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Halcyon Medical Limited Requires improvement Also known as Halcyon Medical Practice

Inspection Summary


Overall summary & rating

Requires improvement

Updated 11 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Halcyon Medical Limited on 10 January 2016. Overall the practice is rated as requires improvement.

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

  • The practice was proactive in identifying, managing and learning from significant events, incidents and complaints.

  • We saw some evidence that 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 care and treatment. However, the practice was unable to demonstrate timely care planning to ensure appropriate treatment and optimal outcome for patients.

  • The practice could not demonstrate clinical quality improvement as all audits were single cycle audits. Following the inspection the practice had submitted evidence that an osteoporosis audit had been undertaken in 2016 and this is due to be re-audited in the next five years. A miscarriage audit in April 2016 had been carried and discussed. It was agreed by the team that no changes were needed and no re-audit was necessary.

  • Patients could access appointments and services in a way and at a time that suited them. The practice offered appointments with nurses and GPs on Saturdays and Sundays which was ideal for many patients who worked during normal hours.However, some patients commented that they found it difficult to get an appointment with a GP of their choice.

  • There were longer appointments available for patients when needed. The practice operated a duty doctor system and telephone consultation and urgent access appointments for those with serious medical conditions.

  • The practice had good facilities and was well equipped to treat patients and meet their needs. A lift was available for patients who had difficulty with their mobility.

  • Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Some areas of governance were not always effective. For example, systems and processes to support clear patient specific directions (PSDs) for the healthcare assistant to administer specific vaccinations; systems to review and update staff training and recruitment files and to ensure regular monitoring of practice performance and patient outcomes. There were no systems to review performance against childhood vaccinations. Clinical outcomes for childhood vaccination were below expected levels.

  • There was a leadership structure in place however, some staff members including management staff members had been and/or were on long term leave which had an adverse effect on some aspects of the delivery of the service.

  • Information about services and how to complain was available and easy to understand. Annual trend analysis of complaints was carried out and improvements made to the quality of care as a result.

The areas where the provider must make improvement are:

  • Effective systems must be in place for timely care planning to ensure appropriate treatment, welfare and optimal outcomes for patients

  • Healthcare assistants must have a patient specific prescription or direction from a prescriber in place to administer medicines to patients.

  • The practice must strengthen governance systems and processes to proactively monitor performance and improve quality. For example, demonstrate quality improvement through at least two completed clinical audit cycles. Governance processes must be effective in delivering good quality care through appropriate monitoring of childhood vaccinations; professional registration to ensure the process for managing blank prescription forms complied with national guidance. Improve telephone access for patients to services they require and ensure staff files are up to date including staff identification and registration with their professional bodies.

  • The practice must assess and mitigate risks by monitoring staffing levels to ensure appropriate cover is in place to reduce impact on the day to day management of the service.

The areas where the provider should make improvement are

  • Review national GP patient survey results and explore effective ways to improve patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Updated 11 April 2017

The practice is rated as requires improvement for providing safe services, as there are areas where improvements should be made.

  • There were effective systems in place for reporting incidents, near misses and positive events, as well as comments and complaints received from patients.
  • Lessons were shared to ensure action was taken to improve safety in the practice.
  • The practice had systems, processes and practices in place to keep people safe and safeguarded from abuse. Staff members we spoke with were aware of their responsibilities to raise and report concerns.
  • Cleanliness, equipment and medicines were monitored and maintained.
  • The practice process for the administration of vaccines by a healthcare assistant through PSDs required review along with its process for management of blank prescription pads. Shortly after the inspection a nurse staff member confirmed to us that they had amended their PSD system to ensure a more effective process was being followed.
  • We observed the premises to be visibly clean and tidy. There were adequate arrangements in place to deal with emergencies and major incidents.
  • Some staff members were on long term leave and the practice did not monitor staffing levels to ensure appropriate cover was in place to reduce impact on delivery and management of the service.

