Bromley Meadows Surgery

We carried out an inspection of Drs Liversedge, McCurdie and Wong following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the key questions effective, caring and well-led.

Because of the assurance received from our review of information we carried forward the ratings for the key questions safe and responsive.

We rated the practice as outstanding overall with the following key question ratings:

Effective – outstanding

Caring – outstanding

Well-led – outstanding

The practice had previously been inspected 20 May 2016 and had been rated as good overall and in all of the key questions.

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 have rated this practice as outstanding overall. The population groups older people, families, children and young people, working age people (including those recently retired and students) and people experiencing poor mental health (including people with dementia) are rated as outstanding, and people with long-term conditions and people whose circumstances may make them vulnerable are rated as good.

We rated the practice outstanding for providing effective services because:

• Outcomes for patients were consistently better than expected when compared with other similar services
• The practice scored higher than the local and national averages relating to quality. This was recognised by external bodies.
• There was a holistic approach to assessing, planning and delivering care and treatment.
• All staff were engaged in activities to monitor and improve quality and outcomes.
• Staff were consistent in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill-health.

We rated the practice as outstanding for providing caring services because:

• People were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service.
• Feedback from patients and stakeholders was positive about the way staff treated people.
• There was a strong, visible person-centred culture.
• Staff were highly motivated and inspired to offer care that is kind and promoted patients’ dignity.
• Staff recognised and respected the totality of people’s needs. They always took people’s
• personal, cultural, social and religious needs into account.
• Patients’ emotional and social needs are seen as important as their physical needs, and every contact

We rated the practice as outstanding for providing well-led services because:

• There was a systematic approach is taken to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money.
• Governance and performance management arrangements were proactively reviewed and reflected best practice.
• There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture. Staff at all levels were actively encouraged to raise concerns.
• There was rigorous and constructive challenge from the patient forum.
• The leadership drove continuous improvement and staff were accountable for delivering change.

We saw several areas of outstanding practice, including:

• Each day a member of the reception team checked all appointments to see if there were any outstanding checks, such as cervical screening, or information, such as smoking status, for the patient. The system was noted so that the clinician could discuss the checks or questions during the consultation. Staff told us this was time consuming but they felt it helped to improve the care they provided.
• All patients over the age of 75 had had a frailty assessment using the Rockwood Frailty Score.
• The practice gained 100% compliance when measured against the CCG’s Bolton Quality Contract.
• The practice exceeded their targets for all childhood immunisations.
• The practice had identified a group of patients who were difficult to reach and had not attended for a health check. The practice manager and practice nurse proactively carried out late evening visits to these patients at their homes. With consent documented, they carried out pulse and blood pressure checks and took blood samples. The initial health check conversation took place and the patient was contacted when the blood results had been seen. This had had a positive impact on the number of NHS health checks carried out by the practice.
• One of the partners had identified an issue with social isolation in the area. In December 2018 they organised a Christmas party for 50 of their most lonely or isolated patients. The patient forum was involved in the organising and local businesses were contacted to ask for donations. The practice had a good response with businesses donating food, gifts and vouchers. Everyone who attended received a gift and a free raffle ticket. The initiative was a success and is being repeated in December 2019. We saw that patients were donating items for the party and all staff were involved in helping to make this a success.
• There was an annual practice barbecue at a partner’s house, where all staff and their families were invited. Staff told us the annual event was a highlight of the year and they found it beneficial meeting the family members of their colleagues and spending time with people they may not have much contact with in work.

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