Spinney Brook Medical Centre

Updated 21 April 2017

Dr Bevan and partners is a semi-rural GP practice which provides primary medical services under a General Medical Services (GMS) contract to a population of approximately 11,200 patients living in Irthlingborough and surrounding areas of Woodford, Little Addington and Great Addington. (A GMS contract is a nationally agreed contract used for providing medical services). The main practice is known as Spinney Brook Medical Centre. There is a branch surgery located in Woodford which has a dispensary that dispenses to approximately 1,500 patients who live more than one mile from a pharmacy. We inspected the dispensary at the branch surgery as part of this inspection.

The main practice operates from a two storey premises. All consultations take place on the ground floor and the first floor accommodates the practice manager and administrative staff and a teaching and meeting room. The practice population has a higher than average number of patients aged 50 to 70 years and 0 to 5 years. National data indicates that the area is not one that experiences high levels of deprivation. The practice population is made up of predominantly white British patients.

There are six GP partners; two female and four male and there is one salaried GP. The practice employ seven practice nurses, an advanced nurse practitioner, a counsellor, and a practice manager who are supported by a team of administrative and reception staff.

The practice is open daily Monday to Friday between 8am and 6.30pm and on Mondays and Wednesdays extended hours appointments are offered until 8pm. The branch practice is open Monday to Friday from 8.30am until 12.30pm.

When the surgery is closed services are provided by Integrated Care 24 out of hours provider who can be contacted via NHS 111.

Updated 21 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of Dr Bevan and Partners on 28 March 2017. This was to check that improvements had been made following the breach of legal requirements we identified from our comprehensive inspection carried out on 18 May 2016. During our inspection in May 2016 we identified a regulatory breach in relation to:

• Regulation 12 HSCA (RA) Regulations 2014 safe care and treatment

This report only covers our findings in relation to the areas identified as requiring improvement following our inspection in May 2016. You can read the report from this comprehensive inspection, by selecting the 'all reports' link for Dr Bevan and Partners on our website at www.cqc.org.uk. The areas identified as requiring improvement during our inspection in May 2016 were as follows:

• Ensure appropriate systems are in place for the proper and safe management of medicines including dispensing, audit, recording and destruction of controlled drugs and followed correctly and that standard operating procedures contain all the relevant information.

In addition, the practice were told they should:

• Ensure staff receive appropriate training and appraisals; update training for dispensary staff in dispensary procedures including management of controlled drugs and update training in infection control and infection control audit.
• Continue to identify and support carers.
• Advise patients at the branch surgery what to do when the dispensary is closed.
• Implement a system to provide an audit trail for blank prescriptions at the branch practice.

Our focused review on 28 March 2017 showed that improvements had been made and our key findings across the areas we inspected were as follows:

• The practice had arranged a training session for dispensary staff in managing controlled drugs (medicines that require extra checks and special storage because of their potential for misuse) and they had put procedures in place to manage them safely. One member of staff had not yet qualified as a dispenser, and was fully supervised when dispensing controlled drugs.
• The controlled drugs policy had been revised to include details of the NHS England Controlled Drugs Accountable Officer.
• Controlled drugs were stored in a controlled drugs cupboard, access to them was restricted and the keys held securely.
• There were arrangements in place for the destruction of controlled drugs, and the out of date stock we saw at our last inspection had been disposed of in the presence of an authorised witness. Records were kept in line with controlled drugs legislation.
• We saw records of regular checks on controlled drugs stock, and a three monthly report was made to the practice clinical meeting. During one of the routine checks, staff had identified a discrepancy which had been appropriately recorded, reported and investigated. The controlled drugs procedure had been revised to reduce the risk of this type of error happening again.
• Blank prescriptions at the branch surgery were stored securely and the practice had introduced a log of serial numbers to monitor their use in line with national guidance.
• In the afternoons when the dispensary was closed, prescriptions and dispensed medicines could be collected by arrangement at the main surgery in Irthlingborough, or the prescription could be sent to a community pharmacy to be dispensed. The practice had taken to steps to ensure patients were aware of who to contact when the dispensary was closed.
• The practice held a register of patients identified as carers and promoted support services available to carers and including information in patients areas in order to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 September 2016

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

• Nursing staff had received training in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The ANP carried out reviews at home for patients with long term conditions who were not able to attend the practice and developed management plans with patients to prevent admission to hospital.
• Longer appointments 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 and ANP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 12 September 2016

The practice is rated as good for the care of families, children and young people.

• The practice had good 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 and demonstrated good communication with other agencies.

• Immunisation rates were high for all standard childhood immunisations.

• We saw the practice had detailed information regarding all children on the safeguarding register and close links had been established with the school liaison officer, school nurse, midwife and health visitor to ensure adequate support and monitoring took place and enable early intervention.
• 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.
• Cervical screening rates were 79% and were comparable to those locally and nationally at 81%.
• The practice offered a full range of contraceptive services including implants and intra-uterine contraceptive devices.
• Appointments were available outside of school hours and the premises were suitable for children and babies. There was a child friendly play area in the reception.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Chlamydia screening was offered for young people between 15 and 24 years.

Updated 12 September 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.
• The practice had employed an Advanced Nurse Practitioner (ANP) to visit care homes weekly and carry out a ward round as well as visit older housebound patients who could not attend the practice for review of their care.
• They practice had close links with the community elderly care consultant and community health care team.

Updated 12 September 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 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 had an ‘information zone’ providing information and self-testing of blood pressure.

Updated 12 September 2016

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

• 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was the same as the national average.
• 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 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 A&E 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 12 September 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 those with a learning disability.

• 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. For example, the pro-active care team.
• 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 a dedicated safeguarding administrator to ensure important information was communicated to relevant professionals.
• The practice had a robust approach to child protection and had implemented multi-disciplinary team meetings where there was a focus on all children at risk in all categories and proactive work was undertaken to prevent abuse and address early warning signs.
• There were systems in place to identify potentially vulnerable patients at registration, for example service veterans.
• The practice held a register of patients identified as carers, they had identified 133 patients as carers which represented 1.2% of the practice list.