Background to this inspection
Updated
25 February 2020
North Brink Practice serves patients living in Wisbech, Cambridgeshire and is contracted to provide general medical services to approximately 19,850 registered
patients. North Brink Practice is located within the Cambridgeshire local authority and is one of 104 practices serving the NHS Cambridgeshire and Peterborough CCG area. The practice dispenses medicines to those patients who live more than one mile from the nearest pharmacy. We visited the dispensary as part of this inspection.
There are four GP partners, three male and one female, a practice manager and deputy practice manager, four nurse practitioners, 17 nurses, six healthcare assistants, one clinical pharmacist and nine dispensers along with a managerial, reception and administration team.
The practice is open between 8am to 8pm Monday, Tuesday and from 8am to 6.30pm Wednesday, Thursday and Friday. The practice also offers extended hours to all Wisbech residents on Saturday from 8am to 12pm and Wednesday 6.30pm to 8pm. The dispensary is open between 8am and 6pm Monday to Friday. Outside of practice opening hours, patients are directed to the local out of hours service provided by Independent Care 24 (IC24) through NHS 111.
The practice serves patients living in a moderately deprived area, the overall deprivation decile is three, where one indicates areas with the most deprivation and ten indicates the least areas of deprivation. The practice demography has a higher than average over age 65 population (practice 35% CCG 26% and England 27%) and a lower under age of 18 years (practice 32% CCG and England 38%).
Updated
25 February 2020
We carried out an announced comprehensive inspection at North Brink Surgery on 26 November 2019. At this inspection we followed up on a breach of regulation identified at a previous inspection on 20 October 2018. We had served a requirement notice for regulation 12 safe care and treatment. The full comprehensive report from the October 2018 inspection can be found by selecting the ‘all reports’ link for North Brink Surgery on our website at www.cqc.org.uk.
At the previous inspection in 20 October 2018 we rated the practice as requires improvement overall as we rated the service as requires improvement for providing safe and responsive because:
- There were no effective systems to review the process for prescribing antibiotics and controlled medicines.
- There was an insufficient appraisal system.
- Patients with long term conditions did not always receive a review in a timely manner.
- Not all recommended emergency medicines were available in the practice.
- The process for acting on safety alerts was inconsistent.
These areas affected all population groups, and the practice was rated as requires improvement in all population groups.
At our November 2019 inspection we have rated the practice as good overall and all the population groups as good. We have rated the practice as outstanding for providing well led services.
We based our judgement of the quality of care at this service on a combination of:
• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.
We found that:
- The practice demonstrated outstanding leadership as senior clinicians and all staff worked in a clear and cohesive patient centre approach to providing primary care to their patients.
- The practice ensured they protected patients and staff by providing comprehensive safety systems to meet the challenges of providing services from a listed building.
- The practice had developed a clinical model which overcame the challenge of not recruiting more GPs. This model of care which comprised of 17 nursing staff and two pharmacists required cohesive team work and robust governance systems.
- They developed this model by working with patients to seek their views and feedback to ensure they delivered high quality, accessible health care.
- Through the development of the wider skill mix they told us they had a truly holistic approach to assessing, planning and delivering care and treatment to all patients who used the services.
- There was a strong person centred and open culture in which safety concerns raised by staff and patients was highly valued as being integral to learning and improvement.
- Patients were supported, treated with dignity and respect and were involved partners in their care.
We rated the practice as outstanding for providing well-led services because:
- The leadership had ensured the practice was able to deliver high quality care and treatment to patients despite the challenge of a scarcity of GPs and a consequent inability to recruit into vacancies. They had developed and implemented an innovative model of care which centred on using a diverse skill mix of clinical staff. They consistently reviewed this and had sustained and further improved patient satisfaction. The practice demonstrated effective governance systems and processes and the open culture was used to drive and improve the delivery of high-quality person-centred care.
The areas where the practice should make improvements are:
- Review and improve the recall system for patients to ensure they receive regular monitoring of blood pressure for patients with hypertension.
- Continue to monitor the prescribing of antibiotics to ensure safe prescribing of medicines.
- Review the safeguarding training of all non-clinical staff and where appropriate ensure they receive safeguarding level two training.
- Continue to review and improve uptake of childhood immunisations to meet the WHO target of 95%.
- Continue to improve uptake of patients who are eligible to attend cancer screening appointments.
- Review and improve the uptake of the annual reviews for patients with learning disabilities.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care