Rising Brook Surgery

Updated 7 February 2018

Rising Brook Surgery is registered with the Care Quality Commission (CQC) as a partnership provider. The provider holds a Personal Medical Services (PMS) contract with NHS England. A PMS contract is a locally agreed alternative to the standard General Medical Services (GMS) contract used when services are agreed locally with a practice which may include additional services beyond the standard contract. We carried out an announced comprehensive inspection at Rising Brook Surgery on 20 June 2016. The overall rating for the practice was good with requires improvement in providing safe services. We carried out a focused follow up inspection on 31 July 2017 and found there were ongoing issues in providing safe services. The practice remained rated as requires improvement for providing safe services. The full comprehensive report for the 20 June 2016 and the focused report for 31 July 2017 can be found by selecting the ‘all reports’ link for Rising Brook Surgery on our website at www.cqc.org.uk.

The patient list size is around 9,323 patients. The patient demographic is comparable with the local clinical commissioning group (CCG) and national averages. Fifty per cent of patients have a long-standing health condition which is comparable with the CCG average of 57% and the national average of 54%. The practice has average deprivation when compared with the local and national averages.

The practice is an accredited training practice for medical students, foundation doctors and GP registrars and is managed by a team of two male GP partners. There is also a regular female locum GP. The partners are assisted by a clinical team of two female advanced nurse practitioners (ANPs), three female practice nurses, a female health care assistant, and two phlebotomists. Clinical staff are assisted by a range of administration and reception staff that includes the practice manager and a patient services team leader.

The practice is open from 8am until 6.30pm Monday to Friday. Pre-bookable extended hours appointments are available Monday, Tuesday, Wednesday and Thursday mornings from 7.30am. Nurses are available during this period on a Monday and a Wednesday. These appointments are usually for people who would otherwise find it difficult to see a GP during normal opening hours. Routine appointments can be booked up to four weeks in advance. Patients are advised to call the practice in the event of urgent medical problems during surgery hours or NHS 111 for problems occurring during surgery closure. The Out of Hours service is provided by Staffordshire Doctors Urgent Care.

The practice offers a range of services for example, management of long term conditions such as diabetes, immunisations for children, travel vaccinations, family planning and child development checks.  Further details can be found by accessing the practice’s website at www.risingbrooksurgery.nhs.uk.

Updated 7 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rising Brook Surgery on 20 June 2016. The overall rating for the practice was good with requires improvement in providing safe services. We carried out a focused follow up inspection on 31 July 2017 and found there were ongoing issues in providing safe services. The practice remained rated as requires improvement for providing safe services. The full comprehensive report for the 20 June 2016 and the focused report for 31 July 2017 can be found by selecting the ‘all reports’ link for Rising Brook Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation 12 that we identified in our previous inspection on 31 July 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good and good for providing safe services for all population groups.

Our key findings were as follows:

• There was a formal system in place to share learning from significant events with all staff and an analysis of trends had been completed.

• A safe and effective system had been implemented to manage the GP workflow throughout the practice.

• Most staff had received recent training in basic life support. Training for all staff had been arranged for February 2018.

• The practice was working with the landlord to ensure that the fire risk, that had exceeded its specified five year duration, was updated. They were exploring training options to ensure there was a fire marshal within the practice.

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

The provider should:

• Ensure that all staff attend and complete the basic life support training planned for February 2018.

• Continue to work with the landlord to ensure the fire risk assessment is updated and there is a trained fire marshal within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 August 2016

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

• The practice shared clinical responsibility for patients with long-term conditions. There was a robust call and recall system in place including telephone calls regarding test results. A number of clinics were provided by specialist nurses to meet the needs of this population group.

• The practice held bi-monthly multidisciplinary and palliative care meetings to share and discuss the needs of patients. The practice had developed positive working relationships with community services.

• Performance for the five diabetes related indicators were comparable or better than the local and national averages. For example, the percentage of patients with diabetes, on the register, with a record of foot examination and risk classification within the preceding 12 months was 94% compared with the local average of 91% and national average of 88%.

• Longer appointments and available when needed.

• Patients had an annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had recently employed a pharmacist to assist with medication reviews and provide specialist support to patients taking multiple medicines and those with complex needs.

Updated 1 August 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 on child protection plans. Staff had developed positive links with health visitors based within the same premises.

• Childhood immunisation rates were comparable to local averages for all standard childhood immunisations.

• Same day urgent appointments were available for young children. Routine appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 80% and the national average of 82%.

• A full range of family planning services were provided by the practice including oral contraception, implant fitting and coil insertion.

Updated 1 August 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 offered a dementia screening service, flexible appointments and home visits for patients who were unable to attend the practice and those with enhanced needs.

• There was a robust call and recall system to ensure that older people attended their appointments when necessary with a GP, nurse or health care assistant.

• Older people who had been discharged from hospital received a telephone call to review their care needs.

• The practice had developed good links with local nursing homes, were involved in a nursing home initiative project, and were looking to roll out Skype (video) virtual consultations shortly.

• The practice had very recently employed a pharmacist to undertake medication reviews in people’s own homes for patients who have difficulty attending the practice.

• Older people had a named GP to help with their continuity of care.

• A phlebotomy service was provided by the surgery, which enabled easier access for older people requiring a blood test.

Updated 1 August 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 offered extended hours with GPs and with nurses to help ease accessibility for patients.

• Telephone consultations were available with a GP.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• An electronic prescription service was available allowing late access to chemists for working people and students.

• The practice was based in a local health centre and patients were conveniently able to access other services within the same premises. As an active member of the local GP Federation, the practice promoted access for patients via the Prime Ministers Challenge Fund that operated every Saturday morning from 9am to 1pm at another local practice.   

Updated 1 August 2016

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

• Patients with severe poor mental health were invited for an annual review of their health. 89% of these patients had a comprehensive, agreed care plan in place compared with the CCG average of 90% and national average of 88%.

• The practice regularly worked with other health care teams in the case management of patients experiencing poor mental health, drug, and alcohol dependence and for those with dementia. For example, weekly substance misuse clinics were being held at the practice with a counsellor to see patients from the local area.

• There was a robust call and recall system in place to ensure patients were effectively monitored. Patient health questionnaires were used to assess and monitor patients presenting with depression.

• Patients experiencing poor mental health had information about how to access various support groups and voluntary organisations. Double appointments were offered to allow sufficient time to deal with any complex issues that may be relevant to a patient’s health and care.

• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice had doubled their dementia register during 2015/16.

• 82% of patients with dementia had their care reviewed in a face-to-face meeting in the preceding 12 months. This was broadly in line with the CCG average of 83% and national average of 84%.

Updated 1 August 2016

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

• The practice offered longer appointments for vulnerable patients including those with a learning disability.

• The practice regularly worked with other health and social 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.

• A child protection register was maintained and updated and staff were made aware of those on the register.

• The computer system alerted staff to vulnerable patients including those requiring extra assistance.

• An interpreter service was available.