We carried out an inspection at the head office site, Bromley GP Alliance Limited on 28 January 2019, as part of our GP provider at scale pilot. This was to assess the centralised functions within Bromley GP Alliance Limited. Bromley GP Alliance provides services from various locations. The services include extended hours primary care services; community dermatology, headache and vasectomy services; a phlebotomy service and the provision of NHS health checks for people aged 40-74. We undertook the site visits on 12 March 2019 and 14 March 2019, as part of our inspection programme. Bromley GP Alliance Limited provides some services which are not regulated by the CQC. Therefore, at Bromley GP Alliance Limited, we were only able to inspect the services which were subject to regulation.

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 service as good overall.

We found that:

• The service 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 way the services were led and managed promoted the delivery of high-quality, person-centre care. Leaders had the capacity and skills to deliver high-quality, sustainable care. They had a shared purpose, strived to deliver and motivated staff to succeed.
• Staff told us they felt supported and engaged with managers and there was a strong focus on continuous learning and improvement at all levels of the organisation.
• The service organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Feedback from patients who used the service, those close to them and external stakeholders was continually positive about the way staff cared for patients.

We saw several areas of outstanding practice:

• The practice provided a headache service exclusively for patients of Bromley. Rather than patients being referred to secondary care, their GPs could refer them to this service. The service was very popular, so the provider put on an additional clinic which reduced the waiting times for patients. Initially when the service started they were providing six routine appointments a week, due to the demand the provider increased the appointments offered and started providing 13 appointments a week. This meant it reduced the waiting times of patients suffering from severe headaches including cluster headaches, episodic tension headaches, medication overuse headaches and migraines. Prior to this service being offered we were told the average waiting time for a hospital referral could be five months, with this service the average waiting time was two months or less. The lead doctor who provided this service was also training local GPs with an interest and raising local awareness of the service to ensure the service was well embedded and sustainable in the longer term.
• Bromley GP Alliance (BGPA) was responsible for chairing the Integrated Care Networks multi-disciplinary meetings to improve patient care and develop services in the community. This initiative had seen over a 30% reduction in patients being admitted for non-elective care in the cohort (around 2000 patients) that had been through the system.

Whilst we found no breaches of regulations, the provider should:

• Consider producing patient leaflets in other languages.
• Review the need for a hearing loop at the headache service.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care