Brunel Medical Centre Also known as Brunel University Medical Centre

Updated 30 August 2017

Dr BS Jassal’s Practice, also known as Brunel University Medical Centre, is located on the campus of Brunel University. The practice provides NHS primary medical services through a General Medical Services (GMS) contract to around 10,150 patients, around 80% of whom are students. The annual turnover of patients joining and leaving the practice is high with around 2000 students registering each year.

The practice operates from a purpose built, two-storey medical centre with access to three consulting rooms on the ground floor and two consulting rooms on the first floor which are accessed by stairs. The building is owned and maintained by the university.

The practice has a much larger than average proportion of young adults on its patient list, particularly in the age ranges 15-19, 20-24 and 25-29. The practice conversely has a small number of patients over the age of 75 years (1.4% of its practice population).

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder or injury; maternity and midwifery and family planning.

The current practice staff team comprises three GP partners (male and female) and one regular locum GP during term time. The practice typically offers around 29 clinical sessions per week. The practice also employs a healthcare assistant, a practice manager and a team of reception and administrative staff and had secured locum practice nurses to cover current vacancies.

The practice is open from 8:30am to 6:30pm Monday to Friday with face to face consultations available between 9am and 6pm. When the practice is closed, patients are directed to local primary care hub services (open weekday evenings and weekends) or the out of hours service as appropriate. The practice also provides information about local out of hours and emergency services on its website, a recorded telephone message and practice leaflet.

The practice provides a range of services including childhood immunisations, antenatal and postnatal care, chronic disease management, sexual health, cervical screening and travel advice and immunisations. Since our previous inspection, the practice has also started offering physiotherapy sessions at the practice.

Updated 30 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr BS Jassal's Practice on 22 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr BS Jassal's Practice on our website at www.cqc.org.uk.

This comprehensive follow up inspection was undertaken on 20 June 2017. We found that improvements had been made since the previous inspection and the practice was meeting all regulations. Overall the practice is now rated as good.

Our key findings across all the areas we inspected were as follows:

• There was a positive, transparent approach to safety and an effective system in place for reporting, recording and learning from significant events and other incidents. Staff were aware of the duty of candour.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained and had the skills, knowledge and experience to deliver effective care and treatment.
• The practice carried out clinical audit to identify areas for improvement and acted on the findings.
• The practice had systems in place for multidisciplinary working for example to support care planning and palliative care.
• The feedback we received from patients was positive and this was consistent with other sources of feedback such as the NHS Friends and family test.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints.
• Patient feedback was positive about access to the service. The practice was planning to make further improvements following an audit of the appointment system. Urgent appointments were available the same day.
• The practice was responsive to the needs of its patients, for example, the needs of students who formed 80% of the patient list.
• The practice had a clear leadership structure and staff said they were supported by management. The practice proactively sought feedback from staff and patients which it acted on.

The areas where the provider should make improvement are:

• The practice should continue to actively identify patients who are carers to ensure their needs are met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 30 August 2017

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

• The prevalence of long-term conditions  such as coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD) and diabetes was low. This was unsurprising due to the high number of students (a relatively healthy population) registered with the practice.
• The practice maintained registers of patients with long term conditions. There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The GPs and practice nurse had roles in long term disease management and had taken additional training where relevant.
• Patients on the long term conditions registers 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 worked with relevant health and care professionals to deliver a multidisciplinary package of care which included referral to structured educational programmes.
• The practice offered in house spirometry. All patients diagnosed with asthma and COPD were issued with personal management plans. Rescue packs were issued for patients with COPD. All patients with COPD were encouraged to attend a pulmonary rehabilitation course.
• Published practice performance on the management of diabetes had improved since our previous inspection and this was now comparable to local and national averages.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

Updated 30 August 2017

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 or who were at risk, for example, children and young people who had a high number of A&E attendances and girls at potential risk of female genital mutilation.
• The practice had achieved over 90%, for all standard childhood immunisations and booster vaccinations in 2016/17.
• Appointments were available outside of school hours and the premises were suitable for children and babies for example, with baby changing facilities.
• The practice worked with midwives, health visitors and school nurses to support this population group. The practice offered antenatal and postnatal care.

• The practice had emergency processes to prioritise acutely ill children, young people and for patients experiencing acute pregnancy complications.

Updated 30 August 2017

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

• The practice had 127 patients over the age of 75. The practice offered proactive, personalised care through care planning to maintain the independence of the older people in its population and meet their needs. Completed care plans were given to the patient, with the surgery’s bypass number and the named accountable GP clearly marked on the front page. 
• The practice had access to a dedicated worker known as a primary care navigator who liaised with local agencies to address social isolation and signpost patients to local services and activities.
• The practice accessed the local Care Continuity Team to work with patients at increased risk of unplanned admissions.
• The practice was responsive to the needs of older people. It carried out annual health reviews, home visits and offered urgent appointments for patients with enhanced needs as required.
• The practice called eligible older patients for the shingles, influenza and pneumococcal vaccinations.

Updated 30 August 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• Around 80% of registered patients were 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.
• Face to face consultations were available between 9am and 6pm which was convenient for students and university staff registered with the practice. The practice also offered telephone appointments and online booking and prescription services and was about to implement an online registration service for students from September 2018.
• The practice offered accessible sexual health services for example, the contraceptive implant was available during university terms.
• The practice’s uptake for the cervical screening programme was 46% in 2015/16 which was significantly below the CCG average of 77% and the national average of 81%. Unverified data for 2017/18 showed significant improvement.
• We saw evidence that the practice was proactive in encouraging uptake through a poster campaign and information on the practice website.The practice told us that alerts were added to patient records and the benefits of screening were discussed opportunistically when patients attended the practice.
• The practice was offered a full range of health promotion and screening services reflecting the needs for this age group. For example the practice offered NHS health checks for 40-74 year olds; chlamydia and gonorrhoea testing; tuberculosis and HIV screening for at risk patients and catch up MMR and meningitis vaccinations.
• The practice liaised with the university counselling service and disability and dyslexia support services.

Updated 30 August 2017

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

• The practice had identified mental health as a priority for their patient population and had effective systems in place to respond to patients in crisis.
• Performance for mental health related indicators was comparable to the national average. For example, in 2015/16, the percentage of patients with a diagnosed psychosis who had a documented care plan in their records was 83% (national average 88%).
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice specifically considered the physical health needs of patients with poor mental health and invited patients for an annual health check.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health. Members of the local community mental health team attended the practice to provide on-going support and counselling to patients.
• The practice had systems in place to follow up patients who had attended accident and emergency or a hospital admission where they may have been experiencing poor mental health.
• Patients at risk of dementia were identified and offered an assessment. In 2015/16, nine out of the ten patients diagnosed with dementia had received a face-to-face review (the national average was 84%).
• The practice had information available for patients experiencing mental distress about how they could access various support groups, voluntary organisations and counselling.

Updated 30 August 2017

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 had carried out an audit of health checks for patients with learning disability and was improving its call-recall system to ensure that all these patients were invited for a regular health check.
• The practice offered longer appointments for patients with a learning disability and supported the 'Patient passport' scheme which included information for health professionals (for example about how the patient liked to communicate).
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and informed these patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They understood the particular difficulties and challenges sometimes experience by students. 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 only rarely cared for patients who required end of life care. The GPs demonstrated they were aware of and had worked with other professionals and agencies to deliver coordinated care which took into account patients' (and their carers') wishes at the end of life.