Archived: Branston and Heighington Family Practice

Updated 30 April 2015

Branston and Heighington Family Practice offers a range of primary medical services from a surgery at Station Road, Branston, Lincoln. There is also a branch surgery at 7a High Street, Heighington. This surgery was not open on the day of our inspection and was not visited.

On the day of our inspection the patient list was 5,993. The patient population has a relatively low depravation score of 9.6 compared to the national average of 21.3.

It is located within the area covered by Lincolnshire West Clinical Commissioning Group. A CCG is an organisation that brings together local GP’s and experience health professionals to take on commissioning responsibilities for local health services.

The practice is staffed by four GPs, consisting of two partners and two salaried GPs. Two GPs are male and two female. The practice employs three practice nurses and one healthcare assistant. They are supported by a practice manager, receptionists and a range of administrative and support staff. Cleaning was provided by the practice’s own employed staff.

The practice dispensed to 1,203 eligible patients by a team of three dispensers.

The surgery is open from 8.30 am until 6 pm Monday to Friday, with GP consultations available from 8.30 am to 12 noon and 3.30 pm until 6 pm. The surgery closed every day for lunch from 1 pm to 2 pm.

The practice has opted out of the requirement to provide GP consultations when the surgery is closed. The out-of-hours service is provided by Lincolnshire Community Health Services NHS Trust.

Prior to our inspection we consulted with the clinical commissioning group (CCG) and the NHS England Area Team about the practice. A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

The practice was last inspected by the Care Quality Commission in May 2014, when it was judged to be in breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 The practice did not have in place effective systems to monitor the quality of the service provided. This related to a failure to regularly seek the views of patients, failing to manage identified risk, ineffective recruitment procedures and failing to provide staff with adequate appraisal and supervision.

During this inspection we spoke with patients and carers that used the practice and met with members of the patient participation group (PPG). A PPG is a group of patients who have volunteered to represent patients' views and concerns and are seen as an effective way for patients and GP surgeries to work together to improve services and to promote health and improved quality of care.

We also reviewed comments cards that had been provided by CQC on which patients could record their views.

Updated 30 April 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Branston and Heighington Family Practice on 29 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, responsive, caring, effective services and for being well led.

We looked at patient care across the following population groups: Older people; those with long term conditions; families, children and young people; working age people(including those recently retired and students); people in vulnerable circumstances who may have poor access to primary care; and people experiencing poor mental health.

• 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, including those relating to recruitment checks.
• 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 were able to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice was equipped to treat patients and meet their needs, although we acknowledge that the restricted space available made the provision of further services difficult.
• 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.

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

Importantly the provider should;

• Ensure that any learning from significant events and complaints is recorded and cascaded to staff to help prevent re-occurrence.
• Establish a regular schedule of meetings for all staff at the practice.
• Improve access to the service for working age patients by offering extended opening times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 April 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 medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 30 April 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. We saw good examples of joint working with midwives and health visitors.

Updated 30 April 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 people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 30 April 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 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. However we noted that no appointments with GPs and nurses were available outside of normal hours.

Updated 30 April 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 88% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. 90% of patients who had been diagnosed with dementia had received and annual review in the year to date.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It 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 in the Mental Capacity Act.

Updated 30 April 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 including homeless people, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and all of these patients had received a follow-up. It offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.