Brownlow Group Practice Also known as Ropewalks General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brownlow Group Practice on 14 & 15 December 2016. Overall the practice is rated as outstanding.

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. All opportunities for learning from internal and external incidents were maximised.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the support given to homeless patients and the support given by student services.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• Regular meetings and discussions were held with staff and multi-disciplinary teams to ensure patients received the best care and treatment in a coordinated way.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• The practice had a contract to support a number of local intermediate care homes and in 2015 this number increased from 45 to 100 inpatient beds. Key changes were made to the practice team to ensure continuity of care and targeted treatments could be achieved. As the roles developed and services were put in place the practice audited their performance to monitor patient experience and outcomes. A review across April to October 2015 showed improvements in the number of patients having letters sent on to their GPs, improved number of pharmacy led medication reviews (37% to 96%) and low numbers of patients being admitted to hospital (only 4% in the audit period) amongst other positive outcomes.

• The practice had a cancer support service. This was a nurse led service providing prompt and targeted cancer support and advice to patients and this was achieved within one week of their cancer diagnosis. The nurse acted as a central point of contact for cancer patients and their families across the practice. Communications improved as the nurse developed close links with local hospitals and cancer and Macmillan support agencies and for this development the practice was nominated as a finalist in the Nurse of the Year award in Innovations in Practice 2014.

• The practice had commissioned a diabetes nurse for two sessions each week to support diabetic students, in particular Type 1 patients. As part of this the nurse had contacted the patients’ previous GPs across the country to ensure that all required treatments and screening had been completed. If not, this would be undertaken at the Student Health location. We found the nurse also provided personalised support via email and mobile number access. These examples had a very positive impact on ensuring continuity of care but also on improving patient outcomes so that a transfer of care could be coordinated safely and effectively.

• The practice had a significant homeless and hostel dwelling population with drug and alcohol dependent needs and access to services for these patients was good. The practice ran a combination of open same day access clinics, along with booked appointments, as this flexible approach best suited the needs of people who often found it difficult to keep to rigid timetabling and appointments. The practice had experienced clinicians including two dedicated homeless nurses, an alcohol nurse, shared drugs workers, two specialist GPs and close links with the local homeless organisations. During the inspection we observed a flexible, sensitive, confidential and responsive approach when dealing with patients with complex health and mental health needs. We found the practice had good links with a local homeless hostel and daily support was given by a support worker who acted as a waiting room mentor to support patients when they first and subsequently attended the homeless clinic.

• The learning needs of staff were kept under constant review. The management team and all staff was supported to undertake training and development appropriate to their roles. For example, to support the patients attending the homeless clinic run each week staff had completed training for undertaking ultrasonic liver function tests. This enabled these patients to have a fuller assessment within the practice rather than having to attend hospital which might cause them anxiety.

However there were areas of practice where the provider should make improvements. They should:

• Review the systems in place for reporting and analysing the risks, adverse incidents and near misses.

• Review the monitoring of all areas of the building to ensure cleanliness standards are maintained in all areas including store cupboards.

• Review the medicines procedures to ensure robust arrangements are in place for doctors taking prescriptions pads to home visits when required

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice