Archived: Carole Brown Health Centre Also known as Vida Healthcare

Updated 21 December 2016

Carole Brown Health Centre is part of Vida Healthcare Group, which is made up of six GP practices in Norfolk. The Vida Group has a senior management team which comprises of clinicians and support executives. The senior management team maintain an overall responsibility for the management of the practices, but delegate some decision making to a local management team.

Carole Brown Health Centre is a semi-rural practice situated in Dersingham, Norfolk and serves the population of Dersingham as well as some of its surrounding villages. The practice provides an on-site dispensing service for any of its patients living more than one mile away from a pharmacy / chemist.

The practice employs five GPs, three male and two female, and one GP registrar. There is a team of ten practice nurses and advanced nurse practitioners, a triage practitioner and three health care assistants. Some nurses offer specialist services such as; diabetes, well-woman, dietary, cardiovascular and respiratory services and work both at the practice and across other Vida general practice locations. The practice coordinator is supported by a team of medical secretaries, IT, administration, reception, a dispensary manager and dispensary staff, some of whom also work across another Vida practice locations.

The practice holds a Personal Medical Service (PMS) contract to provide GP services to a population of 6,094 patients, which is commissioned by NHS England. A GMS contract is a nationally negotiated contract to provide care to patients. In addition, the practice also offers a range of enhanced services commissioned by their local CCG: facilitating timely diagnosis and support for people with dementia, supporting patients with learning disabilities and extended hours access. According to Public Health England information, the practice age profile has higher percentages of patients from 60 to 85+ years compared to the practice average across England. The practice reported a breakdown of 37% of patients over 65 years, 17% over 75 years and 15% under 18 years.

The practice is open between 8.15am and 6pm Monday to Friday. Extended hours appointments are offered from 7am Tuesday mornings for phlebotomy and well woman clinics and to 7.30pm on varied evenings weekly. In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are also available for people that need them. Where patients request an appointment on the day, contact details are transferred to the on call GPs. The patient is then contacted that morning and where required an appointment is allocated with the most appropriate clinician. Telephone consultations are available for patients that wish to use this service.

Out-of-hours care is provided via the NHS111 service.

Updated 21 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Carole Brown Health Centre on 18 August 2016. Overall the practice is rated as good.

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.
• 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.
• 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 told us urgent appointments were available the same day. However, patients we spoke with and Care Quality Commission comment cards we received expressed concerns with appointment availabitiy and with a named GP.
• 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 areas where the provider should make improvement are:

• Ensure the practice is more proactive in identifying carers.
• Continue to monitor and review the appointment system.
• Ensure patients waiting for their appointments in all areas of the practice can be clearly seen by reception staff to enable closer monitoring in case of change in their condition.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 December 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. Nurses also offered specialist services such as; diabetes, well-woman, dietary, cardiovascular and respiratory services.
• The practice QOF performance for asthma, atrial fibrillation, cancer, chronic kidney disease, chronic obstructive pulmonary disease, depression, diabetes, epilepsy, heart failure, hypertension, learning disabilities, osteoporosis and palliative care were all above or in-line with CCG and national averages with the practice achieving 100% across each indicator.
• 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.

Updated 21 December 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 comparable to the CCG and the national average of 74%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.
• 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.
• Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 94%to 99% which was comparable to the CCG average of 93% to 97%, and five year olds from 88% to 97% which was comparable to the CCG average of 89% to 96%. 

Updated 21 December 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. All home visits were triaged by a clinician to prioritise visits and ensure appropriate and timely intervention.
• The practice would contact all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• The practice offered health checks for patients aged over 75.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.

Updated 21 December 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 and flexible.
• 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.
• The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. Figures published by Public Health England showed that 60% of the practice’s target population were screened for bowel cancer in 2014/2015, which was above the national average of 58%. The same dataset showed that 78% of the practice’s target population were screened for breast cancer in the same period, compared with the national screening rate of 72%.

Updated 21 December 2016

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

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 84%, this was comparable to the CCG and national average of 84%. At the time of our inspection there were 47 patients identified as having dementia, with 36 having had a review since April 2016.
• The percentage of patients experiencing poor mental health who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 90%, this was comparable to the CCG average of 91% and the national average of 88%. Of the 36 patients identified as experiencing poor mental health on the practice register 35 had received a health check in the past twelve months with one patient excepted.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. The practice had also raised concerns at the lack of support services available in the Kings Lynn area of Norfolk.
• 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.

Updated 21 December 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 had identified 16 patients with a learning disability on the practice register, 12 of these patients had received a health check with invitations sent to the remaining patients.
• 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.
• The practice had introduced a red card scheme for vulnerable patients, this was a system which ensured vulnerable patients were identified by reception staff and given quick and priority access to medical services.