Archived: Quincy Rise Surgery

Updated 26 January 2017

Quincy Rise Surgery is a long established practice based in the Brierley Hill area of Dudley. There are approximately 3,370 patients of various ages registered and cared for at the practice. Based on data available from Public Health England, the levels of deprivation in the area served by The Greens Health Centre are above the national average, ranked at eight out of 10, with 10 being the least deprived. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The practice is led by a male single handed GP and the clinical team includes a female salaried GP and two practice nurses; the practice is also supported by a female locum GP who works at the practice on a weekly basis. The principal GP and the practice manager form the practice management team. The practice is supported by a non-clinical team of five staff members who covered reception, administration and secretarial and cleaning duties.

The practice is open between 8am and 6:30pm during weekdays, with extended hours operational on Mondays between 6:30pm and 7:30pm and Thursdays between 6:30pm and 8pm.

Appointments are available from 9am until 11:30am and from 4pm to 6:30pm during weekdays and until a later time of 6:30pm and 7:30pm on Mondays and Thursdays during extended opening hours. There is a GP on call between 8am and 9am each morning and also between 11:30am and 4pm. There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We first inspected Quincy Rise Surgery across two dates on 9 March and 4 April 2016.

As a result of our inspection visits, the practice was placed in special measures and was rated as Inadequate overall. This was because we identified regulatory breaches in relation to regulation 12 for providing safe care and treatment and regulation 17 due to inadequate governance arrangements. As breaches of legal requirements were found we issued the following warning notices:

• A warning notice informing the practice that they were required to become compliant with specific areas of Regulation 12: safe care and treatment HSCA (RA) Regulations 2014, by 17 July 2016.

• An additional warning notice informing the practice that they were required to become compliant with Regulation 17: Good governance HSCA (RA) Regulations 2014, by 6 September 2016.

Furthermore, we identified areas where the provider must make improvements and additional areas where the provider should improve. In addition to the warning notices, a requirement notice was also issued for specific aspects of Regulation 12: safe care and treatment HSCA (RA) Regulations 2014.

We carried out an announced focused inspection at Quincy Rise Surgery on 18 July 2016 to focus on the areas identified in the warning notice for Regulation 12 of the HSCA (RA) Regulations 2014. Although we saw that some improvements had been made, the practice did not fully meet the requirements of the warning notice for Regulation 12: safe care and treatment HSCA (RA) Regulations 2014.

We carried out an announced comprehensive inspection at Quincy Rise Surgery on 23 November 2016. This inspection was conducted to see if improvements had been made in line with the special measures period of six months following publication of the final report. Additionally, we conducted this inspection to focus on the areas identified in the warning notice for 17: Good governance HSCA (RA) Regulations 2014. This inspection was conducted to see if improvements had been made in line with the required completion date of 6 September 2016.

You can read the reports from our previous inspections, by selecting the 'all reports' link for Quincy Rise Surgery on our website at www.cqc.org.uk.

Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

• During our inspection we saw that staff were friendly and helpful and treated patients with kindness and respect. We noted a theme of positive feedback from patients we spoke with during our inspection and across completed CQC comment cards.

• During our previous comprehensive and focussed inspections we found that the practice did not have an effective system in place to ensure that the relevant monitoring was in place prior to prescribing high risk medicines. As part of our most recent comprehensive inspection we saw evidence to support that patients on high risk medications were appropriately monitored and up to date with relevant blood tests.

• During our previous comprehensive and focussed inspections we identified gaps in record keeping which indicated that patients had not received medication reviews in line with their needs. We found that record keeping had significantly improved during our most recent inspection. Practice data demonstrated that patients received regular medication reviews and patients had care plans in place.

• We noted that the practice had worked on many improvements since our previous comprehensive inspection. For instance, risks associated with health and safety, fire and infection control had been formally assessed. The management of staff files had improved significantly and the practice gathered feedback from patients and staff through surveys and by implemented formal action plans. The practice also had effective systems, processes and practices in place to keep people safeguarded from abuse.

• The practice had worked on developing a programme of audits since our previous comprehensive inspection. Some of these audits had been repeated and demonstrated improvements.

• However, we noted in other areas that governance, systems and processes were not always effectively operated to support a well led and open cultured team. We noted that in areas the team was disjointed and although there was a regular programme of meetings in place not all staff were invited to the meetings. Additionally, at the point of our inspection we found that not all staff had received an appraisal. Furthermore the practice did not maximise opportunities to share learning, monitor themes and reflect on events across the whole team.

The areas where the provider should make improvements are:

• Ensure that governance arrangements are established and effectively operated to support a well led and open cultured team.

• Ensure that effective leadership is sustained in the practice in order to enable and support the team to continue to embed improvements.

• Continue to support staff and ensure that a regular programme of appraisals is in place as part of this process.

• Review themes from significant events and complaints and maximise opportunities to share learning and good practice across the whole practice; using these as opportunities to proactively drive improvement.

• Ensure that policies are well embedded to support processes such as chaperoning and review complaints policies to ensure feedback from all avenues are considered, such as online feedback from NHS Choices and verbal complaints.

• Continue to identify carers in order to provide further support where needed.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

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

• The practice offered a range of clinical services which included care for long term conditions.

• Performance for the practices use of QOF between March and October 2015 highlighted that the practices performance for hypertension and diabetes were above local and national averages. This was based on partial data because the practice had adopted a local system for monitoring performance and outcomes instead of QOF. The practice had started piloting this with other local practices from October 2015.

• We saw records of an audit produced by the GP which demonstrated improvements in diabetic control for patients who benefited from taking a specific medication in line with NICE guidelines.

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

• We saw evidence that multi-disciplinary team meetings took place on a monthly basis with regular representation from other health and social care services. We saw that discussions took place to assess and plan ongoing care and treatment for the practices patients with long term conditions. 

Updated 26 January 2017

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

• The practice offered urgent access appointments for children, as well as those with serious medical conditions.

• Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, immunisation rates for five year olds ranged from 75% to 100% compared to the CCG average of 72% to 98%.

• 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. The practice also worked closely with the Health Visitors and Midwife.

• The practice’s uptake for the cervical screening programme was 81%, compared to the CCG average of 78% and national averages of 81%.

Updated 26 January 2017

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 people in its population.

• All of these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

• The practice had effective systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were at risk of admission to hospital and patients who had been discharged from hospital were also discussed on a regular basis.

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

Updated 26 January 2017

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

• 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.
• The practice offered extended hours every Monday between 6:30pm and 7:30pm and every Thursday between 6:30pm and 8pm.
• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group.

• Practice data highlighted that 46 patients had been identified as needing smoking cessation advice and support; all of these patients had been given advice and 30 (65%) had successfully stopped smoking.

Updated 26 January 2017

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

• The practice regularly worked with other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia.

• There were 18 patients on the practices mental health register, 94% of these patients had a care plan in place, these patients were regularly reviewed and 100% of the patients on medication had received a medication review.

• There were eight patients on the practices dementia register, 100% of these patients had a care plan in place, these patients were regularly reviewed and 100% of the patients on medication had received a medication review.

• Local quality data provided by the clinical commissioning group (CCG) highlighted that as of November 2016, the practices practice’s predicted dementia prevalence was 53%, demonstrating that the practice was working towards meeting the local threshold of 55% to 75%.

• The practice supported patients by referring them to a number of support groups, onsite counselling services and further support organisations.    

Updated 26 January 2017

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

• The practice regularly worked with other health and social care organisations in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.

• During our previous comprehensive inspection data provided by the practice highlighted that none of their palliative care patients had care plans in place. We looked at this area as part of our most recent comprehensive inspection. The practices palliative care register had increased to 11 patients. Data provided by the practice highlighted that 90% of these patients had a care plan in place and 100% of the eligible patients had received a medication review in a 12 month period.

• During our previous comprehensive inspection we found that only one of the practices patients with a learning disability had a care plan in place. During our most recent comprehensive inspection we noted that there were nine patients on the practices learning disability register, all of these patients had care plans in place and 100% of the eligible patients had received a medication review in a 12 month period.

• The practice had identified nine patients with drug and alcohol dependencies, these were included in the practice register for vulnerable patients. Practice data highlighted that 78% of these patients received medication reviews within a 12 month period and 90% of these patients had a care plan in place.

• Vulnerable patients were regularly reviewed and discussed as part of the multidisciplinary team meetings to support the needs of patients and their families.