Archived: Broughton House Surgery

Updated 31 March 2016

Broughton House GP Practice is part of Locala Community Partnerships independent Community Interest Company which is a social enterprise. Locala provides NHS community services to over 400,000 people in Kirklees and the surrounding areas. Services are delivered at home and in clinics, schools and health centres by teams of GPs, nurses, health visitors, district nurses, therapists and other health care professionals.

The practice is commissioned by NHS England to provide primary care services under a Standard Alternative Provider Medical Services Contract.

The surgery is purpose built with all services on the ground floor, it is open to all patients living within the practice boundary in Batley and the surrounding areas.

The practice serves 3850 patients. The patient list includes asylum seekers and 7% of the patient list are from black minority ethnic populations.

The team is made up of three GP's, one female and two male. There is a nurse practitioner, a substance misuse shared care nurse, a practice nurse, two healthcare assistants and an administrative team.

Staff have access to the Locala head office management team who oversee the management, performance and governance of the practice.

The practice offers a full general practice service which includes minor surgery, ante-natal and post-natal care.

Opening hours are from 8am to 6pm Monday to Friday.

Appointments are from 8am to 5pm Mondays, 8am to 5.30pm Tuesdays, Wednesdays and Thursdays and 8am to 5pm Fridays.Between 6 and 6.30pm calls are transferred to Local Care Direct.

When the practice is closed out of hours services are provided by Local Care Direct and NHS 111.

Updated 31 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Broughton House GP Practice on 10 December 2015. 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 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.
• Patients said they were not always able to make an appointment with a named GP and that there was not always continuity of care
• An urgent telephone triage service and appointments were 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.

We saw three areas of outstanding practice:

• The service had a shared care specialist drug and addiction service. The GPs and specialist nurse worked closely with other local support services and safeguarding teams to support patients’ recovery and help them to regain their independence.
• The practice had a bespoke clinical information system that assured staff had prompt access to safety alerts, clinical guidelines, information and to report incidents.
• A community fund was available to support local groups and initiatives. For example, the practice were supporting a request from the Patient Participation Group and looking to provide funding for free swimming lessons to underprivileged children. The practice held an annual raffle to raise funds for local charities.

The areas where the provider should make improvement are:

• Ensure the Duty of Candour applies to the procedure for responding to significant events.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 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.
• Patients with long term conditions (LTCs) were offered medication reviews annually or more frequently if required.
• Clinical staff worked together to offer reviews for multiple LTCs in one appointment.
• The practice quality and outcomes framework (QOF) indicators for diabetes were 69% which was below the CCG average of 91% and the national average of 89%. To improve they had joined a local initiative (ASPIRE) to improve care for patients with diabetes.
• The practice engaged with specialists to improve care for patients with complex needs, such as diabetic, heart failure and respiratory specialist nurses and the community matrons.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. For example, e-consultations were used with specialist consultant-led services to support more timely care and reduce the need for outpatient appointments.

Updated 31 March 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.
• The practice offered sexual health services. For example, cervical screening, contraceptive advice and chlamydia testing. Seventy eight per cent of women aged 25 to 65 had a cervical screening test performed in the preceding five years compared to the national average of 82%
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 31 March 2016

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

• Patients over 75 had a named GP coordinating their care, were seen at least annually and offered a review of their care and medication.
• Staff proactively offered influenza, pneumonia and shingles vaccines to those at risk in this category. Flu vaccination rates in the over 65s was 76% compared to the CCG and national averages of 73%
• A risk assessment tool was used to identify vulnerable older people and offer them additional support.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 31 March 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.
• Pre-bookable appointments were 15 minutes long to cover complex or multiple issues and allow time for opportunistic health promotion.
• The triage system allowed patients to be called at a pre-agreed time to fit in with their work schedule.
• The practice were piloting the use of web-based systems for virtual consultations.
• ECGs and 24 hour monitoring of blood pressure were offered in house which reduced the need to refer to hospital.
• The practice was proactive in offering and monitoring use of online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 31 March 2016

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

• The practice held a register of patients with severe mental health problems whom were offered an annual health check of both their physical and mental health.
• The practice had undertaken a review of dementia care in 2014. 77% of people diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months.
• Patients with mental health issues such as depression and anxiety were supported in a variety of ways. For example, GP support, signposted to self-help resources and prescribed exercise groups.
• The practice encouraged patients to self-refer to the local Improving Access to Psychological Therapies (IAPT) service.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It carried out advance care planning for patients with dementia.
• The practice was a registered dementia friendly location and proactively sought to identify patients with dementia by utilising a memory screening tool. The six item cognitive impairment test (6CIT) which is a screening tool used in primary care.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• It 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 people with mental health needs and dementia. Staff telephoned dementia patients an hour before their appointment if they had previously forgotten to attend.

Updated 31 March 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 people, travellers and those with a learning disability.
• Longer appointments of 20-30 minutes were offered for people with a learning disability and non-English speakers to meet their needs.
• Practice staff could speak Urdu and Punjabi. A telephone translation service was used for other languages.
• The practice held alcohol and substance misuse clinics, and offered support to vulnerable and homeless patients.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• It had told vulnerable patients about how to access various support groups and voluntary organisations. For example, services to support people experiencing domestic violence and housing associations.
• 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.