Archived: Ambar Medical Centre

Updated 21 March 2016

At the time of the inspection the provider Ambar Medical Centre was a member of Walsall Clinical commissioning Group (CCG) and provided primary medical services to approximately 2300 patients. Since the inspection the provider has retired from the practice and has cancelled their registration with CQC. An application from a new provider is in progress. Patients at the practice continue to receive primary medical services at this location.

The practice employed a practice nurse, who worked 13 hours per week and a practice manager. They were supported by a team of administrative/reception staff.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care.

The practice is open from 8.30am to 7.45pm on Mondays, 8.30am to 6.30pm Tuesdays to Thursdays and 8.30am to 12 noon on Fridays. Appointments were available from 10.30am to 12.30pm Monday to Friday with the exception of Tuesdays where the Baby Clinic ran from 9am to 11am. Routine appointments were available between 11.30am and 12.30pm. Appointments were available until 12 noon on a Friday. Evening appointments were available on Mondays between 4.45pm and 7.45pm and 4.00pm to 6.00pm Tuesdays to Thursdays.

The practice does not have a website.

The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. When the practice is closed during out of hour’s patients can access general medical advice by contacting Badger which is an out-of-hours service provider.

We reviewed the most recent data available to us from Public Health England which showed that the practice is located in an area with a high deprivation score. Data also showed that the practice had a higher than average practice population of patients under the age of 20 in comparison to other practices nationally and a much lower percentage of patients over the age of 45.

The practice achieved 81.9% points for the Quality and Outcomes Framework (QOF) for the financial year 2014-2015. This was below the national average of 93.5%. QOF is the annual reward and incentive programme which awards practices achievement points for managing some of the most common chronic diseases, for example asthma and diabetes.

Updated 21 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ambar Medical Centre on 4 November 2015. Overall the practice is rated as inadequate.

The provider of Ambar Medical Centre is no longer registered with CQC having retired from the practice in December 2015.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment.
• The practice did not routinely identify, record and analyse significant events in order to identify areas of learning and improvement and so mitigate the risk of further occurrence.
• Arrangements were in place to safeguard children and vulnerable adults from abuse, and local requirements and policies were accessible to all staff.
• Patient outcomes were difficult to identify as there were no systems in place to provide accurate performance data.
• Most patients we spoke with on the day were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had limited formal governance arrangements to manage and assess the risk and quality of the service it provided.
• Electronic patient records were not always complete and available in a timely manner.
• It was not always evident from patient records that reviews to medication had taken place or risks considered.

If the provider had still been registered with CQC we would set out the following requirements.

The provider must:

• Ensure appropriate assessments of the risks to the health and safety of patients receiving the care or treatment and doing all that is reasonably practicable to mitigate any such risks.
• Ensure that the practice have robust recruitment arrangements so they are assured that staff providing care or treatment to patients have the qualifications, competence, skills and experience to do so safely.
• The practice must risk assess the need to undertake Disclosure and Barring Service (DBS).
• The practice must develop a system to assess, monitor and mitigate the risks relating to the health, safety and welfare of patients, for example the use of audits, patient feedback and the management of and learning from significant events.
• The practice must maintain an accurate, complete and contemporaneous record in respect of each patient, including a record of the care and treatment provided and of decisions taken in relation to the care and treatment provided.
• The practice must comply with relevant Patient Safety Alerts, recalls and rapid response reports issued from the Medicines and Healthcare products Regulatory Agency (MHRA) and through the Central Alerting System (CAS).
• The practice must implement relevant nationally recognised guidance, including guidelines issued by NICE (National Institute for Health and Care Excellence).

The areas where the provider should make improvement are:

• Consider the benefits to patients and the practice for having registers of patients who may require additional support and care for example patients with learning disabilities and carers.
• The practice should consider the benefits to reviewing the results from patient surveys and developing an action plan to address areas for improvement.
• In the absence of regular team meetings both clinical and non-clinical the practice should consider how they ensure all staff members are kept updated and informed with information relevant to their role.
• In the absence of an Equality impact assessment of the building the practice should consider how they can assure themselves that the all reasonable facilities are available for patients with disabilities.
• Maximise the functionality of the computer system in order that the practice can run clinical searches, provide assurance around patient recall systems, consistently code patient groups and produce accurate performance data.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 March 2016

The practice is rated as inadequate for the care of people with long-term conditions. The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Longer appointments and home visits were available when needed. However, not all these patients had a named GP, a personalised care plan or structured annual review to check that their health and care needs were being met.
• Data showed patient outcomes were low for the locality. For example, performance for diabetes related indicators was 50% which was worse than the CCG and national average of 91.4% and 89.2%.
• Performance for asthma related indicators was 75.6% this was below the CCG and national average of 98.6% and 97.4%
• Incomplete and poorly documented records meant that it was difficult to see whether structured annual reviews had been undertaken to check that patients’ health and care needs were being met.

Updated 21 March 2016

The practice is rated as inadequate for the care of families, children and young people. The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Immunisation rates for the standard childhood immunisations were similar to the national average.
• Staff working at the practice had received safeguarding children training and knew who to contact both inside and outside of the practice.
• Patients at the practice were able to sign up to the Pharmacy First scheme. The scheme aims to speed up access to health services for patients with minor ailments by enabling those who wish to be seen by a community pharmacist.

Updated 21 March 2016

The practice is rated as inadequate for the care of older people. The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• It was responsive to the needs of older people in offering home visits and urgent appointments for those with enhanced needs.
• Care and treatment of older people did not always reflect current evidence-based practice, and some older people did not have care plans where necessary.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mixed.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was lower than the CCG and national averages.

Updated 21 March 2016

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice had extended opening hours on a Monday evening until 7.45pm. This may be beneficial to patients who worked.
• There was no practice website. Facilities were available to book appointments online; however this was not actively promoted to patients.
• Repeat prescriptions could be requested in person or via a pharmacy. There was no system in place to request repeat prescriptions online.
• A GP told us that there had been no NHS Health Checks completed at the practice. An NHS Health Check is available to patients between the ages of 40 and 74 and aims to prevent conditions such as heart disease and diabetes.

Updated 21 March 2016

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice did not hold a register of patients who required support and care for their mental health. Patients who required this care and support did not have care plans and had not been invited to the practice for an annual review of their health needs.

Updated 21 March 2016

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The provider was rated as inadequate for safe, effective and well-led and requires improvement for caring and responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice had a register of 11 patients with learning disabilities. None of these patients had been invited to the practice for an annual review of their health. None of the 11 patients had a care plan in place to support their continued health needs.