Abbots Bromley Surgery

Updated 4 August 2017

Abbots Bromley Surgery is a well-established GP practice located in Abbots Bromley, Rugeley, Staffordshire. The practice is a rural dispensing practice in an area of low deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 4,000 patients. The practice premises are in a single storey building with good access for cars and with parking bays for patients with a physical disability. There is level access to the building for ease of access for wheelchairs and pushchairs.

The practice team consists of:

• Two GP partners who provide 1.76 whole time equivalent (WTE) hours.

• One salaried GP who provides 0.69 WTE hours.

• A Managing Partner/ Practice Nurse who provides 0.88 WTE hours.

• Health Care Assistant who provides 0.18 WTE hours.

• A Senior Practice Nurse who provides 0.53 WTE hours.

• Two female practice nurses who provide1.19 WTE hours.

• One Nurse Practitioner who provides 0.88 WTE hours.

• Five dispensary staff who provide a total of 139 hours.

• A medical receptionist who provides 25 hours per week.

• One data quality analyst who provides 12 hours per month.

The practice is open from 8am to 6.30pm Monday to Friday and offers an open access system to patients. Patients are able to book in to see a GP every weekday between the hours of 9am and 10.30am each morning (8.30am to see a practice nurse) and 4.30pm to 5.30pm on Monday, Tuesday and Thursday afternoons. Patients are able to book to see the nurse practitioner from 9am to 10.30am on Mondays, Thursdays and Fridays mornings and from 4.30pm to 5.30pm on Thursdays. Patients could book to see the health care assistant on a Monday and Wednesday between 11am and 1pm.

The practice has a General Medical Services (GMS) contract with NHS England for delivering care services to their local community. The practice treats patients of all ages. The highest percentages of the practice population are within the 15 to 19 and 45 and 70 age groups.

The practice is a dispensing practice. The dispensary is open Monday to Friday between 8.30am and 1pm and 3pm to 6.30pm. The dispensary is closed between 1pm and 3pm every day, should patients require medication urgently all special requests were said to be honoured. Patient orders for repeat prescriptions are taken from 9am to 1pm Monday to Friday. Repeat prescriptions are available for collection from the dispensary within 48 hours of placing an order.

The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to the out of hours service, Staffordshire Doctors Urgent Care (SDUC) when the practice is closed.

Updated 4 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Abbots Bromley Surgery on 14 July 2015. The overall rating for the practice was good with requires improvement in providing a well led service. The practice was served Requirement Notices in Regulation 17 Health and Social Care Act (Regulated Activity) Regulations 2014, Good Governance and Regulation 18, Staffing. The full comprehensive report on 14 July 2015 inspection can be found by selecting the ‘all reports’ link for Abbots Bromley Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 6 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation identified in our previous inspection on 14 July 2015. This report covers our findings in relation to those requirements.

We found these arrangements had significantly improved when we undertook a comprehensive follow up inspection on 6 July 2017. The practice is now rated as good for being well-led.

Overall the practice is rated as good with outstanding in the population group of patients with a long term condition.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients we spoke with 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.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Report all incidents including dispensers reporting GP prescribing errors.

• Safeguard the medicines and vaccine fridges so they cannot be inadvertently unplugged.

• Complete a general risk assessment of the practice.

• Implement a system to log the action taken by the practice in response to alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).

• Update the practice business continuity plan to include contact details.

• Update non clinical staff records to include their full immunity status.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was higher than the local Clinical Commissioning Group (CCG) and national averages. For example, 85% of patients with diabetes had received a recent blood test to indicate their longer-term diabetic control was below the highest accepted level, compared with the CCG average of 79% and national average of, 78%. Although the diabetes performance data was good the practice felt there was room for improvement with an aim to achieve 100%. They reviewed their diabetes protocol to ensure the training and protocol met best practice in line with NICE guidelines. They appointed a GP and nurse lead, a collaborative approach to diabetes management and dedicated clinics for patients who struggled to manage their diabetes. Progress in respect to these changes were being performance managed and with an aim to improve diabetic patient health and wellbeing.

• Performance for patients with asthma, on the register, who had had an asthma review in the preceding 12 months, was 91%, which was higher than the CCG average of 75% and national average of 76%. There were 196 patients on the practice asthma register. An audit was completed on a specific medicine used to treat asthma. Following this audit the practice had implemented a number of measures to improve patient outcomes. For example, Asthma UK action plans were implemented, patients were invited for a three monthly review prior to repeat medicines being authorised, information was provided to patients about the changes in the repeat medicine procedures and patients attending secondary care were reviewed. The practice repeated the audit after a six month period. They found that patient use of the medicine had reduced and they found improved asthma management in patients. Another repeat audit was planned.

• The percentage of patients with Chronic Obstructive Pulmonary Disease (the name given to a collection of lung diseases) who had a review undertaken including an assessment of breathlessness in the preceding 12 months was 100% when compared with the CCG average of 91% and national average of 90%.

• The percentage of patients with hypertension (high blood pressure) in whom the last blood pressure reading was within a specific range was 88%, when compared with the CCG average of 84% and national average of 83%.

• 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.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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.

Updated 4 August 2017

The practice is rated as good for the care of families, children and young people.

• We found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were high for all standard childhood immunisations.

• Children and babies consultations were available outside of school hours and the practice had suitable premises, for example baby change facilities.

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The practice provided GP services to a local school with overseas boarding students. The practice reached out to the school to enable a positive registration framework for their students to enable timely, appropriate safe care and treatment. An agreement had been drafted regarding registration and deregistration at the practice for boarding students, including parental consent in relation to the child/young person’s past medical history.

Updated 4 August 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible

Updated 4 August 2017

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

• The needs of these population groups had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, open surgeries to enable same day access to all patients.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs of these age groups.

Updated 4 August 2017

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

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

• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the local CCG average of 85% and national average of, 84%.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Performance for mental health related indicators were higher than the CCG and national averages and had reported no clinical exceptions. For example, 100% of patients with severe poor mental health had a recent comprehensive care plan in place compared with the CCG average of 86% and national average of 89%.

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

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

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

Updated 4 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.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

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

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

• The practice had information available for vulnerable 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 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.