This practice is rated as Good overall. (Previous inspection November 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Good

We carried out an announced comprehensive inspection at Brannam Medical Centre on 4 May 2018. The inspection was a routine inspection as part of our inspection schedule.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved processes.
• Audit was embedded, with the practice routinely reviewing the effectiveness and appropriateness of the care it provided. Care and treatment was always delivered according to evidence-based guidelines.
• All 30 patients gave strongly positive feedback at the inspection about staff treating them with compassion, kindness, dignity and respect.
• Staff were caring and raised funds for local charities every year.
• People’s individual needs and preferences were central to the planning and delivery of flexible tailored services. All patient feedback highlighted ease of access to the appointment system, on the day assessment and minor illness services. Extended hours were available every day enabling working patients and school children to access a range of services from the multi-disciplinary team.
• As a training practice, there was a strong focus on continuous learning and improvement at all levels of the organisation. Proactive succession planning based on staff development and training of future GPs, doctors and practice nurses was evident.
• Brannam Medical Centre had successfully registered a further 1650 additional patients in 2017/18 due to the closure of a nearby practice. The practice list size had increased by 3,000 in the last three years. Patient feedback shared with us by patient representatives indicated existing patients had reported no adverse impact for them. 

We saw areas of outstanding practice including:

A housebound patient pathway was developed and adopted locally, enabling vulnerable patients with long term conditions to have comprehensive regular reviews at home carried out by the practice nurse and pharmacist. In total 160 patients, had regular reviews of their health by these staff and received proactive support to reduce any associated risks.

In response to patient need, the practice had set up in-house free counselling service for patients, in conjunction with the local college. Sixty patients with long term conditions, including obesity were able to access support between April 2017 and March 2018. This was in addition to hosting the secondary care depression and anxiety services at the practice for patients.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brannam Medical Centre on 18 November 2014. Overall the practice is rated as good.

We

found the practice to be good for providing safe, effective, caring, responsive and well led services. It was also good for providing services for all the population groups.

Our key findings were as follows:

Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Reference Group. Improvements had been made so that patients with reduced mobility including wheelchair users could access the practice easily. Patients had a variety of ways to make appointments and found the practice to be flexible in meeting their needs.

The practice had a system in place for completing clinical audit cycles in order to monitor safety and effectiveness of practice.

Audits had been done for the benefit of patients. There was a culture of willingness to challenge. There were a range of audits that had been reviewed and repeated annually.

Audits were routinely done on the whole practice list, not just those on individual lists of the GP doing the audit.

Staff compiled a weekly list of vulnerable patients who needed follow-up, having missed for example, international normalisation ratio (INR) which checks whether the anti-coagulant medicine is being given at the correct therapeutic dose. The GP would then decide what action was needed to ensure the patient’s safety.

There was a drop-in clinic for patients under the age of 21, for contraception and general advice. No appointment was necessary and it was open to non-registered patients. Homeless patients referred on to other services could collect details of other medical appointments or messages from the practice.

The practice had good facilities and was well equipped to treat patients and meet their needs. The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example a skin cancer surgery clinic had been offered since November 2013 at Brannam Medical Centre for low risk excisions, by a GP registered with a special interest in dermatology.

The practice had a clear vision which had quality and safety as its top priority and were proud to maintain continuity of care for patients through the GPs personal lists. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

A nurse and GP were on duty every afternoon, running a ‘never full’ system. Anyone who asked for a rapid access appointment was seen on the day and this included patients with minor injuries.

However, there were also areas of practice where the provider needs to make improvements. 

Importantly, the provider should:

Provide staff training

in the Mental Capacity Act 2005 and its relevance for their work in respect of patients who may lack capacity to give informed consent to care and treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice