Clement Road Medical Practice

Updated 22 May 2017

Clement Road Medical Practice is a long established practice located in the Halesowen area of the West Midlands. There are approximately 3400 patients of various ages registered and cared for at the practice. 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 clinical team includes a male principal GP and a male GP partner, as well as an advanced nurse practitioner and two practice nurses. The principal GP, GP partner and the practice manager form the practice management team and they are supported by a team of seven staff members who cover financial, secretarial, administration and reception duties. The practice also employs a cleaner and a long term locum GP works at the practice every Friday.

The practice is open for appointments between 8am and 6:30pm Monday to Friday. During the winter pressure period the practice also offers appointments every Saturday between 9am and 12pm, this service is available until June 2017. There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 22 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clement Road Medical Practice on 25 August 2016. Overall the practice is rated as good.

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

• We observed a patient-centred culture and we saw that staff treated patients with kindness and respect. Patients we spoke with and the completed comment cards we received described staff as helpful, caring and respectful.

• The practice was proactive in identifying and managing significant events. Opportunities for learning from internal and external incidents were maximised.

• The practice had some systems and processes in place to keep people safe and safeguarded from abuse however these were not always effective across all areas. The practice did not actively review or follow up on children who had missed hospital appointments. Additionally, the practice could not demonstrate that nurses received medicines and device alerts.

• We found that in in some areas governance arrangements were not always fully effective. Although policies and documented protocols were well organised and easily accessible to staff, we found that some of the policies were not current and not practice specific.

• There were some records in place to the support the practices arrangements for identifying, recording and managing risks. However, we found that records were not kept to support that regular fire alarm tests and fire drills had taken place in the practice and the practice had not assessed the risk in the absence of emergency medicine associated with minor surgery and fitting specific contraceptive devices.

• A programme of continuous clinical and internal audit was used to monitor quality and to make improvements. We saw that performance data across areas such as diabetes, dementia and mental health had gradually improved over the last 12 months.

• Although 3% of the practice list had been identified as carers, we found that the practice did not always take a proactive approach to ensure that carers were always supported.

The areas where the provider must make improvements are:

• Ensure that child safeguarding is robust, ensure that missed hospital appointments are reviewed and followed up where required.

• Ensure that all relevant staff members receive medicine alerts and medical device alerts.

• Ensure that fire risk is well managed and ensure that records are kept to demonstrate that fire alarms are regularly tested and that fire drills take place.

• Improve risk management, ensure risk is assessed in the absence of emergency medicine associated with minor surgery and fitting specific contraceptive devices.

The areas where the provider should make improvements are:

• Ensure governance arrangements are robust, policies must be practice specific, well embedded and reflect current guidelines.

• Maximise opportunities to support carers and ensure that supportive information is available in an accessible format.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 October 2016

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

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

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

• QOF performance for 2014/15 for diabetes related indicators was 83%, compared to the CCG average of 89% and national average of 90%. More recent data provided by the practice highlighted that diabetes performance had improved and was at 100%.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The percentage of patients with hypertension having regular blood pressure tests was 100%, with an exception rate of 8%.

Updated 12 October 2016

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

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

• Practice data highlighted that during the last 12 months they had 21 missed hospital appointments for registered patients under the age of 16, however we found that the practice did not follow a system to actively review these instances and follow up where necessary.

• Childhood immunisation rates for under two year olds for 2014/15 ranged from 79% to 97% compared to the CCG averages which ranged from 83% to 98%. More recent data provided by the practice highlighted that immunisation rates for under two year olds ranged from 85% and 94%. Immunisation rates for five year olds ranged from 95% to 100% compared to the CCG average of 93% to 98%.
• Current data provided by the practice highlighted that cervical screening rates had improved since 2014/15 when the practice’s uptake for the cervical screening programme was 66%, compared to the CCG average of 73% and national average of 74%. Current results were in line with the local target of 80%.

Updated 12 October 2016

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

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

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

• Immunisations such as flu vaccines were also offered to patients at home, who could not attend the surgery.
• The practice worked with the local Dudley Council for Voluntary Service (CVS) team to help to provide social support to their patients who were living in vulnerable or isolated circumstances. This included members of the practices older population.

Updated 12 October 2016

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

• The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group. The practice offered a range of clinical services which included minor surgery, family planning, travel and well person clinics.

• Practice data highlighted that 30% of their patients had been identified as needing smoking cessation advice and support and 6% had successfully stopped smoking.
• Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations with a GP at times to suit patients. The practice offered text messaging reminders for appointments to remind patients of their appointments in advance.

Updated 12 October 2016

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

• There were longer appointments available at flexible times for people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice also supported patients who were experiencing poor mental health by referring them to a gateway worker who provided counselling services on a weekly basis in the practice.

• QOF performance for 2014/15 regarding mental health related indicators was 68%, compared to the CCG average of 93% and the national average of 92%. More recent data provided by the practice highlighted that performance for mental health related indicators had improved and was at 100%. However, practice data highlighted that only 63% of these patients had an agreed care plan in place.
• Recent data provided by the practice indicated that appropriate diagnosis rates for patients identified with dementia were at 100%.

Updated 12 October 2016

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

• The practice offered longer appointments for patients with a learning disability.
• There were 31 patients on the practices learning disability register, 68% of these patients had care plans in place and 55% of the eligible patients had received a medication review in a 12 month period.
• Vulnerable patients were regularly reviewed and discussed as part of the multidisciplinary team meetings to support the needs of patients and their families.
• Practice data highlighted that approximately 16% of the practices list were from different ethnic groups and some of these patients did not speak English as a first language. The practice developed an accessible information pack so that patients were able to make specific requests such as information in a particular format or specific support such as translation requirements.