Brinsley Avenue Practice

Updated 21 November 2016

Brinsley Avenue Practice is registered with the Care Quality Commission as a partnership provider. A partnership of three GPs holds a General Medical Services (GMS) contract. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

The practice is situated in a residential area of Trentham, Stoke on Trent. The practice area is one of less deprivation when compared with the clinical commissioning group (CCG) and national averages. Services have been provided from the current location for over forty years. The partnership providing services significantly changed in October 2015 following the retirement of a long-standing GP. The practice is currently fully staffed with no vacancies reported.

The practice has patients of all ages ranging care, although there are significant differences in the demographic in groups that are known to increase the workload of GP services:

• 15.4% of the practice population are aged 75 and over compared with the CCG average of 7.5% and national average of 7.8%.

• The practice has 8% of their patients living in a care home; the national average for practices is 0.5%.

• The number of patients aged 18 and under is around 5% less than local and national averages.

At the time of our inspection the practice had 3,837 registered patients.

The practice is open:

• Monday, Tuesday, Wednesday and Friday from 8:30am to 6pm. The reception closes from 12:45pm to 1:45pm on Monday to Wednesday although there is all day telephone access.

• Thursday from 8:30am to 1pm. The practice is closed on a Thursday afternoon under a local agreement and emergency cover is provided by the local GP out-of-hours provider.

• Earlier appointments are available for 7:30am on a Wednesday and Friday.

• Telephone appointments are available daily with GPs and the advanced nurse practitioner.

Staffing at the practice includes:

• Five GPs (three female and two male giving a whole time equivalent (WTE) of 2.6.

• The all-female practice nursing team consists of an advanced nurse practitioner (WTE .74), practice nurse prescriber (WTE 1) and a healthcare assistant/elderly care facilitator (WTE .22 in each role).

• A managing business partner oversees the operational and governance of the practice. The wider administrative team of nine include a reception supervisor and senior administrator.

• A befriending volunteer provides the practice with a link to the community and coordinates activities for the practice befriending club.

Updated 21 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brinsley Avenue Practice on 19 September 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.

• Feedback from patients about their care was consistently positive.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The needs of patients had been identified and measures had been put in place to bridge gaps. For example, the practice ran a voluntary befriending group for those who were socially isolated.
• 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 and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice including:

• The practice was the third highest out of 85 practices for reporting safety concerns about patients. As a result of the practice’s reporting, the clinical commissioning group and local authority had implemented an information sharing agreement to enable quicker sharing of concerns about patients between the organisations.

• The needs of older patients had been extensively assessed. The practice had set up a befriending group to benefit those who were socially isolated. The health, social and care needs of older patients had been assessed and the practice had a list of 130 patients who received regular contact from an elderly care facilitator. Over time, the practice had made a difference by helping patients to secure benefits or referred patients to others for example, the fire service when home safety issues had been identified.

• The practice had 8% of their patients who lived in care homes; this was significantly higher than the national average of 0.5%. Individualised and responsive care had been implemented including regular care home visits and assessment of the reasons why patients had been admitted to hospital unexpectedly. The practice acted on the findings and implemented measures such as training care home staff and introducing protocols for the care homes to assist them on what do when patients deteriorated.

The area where the provider should make improvement are:

• Improve the recording of the actions taken following medicines alerts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 November 2016

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

• The practice had 217 patients identified with diabetes. In 2014/15 a total of 82% of patients with diabetes had received a recent blood test to indicate their longer term diabetic control was below an accepted level, compared with the CCG average of 75% and national average of 78%. In 2015/16 the practice performance was 84%.

• The practice rate of patients with COPD who were admitted to hospital in an emergency was over half the CCG average.

• The practice had lower emergency admission rates observed in patients with Coronary Heart Disease (CHD), cancer and diabetes.

• Longer appointments and home visits were available when needed.

• All these patients 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.

• Patients with long-term conditions were encouraged to receive seasonal flu vaccination and uptake rates were higher than local and national averages. For example, 99% of patients with diabetes had received an annual flu vaccination compared with the CCG average of 95% and national average of 94%.

Updated 21 November 2016

The practice is rated as outstanding 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 who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 86% compared with the CCG average of 80% and national average of 82

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 21 November 2016

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

• The practice had a higher than average patient population in this age group. This corresponded to twice the national average of patients aged 75 years and over.

• The practice had introduced a befriending group for patients who were older and socially isolated. The group provided befriending to practice patients, although others from the wider community were welcomed. The group met regularly and received information health promotion topics, safety talks and other matters of wider interest. The practice had a volunteer befriender who alongside practice staff championed the provision of the service.

• The practice provided an elderly care facilitator to meet the needs of older patients. Since 2015 a total of 130 were included on the case load of a befriending volunteer. Health needs were also considered and the practice recorded that on over 40 occasions they had intervened by referring patients for additional support.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Uptake rates for seasonal influenza (flu) vaccine for the 2015/16 programme showed that 77% of practice patients aged over 65 years received a flu vaccine compared to the CCG average of 72% and national average of 71%.

Updated 21 November 2016

The practice is rated as outstanding 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 was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Extended hours appointments were offered on a two different weekdays from 7:30am.

Updated 21 November 2016

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

• The practice had 135 patients identified with Dementia. In 2014/15 a total of 94% of patients with dementia had a face to face review of their condition in the last 12 months. This was higher than the CCG average of 85% and national average of 84%.

• The practice had 39 patients identified with an enduring poor mental health condition. In 2014/15 performance for poor mental health indicators was higher than local and national averages. For example, 95% of patients with enduring poor mental health had a recent comprehensive care plan in place compared with the CCG and national averages of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 November 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

• The practice had externally reported 58 occurrences of when they had identified concerns about patients who were vulnerable as they relied on others for their care. As a result of the practice reporting of safety issues the local clinical commissioning group (CCG) had implemented an information sharing agreement with the local authority.

• The practice had assessed the reasons for previously higher than CCG average admission rates in vulnerable patients in care homes. The common reasons for admission included acute kidney injury (dehydration) and infections. Practice staff had provided training for care home staff on identifying worsening signs of illness, head injury and weight loss. Emergency admission rates for these conditions had reduced since 2014/15 and at the time of the inspection mirrored the CCG average.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice offered longer appointments for patients with a learning disability.