This practice is rated as Good overall. (Previous inspection October 2015 - Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Bramham Medical Centre on 15 February 2018. We carried out this inspection as part of our inspection programme.

At this inspection we found:

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• Results from the national GP patient survey were consistently good and patient feedback we received on the day largely supported this.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice was involved in a number of local and national initiatives. For example; the locality scheme pilot for a visiting GP service over the winter period and the NHS 111 pilot scheme allowing patients to be remotely allocated to a GP appointment during hours.
• The practice was aware of challenges facing smaller providers and were exploring options to overcome these.

The areas where the provider should make improvements are:

• Continue to embed the new system and keep records of prescription numbers in order to monitor usage of both printed and blank prescriptions.
• Implement fully the significant event policy and supporting reporting form in order to maintain an adequate record of learning from all significant events and incidents.
• Arrange for the Infection Prevention and Control lead to receive additional training to support them in the role.
• Continue to review and improve the function of the patient participation group.
• Review exception reporting rates for the Quality and Outcomes Framework to assure themselves that patients are being excepted in line with the latest guidance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bramham Medical Centre on 7 October 2015. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to fire safety checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.

We saw several areas of outstanding practice including:

• Weekly warfarin clinics are run at the practice to improve access to local services in the community
• Retinal screening services are provided at the practice
• Home visits to elderly house bound patients are provided by an additional nursing staff funded by this and four other local practices
• The practice provided a dermoscopy service for early diagnosis and prompt referral of patients.

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

Importantly the provider should

• Ensure adequate fire safety systems are in place and staff complete fire training and regular fire drills are in place
• Ensure blank prescriptions pads are safely monitored
• Ensure that pharmaceutical guidance is followed in the management of controlled drugs

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bramham Medical Centre on 15 February 2018. The overall rating for the practice was good; with a rating of requires improvement for providing safe services. The full comprehensive report for the February 2018 inspection can be found by selecting the ‘all reports’ link for Bramham Medical Centre on our website at .

In addition to the areas for improvement identified under the key question for providing safe services, at the inspection on 15 February 2018 we also said the practice should consider the following areas:

• Continue to review and improve the function of the patient participation group.
• Review exception reporting rates for the Quality and Outcomes Framework to assure themselves that patients are being excepted in line with the latest guidance.

This inspection was an announced focused inspection carried out on 10 July 2018 to confirm that the practice had made the required improvements identified at the previous inspection on 15 February 2018. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

At this inspection we found:

• The practice had clear systems and processes in place to monitor usage of both printed and blank prescriptions.
• The practice had reviewed the process for recording significant events and incidents. We saw minutes from practice meetings in which significant events had been discussed and learning had been shared with staff.
• We saw that fabric curtains in all of the treatment rooms had been replaced with disposable ones. The practice had a system in place to ensure these were replaced every six months.
• The practice had sourced additional training for the infection prevention and control (IPC) lead. Due to demand and staff availability, the first available course was March 2019. We saw evidence that the infection prevention and control lead had been booked to attend this course.
• The practice had introduced a standard operating procedure to address areas of high exception reporting rates for the Quality and Outcomes Framework.
• The practice had hosted two patient participation group meetings and was taking steps to increase interest from patients.

We saw one area where the provider should make improvements:

• The provider should ensure that the IPC lead attends, completes and implements learning from the additional IPC training that has been booked to support them in their role.

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

Please refer to the detailed report and the evidence tables for further information.