Bramblys Grange Medical Practice

Updated 22 August 2016

Bramblys Grange Medical Practice is situated in the centre of Basingstoke town centre. The practice has approximately 11,700 patients registered with it. There are five GP partners, three of the partners are male and two are female. The practice has three practice nurses, two health care assistants, one practice manager and a team of 13 reception and administration staff.

The practice has slightly higher than the national average number of patients aged 25 to 54 years old. The practice is in one of the third least deprived areas of England. Bramblys Grange Medical Practice has a high multi-cultural mix of patients, and provides a service for patients of no fixed abode. The population is mainly white British, but there are patients of Polish or Romanian ethnicity and a small number of patients who are Nepalese.

The practice is open on Mondays and Tuesdays from 8am until 7.30pm; and 8am until; 6.30pm on Wednesdays, Thursdays and Fridays. Appointments are available with doctors and nurses between these times. When the practice is closed patients are advised to access the out of hours GP service via the NHS 111 Service.

We inspected the only location at:

Dickson House

Basingstoke

Hampshire

RG21 7AP

Updated 22 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bramblys Grange Medical Practice on 8 June 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had a comprehensive action plan in place to address any issues with the organisation of the practice. We found that action had been taken to address shortfalls in reporting and engaging patients in the Quality and Outcomes Framework. Work had been undertaken to improve patient experience and the availability of appointments.

The areas where the provider should make improvement are:

• Continue to review process for handling telephone calls to the practice to maintain confidentiality.

• Review how notices are displayed to make sure patient are aware they can request a chaperone.

• Review recruitment records to include a recent photograph of the member of staff.

• Continue to review arrangements for identifying carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 August 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance data for diabetes indicator were lower than clinical commissioning group (CCG) and national averages. For example, 66% of patients on the register who had a blood cholesterol measurement within acceptable limits; compared with the CCG average of 81%; and the national average of 80%. The practice had taken measures to improve this performance, which included a healthcare assistant visiting patients at home to carry out tests and checks.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 22 August 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Performance data for cervical screening showed that 74% of patients who were eligible had been screened; compared with the CCG average of 81% and national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 22 August 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 22 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 22 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people living with dementia).

• 77% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• Performance for mental health indicators was similar to CCG and national averages. However, we found exception ratings were higher than CCG and national averages. The practice had addressed this and was working to reduce exception reporting.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients living with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and those living with dementia.

Updated 22 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.