Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brookvale Practice on 8th September 2015.

Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were assessed and well managed

• The practice used innovative and proactive methods to improve patient outcomes, for example, through its use of screening services and health promotion.

• There was a robust system in place to undertake audits of the operation of the practice and improve patient care.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• The practice was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. There was a clear leadership structure and staff felt supported by management.

We saw several areas of outstanding practice including:

• The practice proactively engaged patients to promote their well-being. The practice had run several events to raise patient awareness of health conditions and promote good health. For example, a talk was given to patients about mammography screening to improve mammography uptake. This event was held in the evening to promote attendance. A health promotion evening was held were male patients were invited for a range of health checks such as blood pressure, body mass index (BMI) and glucose monitoring. Information stands were available and a presentation was given by one of the GPs about prostate cancer risk. This event was well attended and helped to identify several patients who required follow up. The Fit for 15 campaign was introduced this year to increase the cardiovascular screening of patients aged 18 and over. In the last 12 months the practice had completed 478 health checks compared with 253 the previous year.

• The practice had strategies in place to identify long term conditions early and therefore improve patient care. For example, to identify patients at risk of chronic obstructive pulmonary disease (COPD) spirometry was offered to smokers aged 35 and over. This strategy had been in place for a number of years and this work gained recognition with a prize from the International Primary Care Respiratory Group. The practice also took pulse checks at each chronic disease review and at flu clinics and had an ECG on site to identify patients at risk of atrial fibrillation. Data showed that Brookvale Practice had more patients with atrial fibrillation than other practices within the CCG. A one day event was also held were practice staff visited the homes of patients who were overdue a blood pressure check to carry out this health screening and promote patient wellbeing.

• The practice provided examples of audits to demonstrate that audit and quality improvement were central to the operation of the practice. The practice had been recognised by the RCGP Mersey faculty having won prizes for an audit of diabetes care and an audit of peripheral vascular disease.

• Home visits were undertaken to housebound patients and patients that were hard to engage. The nursing team dedicated two days per week to home visits which included long term condition reviews and immunisation. The effectiveness of this approach (together with extended hours and publicity) was shown in data demonstrating flu vaccine uptake for 2014. For example, the practice had vaccinated 61.5% of the patient population under 65 and at risk compared to 45.7% and 46.9% at two neighbouring practices with a similar patient population. Quality and Outcomes Framework (QOF) Performance also showed the effectiveness of this approach. For example, performance for diabetes assessment and care was higher than the national averages. For example, the percentage of patients with diabetes who had received foot screening was 94% when compared to the national average of 88%. The percentage of patients who had received a blood pressure reading in the last 12 months was 85% compared to the national average of 78% and the percentage of patients who had received an albumin: creatinine ratio test was 94% compared to the national average of 85%.

• The practice provided a range of services to demonstrate that it was person centred in its approach to patient care and that it recognised and respected the totality of patients’ needs. The practice had close links with the Halton Carers Association and a representative from the association attended practice meetings such as the avoiding unplanned admissions to hospital and palliative care meetings so they were able to identify any support needed by carers and act promptly. A carer’s register was maintained. Information publicising services for carers was available in the waiting area and on the website. Text messages were sent to carers notifying them of events and useful information. For example, carers had recently been sent a text message about a non-means tested allowance available to them for breaks. Staff told us that if families had suffered bereavement, their usual GP contacted them or sent them a sympathy card. A Christmas present or hamper was provided to older patients with no family. The practice had signed up for the Safe in Town scheme and provided a safe haven for vulnerable people (vulnerable people were able to come to the practice and the person’s carers would be contacted). In 2014 the practice was awarded a grant to develop a community garden at the practice. Patients worked to create the garden which provided exercise and reduced social isolation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Brookvale Practice on 22 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.