Brook Medical Centre

Updated 4 November 2016

Brook Medical Centre provides primary medical services to approximately 4150 patients through a general medical services contract (GMS). The patient list size is steadily increasing.

The practice has been providing services for 25 years and is situated close to Derby city centre. It occupies premises which were purpose built in 1991. There is car parking; dedicated parking for disabled patients and the practice is accessible by public transport.

The level of deprivation within the practice population is below the national average with the practice population falling into the seventh most deprived decile. Income deprivation affecting children and older people is below the national average. The practice has above average numbers of working age patients.

The clinical team comprises three GP partners (two male, one female), one part-time salaried GP (male), one prescribing nurse, one practice nurses and one healthcare assistant. The clinical team is supported by a practice manager and a team of reception and administrative staff.

The practice opens from 8am to 6.30pm on Mondays, Tuesdays and Thursdays; from 8am to 7.15pm on Wednesdays and from 7.30am to 6.30pm on Fridays. Consulting times are generally from 9am to 11.30am each morning and from 3.30pm to 5.30pm each afternoon. Extended hours appointments are offered on Wednesday evenings with a GP and a nurse and on Friday mornings with a nurse.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Derbyshire Health United (DHU) and is accessed via 111.

Updated 4 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brook Medical Centre on 27 September 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 within the practice. Effective systems were in place to enable staff to report and record significant events. Learning from events was shared with relevant staff.
• Risks to patients were assessed and well managed. A range of risk assessments were in place within the practice to support the ongoing review and management of risk.

• In response to a recent child death enquiry in the Midlands, the practice made the decision to automatically register all babies on receipt of the birth notice rather than waiting for the parents to register them. The practice told us they hoped that this would prevent children being missed and not known to health and care services.

• 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.
• Feedback from patients about their care, and their interactions with all practice staff, was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Most patients said they found it easy to make an appointment with a GP. Urgent appointments were available on the day for patients who needed them. Advanced bookings could be made with no restriction on timescales.

• The practice used clinical audits to review patient care and outcomes had been used to improve services as a result.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice worked effectively with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe.
• There was a clear leadership structure within the practice, and staff felt well-supported by management.
• The practice reviewed the way it delivered services as a consequence of feedback from patients and from staff. For example the practice had recruited a healthcare assistant to support the nursing team following feedback.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 November 2016

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

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

• Performance for diabetes related indicators was 95.9% which was 2.8% above the CCG average and 6.7% above the national average. The exception reporting rate for diabetes indicators was 12.5% which was in line with the CCG average of 13.4% and the national average of 10.8%.

• Performance for indicators related to hypertension was 100% which was 1.4% above the CCG average and 2.2% above the national average. The exception reporting rate for hypertension related indicators was 2.8% which was below the CCG average of 4.1% and the national average of 3.8%.

• Bespoke templates had been developed by the practice to aid the monitoring and management of patients with some long-term conditions. These had been shared with other local practice.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered 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 4 November 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. We were provided with a number of examples of action taken by staff within the practice to protect children from suspected abuse.

• All clinical staff had access to a smartphone application which provided them with accessible information about local child safeguarding information.

• All babies were automatically registered with the practice on receipt of the birth notice to ensure they were entered into the system.

• The premises were suitable for children with dedicated baby changing facilities and a large play area for children.

• Appointments were available outside of school hours with the GP and nurses.

• We saw positive examples of joint working with midwives, health visitors and school nurses. There was a weekly midwife clinic held at the practice.

• All children under five were offered same day appointments.

• Reception staff sent a congratulatory card to parents on the birth of new babies.

Updated 4 November 2016

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

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

• Longer appointments were also provided for older people on request.

• A phlebotomy service was offered in the practice to reduce the need for patients to travel.

• Care plans were in place for older patients with more complex needs. Monthly multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure were in line with local and national averages.

• Older patients had direct access to the practice’s care coordinator who would meet with them as required.

Updated 4 November 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. For example, extended hours appointments were offered one morning and one evening per week. An audit had shown that 86% of these appointments were used by working age people.

• 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.

• Test messaging was used to communicate information to patients.

• Patients could access telephone advice from nurses and GPs.

Updated 4 November 2016

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

• Performance for mental health related indicators was 84.4% which was 12.5% below the CCG average and 8.4% below the national average. The exception reporting rate for mental health related indicators was 6.3% which was significantly below the CCG average of 16.9% and below the national average of 11.1%.

• 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 4.6% above the CCG average and 6% above the national average. This exception reporting rate for this indicator was 4.8% which was below the CCG average of 9.2% and the national average of 8.3%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 dementia.

Updated 4 November 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 those with a learning disability. Homeless people could register with the practice.

• 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 and informed patients 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.