Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bramblehaies Partnership

on Tuesday 8 August 2017. 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 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.
• There was evidence of effective working with health care professionals and care homes in the area. The practice provided a dedicated direct telephone number so health care professionals could speak with the practice promptly.
• 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.
• Staff told us that new parents were sent a birth congratulations card. New patients were sent a welcome letter and fridge magnet which contained the practice contact details.
• The practice offers extended hours on Tuesday, Wednesday and Thursday until 7:30pm and until 7pm on Monday and Friday.
• The practice carried out advance care planning for patients living with dementia. In-house dementia training sessions had been delivered by a local charity in May and the practice had been recognised with the Culm Valley Action Dementia Alliance
• 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.

We saw one area of outstanding practice:

• A health facilitator is employed by the practice for four hours per week to offer social prescribing, support and motivation to selected patients within the practice. The aim was to develop self-care regarding diet, exercise, smoking cessation and social activity to reduce social isolation. Patients could access a community LIFE Hub (LIFE stood for Listening, Involving, Friendship and Education). The hub provided patients with activities including groups for; seated exercise, parenting, creative writing, knitting, walking, pilates, information and advice and depression and anxiety. Data from 2016/17 showed that of 15 randomly selected patients six had reduced their number of appointments with the GP following interaction with the health facilitator.

The area where the provider should make improvement are:

• Ensure the consent form used for minor surgery meets relevant national guidelines.

Professor Steve Field

CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Bramblehaies Partnership was inspected on Wednesday 5 November 2014. This was a comprehensive inspection covering Bramblehaies Medical Practice.

Bramblehaies Partnership provides primary medical services to people living in Cullompton and surrounding villages in Devon covering approximately 180 square miles.

The practice provides services to a diverse population. At the time of our inspection there were approximately 6,500 patients registered at the service with a team of four GP partners. GP partners held managerial and financial responsibility for running the business. In addition there was one additional salaried GPs, four registered nurses, two health care assistants, a practice manager and team of administrative staff. We spoke with 11 staff in total.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

The practice is rated as good. Our key findings were as follows:

• Patient comments were positive about the care and support they experienced at the practice. In particular, the staff were said to be compassionate and supportive in promoting good health and well being.

• Patients reported having good access to appointments at the practice and had a named GP which improved their continuity of care. The practice was clean, well-organised, had good facilities and was well equipped to treat patients.

• The practice valued feedback from patients and had an active patient participation group (PPG) and 'Friends of Bramblehaies' that saw their suggestions put into place. The practice was ready to start the ‘Friends and Family Test’ with patients to receive daily feedback about their experiences of care and treatment there.

• The practice was well-led and had a clear leadership structure in place whilst retaining a sense of mutual respect and team work. There were systems in place to monitor and improve quality, identify business risk and systems to manage emergencies.

We saw several areas of outstanding practice including:

• Patients with long term conditions were benefitting from specialist equipment that had been purchased so that blood screening was carried out at the practice for patients. Instead of receiving results the next day, results were available immediately and discussed with patients. Immediate changes to their medicine dose could then be made in response and additional advice and support given where needed.

• A named GP and nurse monitored the health and well being of vulnerable patients with a learning disability and/or complex mental health needs. This promoted a trusting rapport with patients. The expertise of a national charity had been used to make all information at the practice accessible for vulnerable patients with a learning disability. Information leaflets and posters were in easy read and picture formats. This had increased patient involvement in the management their health and well being.
• The practice was successful in engaging patients with mental health needs to ensure their health and well being was closely monitored. Longer appointments, at quieter times of the day and with named staff were taking place. Information received about the practice prior to and during the inspection demonstrated the practice performed better compared with other practices. These areas included cervical screening for women with complex mental health needs and annual health checks of patients with a learning disability.

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

Importantly, the provider must:

• Have effective operating systems for the handling pathology results, scanned correspondence to mitigate the potential risks of inappropriate or unsafe care and treatment of patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice