Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bramblys Grange Medical Practice on 8 June 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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 and complied with the requirements of the duty of candour.
• The practice had a comprehensive action plan in place to address any issues with the organisation of the practice. We found that action had been taken to address shortfalls in reporting and engaging patients in the Quality and Outcomes Framework. Work had been undertaken to improve patient experience and the availability of appointments.

The areas where the provider should make improvement are:

• Continue to review process for handling telephone calls to the practice to maintain confidentiality.

• Review how notices are displayed to make sure patient are aware they can request a chaperone.

• Review recruitment records to include a recent photograph of the member of staff.

• Continue to review arrangements for identifying carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We found the provider had made improvements to their infection control and prevention processes. They had identified and implemented changes relating to national guidance. Clinical waste storage facilities had been reviewed and actions taken to reduce identified infection control risks.

Bramblys Grange Medical Practice had recently appointed a new practice manager, who had undertaken a review of nursing staff, responsibilities and services. We spoke with three nurses who reported that they had been involved with the review and were able to provide feedback and make suggestions about the proposed changes. They also confirmed that changes had been made and they had noticed their workloads were more manageable. At the time of inspection there were adequate levels of suitably trained and skilled nursing staff.

We found the practice had made significant improvements to ensure that effective systems for identifying, assessing and monitoring risks were implemented. Medication checks had been completed. We noted that processes for the storage and destruction of medicines had been reviewed and corrective actions taken.

During our inspection we spoke with ten patients who used the service. People told us that they were satisfied with the care and treatment they received. One patient told us "the GPs are very flexible and supportive. Whilst going through a difficult time they remembered the smaller details about me and my husband. This meant a lot to us".

Patients who used the service were protected from the risk of abuse. Patients we spoke with all said they felt safe when they visited the practice.

We found the consulting rooms and waiting area clean and tidy and mostly free from odours. Patients we spoke with said they had no concerns about hygiene standards within the practice. One patient said "The practice is always clean and tidy. I am also impressed at how clean the toilets are here". However, we found that people were not always protected from the risk of infection because appropriate guidance had not been followed.

Patients told us that the GPs explained the reasons for newly prescribed drugs. Others said that there were invited to undertake medication reviews on a regular basis. However, we found that other management processes and the disposal of medicines was not always in line with national guidance.

There were not always enough nursing staff to support and safeguard the health, safety and welfare of service users. This was because the practice had experienced staff absences and shortages since April 2013.

The practice sought the views of patients and acted upon the feedback received. We saw that audits took place at regular intervals throughout the year. However, we also found the practice did not always have effective systems or processes to identify, assess and manage risks to the health, safety and welfare.

Complaints were dealt with appropriately within the practice. The patients we spoke with told us that they knew of the complaints process and that they were confident that the practice would respond appropriately.