Brent Area Medical Centre

Updated 24 December 2015

The practice is located in East Brent, a village located close to the M5 motorway, 5 miles (8.0 km) west of Axbridge and on the edge of the Somerset Levels in the Sedgemoor district of the county of Somerset. The practice provides primary medical services for four local villages with some additional patients from two nearby towns.

The practice is located in a converted Victorian house which contained three consulting rooms; a treatment room and a dispensary. The practice supports the local community responder scheme by providing, without charge, the cost of housing a Community Heartbeat Trust defibrillator at the entrance.

The practice has a population of approximately 2669 patients. The practice dispenses medicines to 90% of the practice population from a single room in the surgery. The practice has a higher than England average of patients aged between 45 and 84 years and a higher than Clinical Commissioning Group (CCG) average of patients aged between 50 and 60 years of age. The practice is situated in an area with lower deprivation with a deprivation score of 12.1 compared to the CCG average of 16.8 and the national average of 23.6 with only 3% living in the most deprived 10% of neighbourhoods in Somerset and 10% living in the 20% most deprived areas.

The practice team includes two GP partners, one male and one female, (who have been in a partnership since 1994) providing a whole time equivalent of 1.5; a part time practice nurse and health care assistant; practice manager and administrative staff which include dispensary staff; receptionists; a secretary and an IT coordinator. In addition a GP from a local practice provides locum work one day every week.

The practice is a training practice for medical students with one GP providing training support. At the time of our inspection a final year medical student was being supported by the practice.

The practice had a General Medical Services contract (GMS) with NHS England to deliver general medical services. The practice provided enhanced services which included facilitating timely diagnosis and support for patients with dementia; learning disabilities and minor surgery.

The practice is open between 8:30am to 6:15pm Monday to Thursday. On Friday the practice is open from 8:30am to 12:30pm and 2pm to 6.15pm. Telephone access is available from 8am to 6:30pm daily. Extended hours surgeries are no longer offered due to poor take up from patients. The practice provided 16 GP sessions per week between 08:30am to 12:20pm and 14:30pm to 17:45pm. The national GP patient survey (July 2015) reported that patients were satisfied with the opening times and making appointments. The results were above local and national averages.

The practice has opted out of providing Out Of Hours services to their own patients. Patients can access NHS 111 and Somerset Urgent Care Doctors provide an Out Of Hours GP service.

Updated 24 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brent Area Medical Centre on 3 September 2015. Overall the practice is rated as good. Specifically, we found the practice to be outstanding for providing responsive services. The practice was good for providing safe; effective; caring and well-led services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned. 
• 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice supported the local population and actively engaged and challenged commissioners. For example, when the district nursing treatment room service was to be relocated.
• 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.

We saw areas of outstanding practice:

• The practice was proactive in identifying, recording and managing risks and concerns raised by the health care provided by other organisations. This included raising concerns with the Clinical Commissioning Group (CCG) in addition to required notifications; engaging and working with partner agencies to share action plans and lessons learnt.
• There were high levels of staff satisfaction and the practice worked to ensure staff were proud of the organisation. For example, setting up of a local practice nurse forum; results from a county survey of GP practices placed the practice in the top two practices where staff were enthusiastic and motivated about their roles.
• The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. For example, a weekly walking health group for patients; the setting up of a local support group , Village Agents, for socially isolated, excluded, vulnerable and lonely patients and securing funding for a ‘singing for the brain’ group.
• Practice staff actively engaged in providing patients with a high quality of care above the service expectations. For example, staff delivered patients prescriptions on their way home; GPs visited unwell or recently discharged patients at weekends.

However there was an area of practice where the provider should make improvements:

• The practice should consider the use of alerts on their record keeping system so that any new member or temporary members of staff were aware of any impacts on health management.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 December 2015

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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that 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 GP partners and nurse had undergone additional training to be able to offer patients care plans.

Updated 24 December 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 circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were 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. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 24 December 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older patient in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice was responsive to the needs of older patients, and offered home visits and rapid access appointments for those with enhanced needs.

The practice set up a local scheme to provide extra support for the isolated frail elderly patients, and patients with long term conditions in the locality.

Updated 24 December 2015

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 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.

Updated 24 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). All patients experiencing poor mental health had received an annual physical health check. 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 informed patients experiencing poor mental health about how to access various support groups and voluntary organisations. They had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for patients with mental health needs and dementia.

One GP was the dementia lead for the local GP federation.

Updated 24 December 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 living in vulnerable circumstances. They had carried out annual health checks for patients with a learning disability and 100% of these patients had received a follow-up. The practice offered longer appointments for patients with a learning disability.

Patients living with a learning disability in a local residential home were offered home visits or if they attended the practice staff would collect them from the car park in order to reduce anxiety for patients who found it hard to access the service.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. Vulnerable patients were informed 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.

The practice provided food bank vouchers.