Effective

Requires improvement

Updated 11 April 2017

The practice is rated as requires improvement for providing effective services, as there are areas where improvements should be made.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes overall were below local and national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • GPs were reviewing their practice and undertaking quality improvement activity through clinical audits. However, they were single cycle audits and therefore could not demonstrate improvements. Following the inspection the practice had submitted evidence that an osteoporosis audit had been undertaken in 2016 and this is due to be re-audited in the next five years. A miscarriage audit in April 2016 had been carried and discussed. It was agreed by the team that no changes were needed and no re-audit was necessary.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. However, staff files needed to be reviewed to ensure training and registration details for some staff members were up to date and current.
  • There was evidence of appraisals and personal development plans for staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice was unable to evidence that adequate care plans were in place to support vulnerable patients or those patients with more complex needs.

Caring

Good

Updated 11 April 2017

The practice is rated as good for providing caring services.

  • Results from the national GP patient’s survey published in July 2016 highlighted that patients were mostly happy with how they were treated. The practice results for its satisfaction scores on consultations with GPs were mostly in line with CCG and national averages. However, satisfaction score for nurses were slightly below local and national averages.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • The practice sent out text message appointment reminders. If patient no longer need the appointment they could respond to the message reminder cancel their appointment.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice demographics confirmed a younger than average list and therefore, they were only able to identify 0.1% of its patient population as carers. Staff we spoke with advised that they were continuously working on identifying cares to offer them support and carers packs were available in the waiting area.

Responsive

Requires improvement

Updated 11 April 2017

The practice is rated as requires improvement for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example the practice took part in the primary care commissioning framework (PCCF) to improve quality of care. As part of the PCCF the practice offered weekend opening hours.
  • Most of the GP worked set days and hours and some patients said they found it difficult to get an appointment with a named GP. The GPs worked set days and shifts to cover extended hours during the week and at weekends.
  • There was a duty GP system and urgent appointments were available the same day with the GP on duty.
  • Many patients were international students from a local university registered with the practice. The practice engaged with these patients by delivering talks at the university on the NHS system and encouraged them to join a GP.
  • Patients could use on-line access to book appointments directly with the GP of their choice and access their own medical records.
  • The practice was located on the lower ground floor of a city centre chemist and a lift was available for patients who had difficulty with their mobility.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.
  • The practice was rated below local and national averages for some areas of care in the national patient survey. However, relevant staff members we spoke with were unaware of this and were unable to provide evidence that an action plan had been developed to make improvements to patient satisfaction. Following the inspection, the practice forwarded evidence to demonstrate that the results were shared with the Patient Participation group (PPG).
  • Where the practice was made aware that improvements were required action was not taken. For example, the practice regularly received information from the telephone provider that maximum call parameters had been reached when people were waiting for calls to be answered. However, the practice had not taken any action.

Well-led

Requires improvement

Updated 11 April 2017

The practice is rated as requires improvement for providing well-led services, as there are areas where improvements should be made.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients’ and this was displayed in the patient waiting area. Staff were clear about the vision and their responsibilities in relation to it. However, some staff members were on long term leave which impacted the practices ability to deliver this vision.
  • There was a governance framework to support the delivery of good quality care. This included arrangements to monitor and improve quality and identify risk. However, this needed to be further strengthened as there were no plans to monitor and improve performance in areas such as QOF achievement or to maintain adequate record keeping of staff training and registration.
  • The practice had a number of policies and procedures to govern activity and held regular team meetings. The practice held team away days annually to discuss and update on its strategy. However, we saw that the strategy had not been updated since 2015 despite having been revised during the annual away day in 2016.

  • The practice patient participation group (PPG) was active and a member we spoke with told us that the practice acted on their feedback.
Checks on specific services

Older people

Requires improvement

Updated 11 April 2017

The provider was rated as requires improvement for safe, effective, responsive and well led. The issues identified as requiring improvement overall affected all patients including this population group.

