of Care Bundles to use in association with their QOF data. A Care Bundle is a set of evidenced based interventions that, when used together with QOF data significantly improves patient outcomes.
• Clinical staff were aware of the Mental Capacity Act (MCA) 2005 and their duties in fulfilling it. all members of the clinical team and non-clinical team worked with families and people with dementia to ensure that they received individualised care dementia friends.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Complaints were dealt with appropriately and in a timely manner.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted upon.
• The practice openly engaged with the local community where they regularly had a stall at the local community fund day designed to promote a healthy lifestyle.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Ensure that practice policies are more comprehensive.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 November 2015

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

The practice had a high proportion of patients with long term conditions. Nursing staff and named GPs had lead roles in chronic disease management. The practice had achieved 100% of their available points in respect of the Quality Outcomes Framework (QOF) 2013 to 2014.which were above the CCG and national average in all areas. For example, the practice was 1.7 percentage points above the local CCG and 2.8 percentage points above the national average with regard to monitoring patients with asthma We saw evidence that patients with diabetes and other long term conditions had personalised holistic care plans.The local PPG was working with the practice to arrange special events to support and educate patients and their carer’s with long term conditions such as fibromyalgia a condition characterized by muscular pain with stiffness and localized tenderness at specific points on the body, dementia and more recently diabetes. Longer appointments and home visits were available when needed. For those patients with the most complex needs, the named GP worked with relevant health and care professionals, for example a diabetes specialist nurse to deliver a multidisciplinary package of care.

Updated 12 November 2015

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 circumstance who were at risk. The practice worked with and was responsive to partner agencies to ensure care for patients assessed as at risk was co-ordinated. A GP took the lead for safeguarding with the local authority and other professionals to safeguard children and families. Staff were proactive in identifying children at risk. All clinicians had received IRIS training. (Identification of Risks to improve Safety) which is a general practice-based domestic violence and abuse (DVA) training support and referral programme. As a result of this training staff were more vigilant of domestic abuse and made the appropriate referrals where necessary.

In line with the Healthy Child programme, the practice offered six to eight week check for new babies. Staff were aware of the Gillick competencies which are used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. Appointments were available outside of school hours and the premises were suitable for children and babies.

Childhood immunisation rates were higher than the CCG average. Non-attenders were followed up by practice nurses/GP’s and administrative staff.

The practice actively encouraged children to understand the importance of healthy eating by involving local schools in designing art work displaying healthy eating messages. This was clearly displayed in the designated children’s area within the practice.

Updated 12 November 2015

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

The practice had a register of all patients over the age of 75 and these patients had a named GP. There was a nominated GP for each of the seven care homes in the practice area. The practice had identified the most vulnerable 2% of its older population and had care plans in place.

The practice was responsive to the needs of older people. A risk stratification toolkit was used to identify those at risk of A&E attendances / admission. We saw evidence of personalised care plans as part of these unplanned admissions assessments.

We saw evidence that the practice was aware of the impact of loneliness in the elderly population by the amount of referrals to ‘Jigsaw’. Jigsaw is a support scheme commissioned by the local CCG to befriend and support individuals identified by clinicians in the practice as lonely.

The care for patients for the end of life was in line with the Gold Standard Framework. The practice worked as part of a multidisciplinary team and out-of-hours services to ensure both consistency of care and a shared understanding of patients’ wishes.

Updated 12 November 2015

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

Following feedback from a patient PPG survey, the practice had taken recent action to increase awareness of their online appointment booking system. The practice had extended opening hours to enable patients to make appointments outside of normal working hours.

Patients were provided with a range of healthy lifestyle support including smoking cessation with referrals available to external agencies to support people in leading healthier lifestyles.

Updated 12 November 2015

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

Patients experiencing poor mental health were invited for annual health reviews. The practice worked with multi-disciplinary teams to support people experiencing poor mental health including those with dementia. All staff had received Mental Capacity Act (2005) training and four of the GPs worked closely with people with dementia and their families to ensure they received individualised personal care.

The practice made referrals to a specialist mental health therapist who held regular weekly clinics at the practice to enhance the quality of patient care provided for these patients. Patients were also referred to MIND which is a support group for people experiencing mental health problems. Patients were also referred to a local counselling service where appropriate.

Updated 12 November 2015

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

The practice held a register of patients who had a learning disability and offered annual health checks to this group of patients. We saw evidence that 37 out of all 67 patients on the register had all their health checks completed. Staff were working to ensure that all clients from this group had their health checks completed. Patients with a learning disability had a named GP and also a named nurse who was trained in learning disability management.

If a patient with a learning disability declined a health check, the patient would be invited to attend an appointment with the specialist nurse who worked with the individual patient to identify the reason why they would not attend for their health check to enhance patient care.

The practice had systems in place to identify those individuals who had no fixed abode and we were informed that any patient on the current register who became homeless for any reason would be kept on the register unless there were extenuating circumstances. For example safety of staff or other service users.

The practice used interpreter services for those patients whose first language was not English. It offered double appointments for a number of patients whose circumstances may make them vulnerable. Staff at the practice were aware of the arrangements in place to safeguard their patients, and how to respond to concerns.

Information about how to access support services was available in the practice. Owing to the high proportion of patients in the seven care homes for which clinical staff had responsibility, all clinical staff had been trained to recognise when deprivation of liberty safeguarding assessments (DoLS) were required. DoLS have been designed to make sure that residents in care homes hospitals and supported accommodation are living in a way that does not inappropriately restrict their freedom