Bramhall Health Centre

Updated 29 December 2016

Bramhall Health Centre is located in Bramhall, Stockport, Greater Manchester. The practice was providing a service to approximately 12,900 patients at the time of our inspection.

The practice is part of Stockport Clinical Commissioning Group (CCG). The practice is situated in an area with lower than average levels of deprivation when compared to other practices nationally. The practice has a higher than average population aged over 65 years of age and 59% of the patient population has a long standing health condition which is higher than the national average of 54%.

The practice is run by three GP partners. There are an additional three salaried GPs (three male and three female). There are two practice nurses, two health care assistant, a practice manager and a team of reception/administration staff. The practice is a training practice for trainee GPs.

The practice is open from 8am to 6.30pm Monday to Friday. Extended opening hours are provided two evenings per month until 9pm and two Saturdays per month from 9am to 5pm. When the practice is closed patients can access the out of hours service provided by ‘Mastercall’ by calling 111.

Patients can book appointments in person, via the telephone or online. The practice provides pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services.

The practice has a General Medical Services (GMS) contract. The practice provides a range of enhanced services, for example: extended hours, childhood vaccination and immunisation, checks for patients who have a learning disability and avoiding unplanned hospital admissions.

Updated 29 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bramhall Health Centre on19 October 2016. Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Significant events had been investigated and action had been taken as a result of the learning from events.

• Systems were in place to deal with medical emergencies in the practice and staff were trained in basic life support.

• Systems were in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment. However, some additional checks were required to fire safety and electrical safety.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Data showed that outcomes for patients at this practice were similar to outcomes for patients locally and nationally.

• Staff had generally been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, not all staff had been provided with safeguarding training.

• Staff felt well supported in their roles and had undergone a regular appraisal of their work.

• Feedback from patients about the care and treatment they received from clinicians waspositive overall. Patients told us they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• Improvements had been made to the appointments system in response to feedback from patients. Urgent appointments were available the same day and routine appointments could be booked in advance.

• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

• Complaints had been investigated and responded to in a timely manner.

• There was a clear leadership and staff structure and staff understood their roles and responsibilities.

• The practice provided a range of enhanced services to meet the needs of the local population.

Areas where the provider should make improvement are:

• Review the procedures for patient specific directions (PSDs) to ensure they support the safe administration of medicines.

• Ensure the system for managing safety alerts clearly demonstrates the actions taken.

• Carry out a risk assessment with regards to the decision not to carry emergency medicines on home visits.

• Ensure a system is in place for the regular check of equipment carried in GPs’ bags.

• Ensure all required health and safety related checks are carried out at appropriate intervals.

• Formalise the process for the induction of non-clinical staff.

• Review the information provided to patients about the complaints process.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 December 2016

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

• The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.

• Regular, structured health reviews were carried out for patients with long term conditions.

• Data from 2015 to 2016 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions such as diabetes.

• Patients with multiple long term conditions were offered a single appointment to avoid additional visits to the surgery and home visits were available for patients when these were required.

• The practice provided an enhanced service to prevent high risk patients from unplanned hospital admissions. This included these patients having a care plan and a regular review of their medicines.

• Patients were provided with advice and guidance about ill health prevention and the management of their health and were signposted to support services.

• Regular multi-disciplinary meetings were held to discuss patients with complex needs and patients receiving end of life care.

• Regular clinical meetings were held to review the clinical care and treatment provided and ensure this was in line with best practice guidance.

Updated 29 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 those who were at risk, for example, children and young people who had a high number of A&E attendances.

• A GP was the designated lead for child protection.

• Staff we spoke with had appropriate knowledge about safeguarding and they had ready access to safeguarding policies and procedures. However, not all staff had been provided with safeguarding training.

• Family planning and contraceptive services were provided.

• Child surveillance clinics were provided for 6-8 week olds.

• Immunisation rates were comparable to the national average for all standard childhood immunisations. Opportunistic immunisations were given to encourage uptake.

• The practice monitored non-attendance of babies and children at vaccination clinics and staff told us they would report any concerns they had identified to relevant professionals.

• Babies and young children were offered an appointment as priority and appointments were available outside of school hours.

• The premises were suitable for children and babies and baby changing facilities were available.

Updated 29 December 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to those of patients locally and nationally.

• GPs carried out daily visits to a local care home to assess and review patients’ needs and to prevent unplanned hospital admissions.

• Home visits and urgent appointments were provided for patients with enhanced needs.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

• Older patients had access to a named GP and a structured annual review to check that their health and medicines needs were being met.

• Staff worked with relevant health and social care professionals to deliver a multi-agency approach to care and treatment for those people with the most complex needs.

Updated 29 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, flexible and offered continuity of care.

• The practice provided extended hours appointments to accommodate this population group.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group. Screening uptake for people in this age range was comparable to or above national averages.

• The practice was proactive in offering online services including the booking of appointments and requests for repeat prescriptions. Electronic prescribing was also provided.

Updated 29 December 2016

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

• The practice held a register of patients experiencing poor mental health and these patients were offered an annual review of their physical and mental health.

• Data about how people with mental health needs were supported showed that outcomes for patients using this practice were similar to or better than those locally and nationally.

• The practice had a designated lead for mental health.

• The practice referred patients to appropriate services such as psychiatry and counselling services.

• The practice worked with other health and social care professionals in the case management of people experiencing poor mental health, including those with dementia.

• A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

• Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they were prescribed.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

Updated 29 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 in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these.

• The practice worked with other health and social care professionals in the case management of vulnerable people.

• 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 was accessible to people who required disabled access and facilities and services such as a hearing loop system (used to support patients who wear a hearing aid) and translation services were available.

• Information and advice was available about how patients could access a range of support groups and voluntary organisations.