We carried out an announced comprehensive inspection at Brampton Medical Practice on 22 February 2019 as part of our inspection programme. (Previous rating August 2015 – Good)

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups except families, children and young people, which we have rated outstanding.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw an area of outstanding practice:

• The practice had achieved high levels of childhood immunisation rates. Rates for all age groups exceeded the 95% target set by the World Health Organisation and for one year olds exceeded 99%. The practice also held a clinic with a local paediatric consultant.

However, there were some areas where the practice should make improvements:

• Continue to ensure Patient Specific Directions are signed by a qualified prescriber;
• Look for ways to help staff complete mandatory training in a timely manner;
• Introduce a formal programme of clinical audit.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected the practice on 12 November 2014. We inspected this service as part of our new comprehensive inspection programme. Overall, we rated the practice as good. Specifically, we found the practice to be good for providing effective, caring, responsive and effective services, but as requiring improvement for providing safe services. It was also good for providing services for the six key population groups.

Our key findings were as follows:

• Patients reported good access to the practice, including the provision of same day appointments and access to clinical advice and support for those with urgent care needs;
• Patients reported they were treated with kindness and respect, and received safe care and treatment which met their needs;
• Patient outcomes were either in line with, or better than average, when compared to other practices in the local Clinical Commissioning Group (CCG) area;
• Practice staff followed guidance produced by the National Institute for Health and Care Excellence (NICE) when providing care and treatment to patients;
• The practice was clean and hygienic, and good infection control arrangements were in place;
• The practice learned from significant events and incidents and took action to prevent their recurrence.

Importantly, the provider must:

• Ensure patients are protected from the potential risks associated with medicines. The provider must put appropriate arrangements in place to manage medicines: repeat prescriptions must be signed before dispensing takes place; medicines must be stored or transported safely; medicines must be disposed of appropriately. (Regulation 13 of the Regulated Activities Regulations (2010).)

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Brampton Medical Practice is a rural dispensing practice which consists of one main surgery in Brampton and two branch surgeries at Corby Hill and Wetheral. The practice is registered with the Care Quality Commission to provide the following regulated activities: treatment of disease, disorder and injury; diagnostics and screening procedures; family planning; maternity and midwifery services and surgical procedures.

We carried out an announced inspection on 6 May 2014. During the inspection we spoke with patients and staff. We also reviewed a completed comment card. Feedback from patients was mainly positive. They told us they were satisfied with the care and treatment they received. Whilst the majority ofpatients we spoke with expressed no concerns about getting through to the practice on the telephone, 42% said they had experienced difficulties in this area. Also, whilst some patients said they had experienced no difficulty obtaining an appointment, 71% said they had experienced problems, and 21% said they had found it problematic to obtain an appointment in advance.

Patients’ care and treatment achieved good outcomes and was seen to be based on the best available evidence. Patients were seen to be treated with compassion, kindness, dignity and respect with services organised wherever possible to meet their needs.

The way the practice was managed promoted an open and fair culture which showed a commitment to providing safe patient care, although we found patients were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage them.

There was a strong and visible leadership team with a clear vision and purpose. Governance structures were, overall, robust and there were systems in place for managing risks. The practice had made arrangements to provide care and treatment that was tailored to patients’ individual needs and circumstances. For example, steps had been taken to review unplanned admissions and readmissions into hospital for older people. Patients with long term conditions were provided with access to a regular patient care review which monitored their condition, provided them with on-going treatment and advice, and helped them to better manage their own condition. Arrangements had been made to safeguard children and vulnerable patients from abuse or harm, including the provision of training for practice staff. The main practice was open until 18:30pm each week day and on every Saturday morning, to help provide working age patients with easier access to appointments.

Letter from the Chief Inspector of General Practice

We carried out comprehensive inspections of this practice in May and November 2014. During the inspection in May 2014, we found there had been a breach of legal requirements. After that inspection the practice wrote to us to say what they would do to comply with the compliance action (now known as a requirement notice) we set under Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines (which corresponds to Regulation 12 (f) and (g) of the HSCA 2008 (Regulated Activities) Regulations 2014). During the inspection we carried out in November 2014, we found that some of the concerns we had identified had been addressed, but others had not been fully addressed.

We undertook this desk-based review in August 2015 to check that the practice had followed their action plan and to confirm they now fully complied with the above regulation. This report only covers our findings in relation to this requirement notice. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Brampton Medical Practice on our website at www.cqc.org.uk.

Our key findings were as follows:

• The practice had addressed all of the issues identified during the previous inspection;
• Staff who worked in the dispensary had undergone an assessment of their knowledge of medicines and their competency to dispense;
• Changes had been made to the practice’s procedures for the ordering and delivery of medicines requiring cold storage to the branch surgeries. These changes meant that medicines requiring cold storage were now delivered directly to the branch surgeries;
• Changes had been made to the practice’s systems and processes which meant that repeat prescriptions were no longer being dispensed before a GP had reviewed and authorised them;
• The practice had made arrangements for medicines awaiting disposal to be picked up more frequently to help prevent stocks of these building up.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice