Archived: Jubilee Health Centre

Updated 6 December 2017

Jubilee Health Centre is located in the heart of Wednesbury Town, West Midlands within easy reach of the bus station, providing NHS services to the local community.

Based on data available from Public Health England, the levels of deprivation in the area served by Jubilee Health Centre is above the national average, ranked at two out of 10, with 10 being the least deprived (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial). The practice serves a higher than average patient population aged between 45 to 59 and 70 to 85 and over, and has a below average practice population aged between 20 to 24 and 30 to 44. Based on data available from Public Health England, the Ethnicity estimate is 2% Mixed, 13% Asian and 3% Black.

The patient list is approximately 4,320 of various ages registered and cared for at the practice . Services to patients are provided under a General Medical Services (GMS) contract with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG to deliver primary care services to the local community.

The surgery 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. For example, childhood immunisations.

The surgery is situated on the ground floor of a multipurpose building shared with other health care providers. On-site parking is available for patients who display a disabled blue badge and for cyclists. Patients without a disabled blue badge are able to access local pay and display parking facilities. The surgery has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staffing comprises of two male GP partners, one male locum GP, a part time practice nurse, one health care assistant, a practice manager, an administrator, five receptionists and one senior receptionist.

The practice is open between 8am and 7.15pm on Mondays, 8am to 6.30pm on Tuesdays, and Fridays, 8am to 8pm Wednesdays and 8am to 3pm on Thursdays.

GP consulting hours are from 8am to 7.15pm on Mondays, 8am to 6.30pm on Tuesdays, and Fridays, 8am to 8pm Wednesdays; 8am to 2pm on Thursdays. There are arrangements in place with a neighbouring practice where patients are able to access appointments on Thursdays from 3pm to 4pm and Saturdays from 3pm to 4pm.

The practice has opted out of providing cover to patients in their out of hours period. During this time, NHS 111 provides services.

Updated 6 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Jubilee Health Centre on 9 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. We also carried out enforcement actions which required the practice to provide a report outlining what actions they were going to take to meet legal requirements’.

On the 22 May 2017 we carried out a focused follow up inspection to check whether the practice had carried out their plans’ to meet the legal requirements’ as set out in the enforcement actions which detailed breaches in regulations identified in our January 2017 inspection.

The full comprehensive report on the January 2017 inspection and focused follow up report on the 22 May 2017 inspection can be found by selecting the ‘all reports’ link for Jubilee Health Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 26 September 2017. Overall the practice continues to be rated as inadequate.

Our key findings were as follows:

• The practice did not operate an effective recall or checking process for patient’s prescribed high-risk medicines to ensure prescribing was in line with best practice guidelines for safe prescribing.
• Consultation notes were not comprehensive, there were missed opportunities to assess patients who were over using their medicines and care plans lacked detail.

• Systems were in place for reporting and recording significant events. Individual staff were able to explain learning from incidents; however, documents we viewed did not show evidence of shared learning or actions taken in response to safety incidents.

• The practice operated a system to ensure vaccinations in clinical rooms were within their expiry dates. However, a system for monitoring the content of the GP’s bag was not established and we found an out of date medicine.

• The practice demonstrated compliance with relevant patient safety alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA). However, were unable to demonstrate systems to ensure compliance with local alerts.

• Data from the latest published Quality and Outcomes Framework showed variations in patient outcomes compared to the national average. Unverified data provided by the practice showed progression in achieving 2016/17 QOF targets.

• The practice was able to demonstrate how they had used clinical audits in some areas to improve outcomes for patients and the quality of the service provided. However, systems for monitoring whether actions aimed at achieving quality improvement had been carried out were not established.

• Data from the July 2017 national GP patient survey showed patients satisfaction in some areas had declined since our previous inspection. Staff was aware of survey results and made changes in some areas to improve patient satisfaction.
• Care Quality Commission comment cards we received as part of our inspection showed patients felt they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However, some comments highlighted difficulties in making appointments.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• The practice had a leadership structure and staff felt supported by management. However, we found the leadership structure lacked ownership or joint approach to address gaps where improvements where needed. There were areas where governance arrangements were not established, effectively operated or implemented. For example, the practice did not operate effective systems to monitor whether relevant nationally recognised guidance were being followed.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. In particular, management of medicines, ensuring relevant nationally recognised guidance are implemented and followed to reflect best practice to improve patients care and treatment.

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Continue to encourage patients to attend national screening programmes such as breast cancer screening.

• Continue to monitor and ensure ongoing improvement to patient satisfaction in line with local and national averages.

• Ensure effective methods are established for sharing learning from incidents.

• Establish a system for distributing local safety communication with relevant staff within the practice.

• Establish a system for monitoring the content of GPs bag and ensure medicines are within manufacturers’ expiry date.

This service was placed in special measures in January 2017 Insufficient improvements have been made such that there remains a rating of inadequate for providing safe and well-led services. Therefore, we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 December 2017

The provider was rated as inadequate for providing safe, effective and well-led services. The issues identified as inadequate overall affected all patients including this population group.

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

• Overall performance for diabetes related indicators was comparable to the local and national average.

• All these patients had a named GP and 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.

• Staff we spoke with explained that the practice offered a range of services in-house to support the diagnosis and monitoring of patients with long term conditions. These included spirometry, phlebotomy (taking blood for testing).

• The practice were unable to demonstrate how they followed recognised asthma pathways.

• Unverified data from the 2016/17 QOF year provided by the practice showed the percentage of patients with atrial fibrillation (an irregular and sometimes fast pulse) treated using recommended therapy has improved from 68% to 96%, compared to CCG average of 86% and national average of 87%; with a zero percent exception reporting rate.

Updated 6 December 2017

The provider was rated as inadequate for providing safe, effective and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• 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. However, systems for ensuring the practice safeguarding list remained up to date and to ensure alerts were being placed on patients records were not effective.

• Immunisation rates were comparable to local and national averages for all standard childhood immunisations. Eight week baby checks were undertaken and patients who missed appointments were recalled and referred to the Health Visiting Team following three missed appointments.

• Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

• The practice’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 80% and the national average of 81%. Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 6 December 2017

The provider was rated as inadequate for providing safe, effective and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• The practice offered personalised care to meet the needs of the older people in its population. All patients had a named GP.

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

• Members of the clinical team visited local nursing and care homes to provide patient care, older patients were offered carers support if needed.

• The practice provided health promotion advice and literature which sign-posted patients to local community groups and charities such as Age UK.

• The practice was accessible to those with mobility difficulties.

Updated 6 December 2017

The provider was rated as inadequate for providing safe, effective and well-led services. The issues identified as inadequate 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.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice offered travel vaccinations available on the NHS and staff sign posted patients to other services for travel vaccinations only available privately such as yellow fever centres.

• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.

• Data from the July 2017 national GP patient survey indicated that the practice was below local average regarding opening times; experience and convenience of making appointments.

Updated 6 December 2017

The provider was rated as inadequate for providing safe, effective and well-led services. The issues identified as inadequate overall affected all patients including this population group.

• 95% of patients diagnosed with dementia had their care plan reviewed in a face-to-face review in the preceding 12 months (01/04/2015 to 31/03/2016), compared to CCG and national average of 84%. Unverified data from 2016/17 QOF year showed exception reporting rate had reduced from 17% to 3% compared to CCG and national average of 7%. However, an anonymised sample of care plans we viewed were not comprehensive and lacked detail.

• QOF data showed performance for mental health related indicators was comparable to the national average. For example, 90% had a care plan documented in their record in the preceding 12 months, compared to the CCG average of 91% and national average of 89%.2016/17 unverified data provided by the practice showed performance was 81%,exception reporting rate improved from 55% to 0%, compared to CCG average of 15% and national average of 13%.

• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health. For example, the practice offered a counselling service for anxiety and depression, where a counsellor visited the surgery.

• Staff we spoke with explained that patients experiencing poor mental health were told 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 an understanding of how to support patients with mental health needs and dementia.

Updated 6 December 2017

The provider was rated as inadequate for providing safe, effective and well-led services. The issues identified as requiring inadequate overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• 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; staff explained that vulnerable patients who lived alone were signposted to carers support services.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff we spoke with 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. However, staff was not always applying alerts to patient records which notified staff of safeguarding concerns.