  • The practice population comprised mainly of students and working age people. However, the practice offered some services to meet the needs of these population groups. For example, they offered a shingles vaccinations service as well as a home visits. We were told that only one home visit was requested over the last four months.
  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.
  • Many of the elderly patients lived outside of the catchment area but the practice had a flexible approach to registration allowing these patients to stay registered with the practice.

People with long term conditions

Requires improvement

Updated 11 April 2017

The provider was rated as requires improvement for safe, effective, responsive and well led. The issues identified as requiring improvement overall affected all patients including this population group.

  • The practice overall achievement for QOF was below local and national averages. Management staff we spoke with were unaware of this and therefore there were no plans in place to make improvements.
  • The practice explained that they had a large number of students registered at the practice. Many of these students moved out of the city after completing their studies without informing the practice and this made it difficult for the practice to engage these patients for any check-up or reviews.
  • Due to poor uptake the practice stopped offering dedicated clinics for long term conditions and instead offered flexible appointments for long term conditions to suit patient needs.

  • Performance for overall diabetes related indicators was 88%, compared to the CCG average of 88% and national average of 90%.

  • The percentage of patients with hypertension having regular blood pressure tests was 88%, compared to the CCG average of 82% and national average of 82%.

  • Longer appointments and home visits were available when needed.

Families, children and young people

Requires improvement

Updated 11 April 2017

The provider was rated as requires improvement for safe, effective, responsive and well led. The issues identified as requiring improvement overall affected all patients including this population group.

  • Immunisation rates for the standard childhood immunisations were below local and national averages.
  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.
  • Data from 2015/16 showed that the practice’s uptake for the cervical screening programme was 78% and was comparable to the CCG average of 78% and national averages of 81%.
  • Appointments were available outside of school hours. The practice was open on Saturdays and Sundays and appointments were prioritised for working patients and families. The premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives and health visitors.

  • The practice supported parents of children admitted to the nearby children’s hospital through temporary registration at the practice.

Working age people (including those recently retired and students)

Requires improvement

Updated 11 April 2017

The provider was rated as requires improvement for safe, effective, responsive and well led. The issues identified as requiring improvement overall affected all patients including this population group.

  • 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.
  • Most patients registered at the practice were students and people working in the centre of Birmingham. Many of the patients were international students and the practice engaged with these patients by delivering talks to them about the NHS system and to encourage them to register with a GP.
  • Patients could access appointments and services in a way and at a time that suited them.

Appointments could be booked over the telephone, face to face and online (directly with the GP of their choice and access their own medical records).

  • The practice offered weekend appointments and prioritised these for working patients and families.
  • The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group including sexual health services. The practice had good links with a local young people’s mental health services.

People whose circumstances may make them vulnerable

Requires improvement

Updated 11 April 2017

The provider was rated as requires improvement for safe, effective, responsive and well led. The issues identified as requiring improvement overall affected all patients including this population group.

  • The practice was located in a city centre chemist in Birmingham. The practice had registered homeless and refugee patients and staff members demonstrated adequate understanding of their needs to enable them to access a range of health and social services required to meet their needs.
  • The practice offered longer appointments for vulnerable patients including those with a learning disability.
  • The practice had a list of vulnerable patients but could not demonstrate if care plans were in place for any of these patients.
  • 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 such as mental health 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.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 11 April 2017

The provider was rated as requires improvement for safe, effective, responsive and well led. The issues identified as requiring improvement overall affected all patients including this population group.

  • 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the local CCG of 83% and the national average of 84%. The practice exception reporting was 0% which was better than the local CCG and national exception reporting of 7%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • A staff member employed by Birmingham Healthy Minds held clinics twice weekly and patients were seen through a referral process by their GP.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Most of the patients registered at the practice were students and those working in the city centre of Birmingham. The practice had good links with a city centre drop in service (Pause) providing mental health support for people aged 0-25.

  • Data we looked at before out inspection confirmed that the practice carried out advance care planning for patients with dementia. However, the practice was unable to show us any care plans on the day.