Archived: Dr D T Brazier & Dr D York Also known as Trinity Medical Centre

Updated 5 May 2016

Dr DT Brazier and Dr D York provide primary medical services in Littleborough near Rochdale from Monday to Friday. The practice is open between 8am and 6.30pm. The first appointments of the day with a GP are open surgeries between 8.30am and 10.30am. Bookable appointments are available between 3.30pm and 6pm. Extended hours are offered on Monday evenings until 7pm and Thursday mornings between 7.15am and 8am. Same day urgent appointments are available each day.

The practice is part of a local federation of practices offering seven day access to a GP.

The practice of Dr DT Brazier and Dr D York is situated within the geographical area of Heywood, Middleton and Rochdale Commissioning Group (CCG).

The practice has a Personal Medical Services (PMS) contract. The PMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Dr DT Brazier and Dr D York are responsible for providing care to 3852 patients. Nearly 20% of the practice population is aged over 65 and 1% live in residential or care homes.

The practice consists of two GP partners one male and one female, two salaried GPs, one male and one female, two practice nurses, and one clinical support worker. The practice is supported by a practice manager and administration and reception teams. It is a teaching practice with regular medical students.

When the practice is closed patients are directed to the out of hour’s service.

Updated 5 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs DT Brazier and D York on 17 March 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Overall risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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 and complied with the requirements of the Duty of Candour.
• The practice took part in peer reviews to ensure best and safe working practice.

However there were areas where the provider should make improvements

• Remove all equipment no longer in use from the emergency trolley.
• Label training items as such and separate from items in stock.
• Introduce a system where staff training is more easily monitored.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 5 May 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• 97% of diabetic patients had a record of having had a foot examination and risk classification within the preceding twelve months compared to the national average of 88%.
• 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.
• All patients diagnosed with COPD were offered a personalised care plan.
• The practice nurse had been trained and was able to initiate insulin to its diabetic patients.

Updated 5 May 2016

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 and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• 72%of patients with asthma had had an asthma review in the preceding 12 months that included an assessment of asthma control using the three Royal College of Physicians questions which was comparable to the national average of 75%.
• 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.
• 77% of women aged between 25 and 64 had their notes recorded that a cervical screening test had been performed in the preceding five years which was comparable to the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and school nurses.
• “When should I worry” information was given to parents of young children.

Updated 5 May 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• All elderly patients were offered an annual health check including a falls risk assessment, a frailty assessment and medication review.
• The practice embraced the Gold Standards Framework for end of life care. This included supporting patients’ choice to receive end of life care at home.
• Carers were offered health checks and given longer appointments as required.
• Patients suffering from dementia were signposted to the local Drop In Dementia Café.
• Ward rounds were carried out in the local Nursing Homes by the GP and assessment rounds were carried out by the practice nurse and the clinical support worker which included checks for pressure sores.
• The practice nurse carried out a bladder and bowel assessment before referring appropriate patients to the bladder and bowel service.

Updated 5 May 2016

The practice is rated as good 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.
• Open access surgery was available every weekday morning for patients to access when they were unable to attend an appointment during the working day.
• The practice were part of a group of local practices offering seven day access to a GP.

Updated 5 May 2016

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

• 78% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%.
• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months is better than the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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.
• Patients suffering from dementia were signposted to the local Drop In Dementia Café.

Updated 5 May 2016

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 offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. 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.