This practice is rated Good overall.

Limelight Health and Well-being Hub, also known as Brooks Bar at Limelight, moved to its new location in April 2018. It was previously known as Brooks Bar Medical Centre and the current provider was first registered by the Care Quality Commission (CQC) in 2017. Before the new provider, Brooks Bar Medical Centre had been placed in special measures and CQC acted to cancel the registration. This is the first inspection of the newly registered practice and to the new location.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Outstanding

We carried out an announced comprehensive inspection at Brooks Bar at Limelight on 20 April 2018 as part of our inspection programme.

At this inspection we found:

• The practice had introduced a comprehensive system to manage risk so that safety incidents were less likely to happen. People were protected by a strong system and a focus on openness, transparency and learning when things went wrong.
• Outcomes for people who used services had consistently improved and were better than expected when compared with other similar services since the change of partnership.
• There was evidence to demonstrate that medicine management and overall prescribing had improved and continued to improve since the change of partnership.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided and ensured that care and treatment was delivered according to evidence- based guidelines.
• People were respected and valued as individuals. Staff were trained to understand patients’ needs so that they could provide the correct information for example with recent changes in the appointment system, the move to new premises and other support services available within the premises and within the local area.
• Services were tailored to meet the needs of individual people, specifically those who were vulnerable, and were delivered in a way to ensure flexibility, choice and continuity of care. Examples included multidisciplinary working and “one stop shop” appointments for patients with more than one long-term condition.
• The leadership, governance and culture were used to drive and improve the delivery of high quality, person-centred care.

We saw several areas of outstanding practice:

• When the current provider took over the practice there was significant over prescribing. A high number of patients were being prescribed hypnotic medicines (commonly known as sleeping tablets) and anxiolytic medicines (commonly known as anxiety tablets). Those patients were brought in for review and reduction. The number of hypnotic and anxiolytic items prescribed was reduced month on month and evidence showed a total reduction of 27% between March 2017 and February 2018. There was also a reduction in antibiotic prescribing from 14 units in the first quarter of 2017/18 to 9 units in the last quarter of 2017/18 and, in addition, evidence showed that the number of units prescribed for most medicines had improved. The practice had moved from being the second worst prescribers out of 32 practices in the CCG in 2015/16 to above average in 2017/18.

• The practice monitored all types of health alerts, kept a log and informed staff, and took a very pro-active approach. For example, when a recent measles outbreak was identified in a neighbouring borough, the practice did a search to see how many people were missing a full mumps, measles and rubella (MMR) course. 119 patients were found and invites were sent out for them to come in urgently for the second course of vaccinations. They also alerted staff that any patients attending with rash and high temperature together must be kept isolated. They also discussed immunity with staff and checked staff immunisation status.

• The practice had engaged with the community and patient population by creating and hosting a joint community patient participation group (PPG) at their practice. This had brought about positive and continuous change with the involvement of the wider community. This had fostered a sense of achievement amongst the PPG members who were now actively engaged in the changes taking place within local healthcare. They were communicating with patients in Trafford about new roles in primary care such as clinical pharmacists and assistant practitioners, that have led to frustration amongst patients when requesting to see a GP or nurse. Reception staff at Brooks Bar have reported less challenge from patients when being booked into non-doctor appointments.

• The lead GP had hosted and been a member of the Building User Group (BUG) for Limelight since its inception. Because of this they could forge good relationships with services and the Limelight Community. They had shared processes with other services such as registration and on-line access so that patients were met with a joined community services approach and they had created a “one door, one building” culture. During patient consultations, all staff were fully aware of the services that patients could benefit from, having learned about them over the previous twelve months through the user group meetings. For example, patients could be signposted immediately to the library for disabled blue badges, where the library staff could progress applications and take photographs for the patients. The progressive work continued and an internal telephone system had been requested so that everyone using Limelight had access to any queries about all the services provided. The lead GP has led on all this to create maximum benefit from every contact that people make.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice