Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brockwell Medical Group on 5 February 2016. The overall rating for the practice was good. However, we rated the practice as requires improvement for providing safe services. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Brockwell Medical Group on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 5 February 2016. This report covers our findings in relation to that requirement and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings from this inspection were as follows:

• The provider had complied with the requirement notice we set following our last inspection visit. In particular, we found that required pre-employment checks had been completed for all newly employed clinical staff.

In addition, the provider had also addressed the improvements we asked them to make. In particular, the provider had:

• Taken action to ensure the practice actively used the local clinical commissioning group’s (CCG) Safeguarding Incident and Risk Management System (SIRMS), to report concerning incidents. (The SIRMS system enables GPs to flag up any issues via their surgery computer to a central monitoring system, so that the local CCG can identify any trends and issues for improvement across its whole area.)

• Improved the practice’s telephone system. In collaboration with their telephone provider, the provider had doubled their line capacity at all three locations. For example, at the Brockwell Surgery, 20 lines were provided rather than the previous ten. In addition, to help address continuing concerns raised by some patients about not being able to get through to the practice, the provider had further upgraded their telephone system. They had introduced a queuing system, which enabled more calls to be accepted and gave callers information about when they could expect their call to be answered. The provider told us that, since this latest system upgrade, introduced in September 2016, the practice had not received any further comments from patients about being unable to get through to the practice.

• Taken action to ensure that all staff knew how to access the practice’s policies and procedures, and understood its business continuity plan and, whistle-blowing and medicine policies.

• Taken significant action to help improve its Quality and Outcomes Framework (QOF) performance. For example, the practice had implemented a nurse-led, ‘Year of Care’ (YoC) approach to the carrying out of all long-term conditions (LTCs) reviews. To help implement the new approach, additional advanced nursing practitioners had been appointed, to manage these clinics. The patient recall system had been strengthened by aligning each patient’s recall with their birth month. The provider had also reviewed and improved their systems and processes for ensuring that information entered onto the QOF system was accurate. They had expanded their Clinical Quality Team (CQT), to help ensure that all patient related correspondence coming into the practice that included QOF related data, was appropriately documented and coded on patients’ medical records. The CQT had also been allocated the responsibility for monitoring the practice’s QOF performance and ensuring that appropriate steps were taken, to ensure patients attended for routine checks and LTCs reviews. Because the introduction of new care planning, patient recall and QOF monitoring systems and processes had not had sufficient time to have an impact on the practice’s QOF performance for 2015/16, we are repeating the area of improvement we previously asked the provider to consider.

However, there were also areas where the provider should make improvements. The provider should:

• Continue to take action to build on the arrangements it has put in place since our previous inspection to improve the practice’s QOF performance.

• Consider replacing the flooring covering in the corridors and patient waiting area.

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 the Brockwell Medical Group on 05 February 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 there was a good system for reporting and recording significant events. The staff team took the opportunity to learn from all internal incidents.

• The practice had a clear vision to deliver high quality care and promote good outcomes for their patients. The GP team was motivated and committed to exploring possibilities for providing better patient care. This included actively collaborating with their peers to develop new ways of delivering primary care, within their locality. Recent changes in leadership had resulted in action being taken to improve governance and the practice’s Quality and Outcomes Framework (QOF) performance.

• Staff demonstrated a strong commitment to supporting patients to live healthier lives and were actively taking steps to achieve this.

• There was a lack of documentary evidence to demonstrate that the practice’s staff recruitment procedures had been implemented effectively and that required pre- and post-employment checks, had been completed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. They had the skills, knowledge and experience to deliver effective care and treatment.

• Staff had developed strong and effective working relationships with other healthcare colleagues, to ensure the needs of vulnerable patients, and patients with complex health conditions, were met.

• Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their treatment. Information about the services provided by the practice and how to complain, was available and easy to understand.

• The main practice and the branch surgeries had good facilities and were well equipped to treat patients and meet their needs.

The area where the provider must make improvement is:

• Ensure that the required pre-employment and post-employment checks are carried out.

However, there were also areas where the provider should make improvements. The provider should:

• Use the local clinical commissioning group (CCG’s) Safeguarding Incident Reporting Management System to report concerning incidents.

• Improve the practice’s QOF performance.

• Continue to take steps to improve telephone access.

• Make sure all staff know how to access the practice’s policies and procedures. Ensure all staff know and understand the practice’s business continuity plan, and whistleblowing and medicines policies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People expressed their views and were involved in making decisions about their care and treatment. We saw that staff dealt with enquiries from patients as discretely as possible. Patients told us they were happy with the treatment they received. Comments included, “The doctors are good. They discuss your care with you” and “It’s very thorough, yes. I feel involved in my own treatment.”

We spoke with seven patients who were all complimentary about the care they received. Comments from patients included; “They’re always really good. The nurses are friendly and kind”; “It’s been fine. I’m a new patient and they really go to town about your health” and “I’ve been here for about 35 years and they are very good.”

The practice had in place safeguarding policies for both children and vulnerable adults. There was an identified lead clinician with clear roles and responsibilities to oversee safeguarding within the practice.

The practice was well organised and presented as clean, tidy and generally well maintained. There were effective systems in place to reduce the risk and spread of infection.

The provider had a recruitment policy in place. General practitioners and nurses employed within the practice were checked to ensure they had an up to date registration with the appropriate professional body.