Archived: Grange Hill Surgery

Updated 7 April 2017

Grange Hill Surgery is located in the Kings Norton suburb of Birmingham. The practice holds a General Medical Services (GMS) contract, a nationally agreed contract commissioned by NHS England. There are 2,400 registered patients.

There is a higher than average proportion of patients of both sexes aged 45 to 49 years and those aged 65 to 79 years registered with the practice.

The practice is managed by the partnership of a female GP and one non-clinical partner who has the executive management role including practice manager. Clinical work is further supported by regular locum GPs. The practice employs a practice nurse who carries out reviews of patients who have long term conditions such as; diabetes, asthma and hypertension. They also provide cervical screening and contraceptive services. The practice uses a regular locum health care assistant (HCA) who carries out duties such as, phlebotomy (taking blood for testing), health checks and vaccinations. The practice also employs a practice manager, two administrators/senior receptionists and one administrator/receptionist.

The practice offers a range of services for chronic disease management and minor surgery.

The Practice employs a research nurse who is funded by the National Institute for Health Research (NIHR), who is undertaking studies of a range of illnesses such as, blood pressure monitoring in differing ethnic groups.

There is a dedicated parking area for patients. There is a toilet that is adapted for use by people who have restricted mobility. There are two consulting rooms, a nurse’s room and a treatment room.

The practice is open from 8.30am until 6.30pm every weekday with the exception of Wednesdays when the practice closes at 1pm. Patients who contact the practice between 8am and 8.30am each day and Wednesday afternoons are directed to the South Doc out of hours’ service as part of an agreed contract.

Appointments times are:

• From 9am until 11am each weekday

• From 4pm until 6pm Mondays, Tuesdays, Thursdays and Fridays.

• Extended opening hours are provided by pre-bookable appointments with the practice nurse from 6pm until 8pm every Tuesday.

• Requests for home visits may be contacted by telephone to enable GPs to prioritise which patients should be visited first.

The practice has opted out of providing GP services to patients out of hours. During these times GP services are provided by South Doc In Hours Services Ltd GP cooperative. When the practice is closed, there is a recorded message giving out of hours’ details. The practice leaflet includes contact information and there are out of hours’ leaflets in the waiting area for patients to take away with them. Information is also on the practice website.

Updated 7 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grange Hill Surgery on 11 January 2017. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Significant events were investigated, acted on when necessary. All opportunities for learning from internal and external incidents were maximised to support improvement.

• Risks to patients were assessed and well managed. There were safe systems for prescribing medicines. Clinical staff processes ensured that patients received safe and appropriate care and this was clearly documented.

• Staffing levels were monitored to ensure they matched patients’ needs. Appropriate recruitment checks were carried out.

• Practice staff were using proactive methods to improve patient outcomes and staff linked with other local providers to share best practice. For example, clinical staff had identified patients who had complex diabetes needs and a consultant saw those patients at the practice.

• Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Accessible information was provided to help patients understand the care available to them.

• Senior staff had developed partnership with a specialist organisation to provide access to videos regarding healthy living and management of long term conditions. All videos were available online to patients in their homes. Patients were given leaflets about this and by the date of our inspection 62 patients had taken up this service. Practice leads had developed two videos which were being converted to digital format to assist patient access via the website. Additional videos were played constantly in the waiting area including dementia, looking after a child with fever and NHS health checks.

• Data from the National GP Patient Survey published July 2016 showed that patient satisfaction in respect of access to the service and the standard of care were rated above the local and national averages. Patients said they found it easy to make appointments and there was continuity of care, with urgent appointments available the same day.

• Information about how to make a complaint was readily available and easy to understand. Complaints were dealt with in a timely and appropriate way.

• The practice had a clear vision which had quality and safety as its top priority. High standards were promoted and owned by all practice staff with evidence of team working. There was a business plan that was monitored and regularly reviewed. Management sought feedback from patients, which it acted on.

• The delivery of high quality care was assured by the leadership, governance and culture and culture within the practice. Clinical staff were consistent and proactive through a targeted approach towards health promotion, care and treatment of its population groups.

We saw an area of outstanding practice:

• All locum and regular session GP holders were provided with a purpose designed template to record difficult and challenging patient consultations, referrals, path lab reports and areas of concern including safeguarding issues. A debrief meeting was held by the lead GP at the end of their session to review all patients seen during the session and discuss management of complex and challenging cases. Following absence of the lead GP all templates generated were reviewed and any identified actions were carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 April 2017

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

• Patients with long-term conditions had structured annual reviews to check that their health and medicine needs were being met. Where necessary reviews were carried out more often.

• Clinical staff worked with health care professionals to deliver a multidisciplinary package of care for patients.

• Where necessary patients in this population group had a personalised care plan in place and they were regularly reviewed.

• Data for 2015-2016 showed that the percentage of patients with diabetes who had received a foot examination within the last 12 months was 99%; which higher than the CCG average of 91% and the national average of 89%.

• The Practice had developed partnership with a specialist organisation that provided patient access to videos regarding healthy living and management of long term conditions. Statistics showed that patients were using this service.

Updated 7 April 2017

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

• There were systems to identify and follow up children living in disadvantaged circumstances and who were at risk.

• Alerts were put onto the electronic record when safeguarding concerns were raised.

• There was regular liaison and meetings with the health visitor to review those children who were considered to be at risk of harm.

• The practice had developed its own initiative on child safety that included the storage of and inappropriate access to medicines. 

• All children up to the age of 12 years were triaged and if necessary seen the same day.

• Patients and their children told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Practice staff ensured that late afternoon appointments were available for children to attend between 4pm and 6pm each day except Wednesdays when the practice was closed.

• Childhood vaccinations were in line with the local and national averages.

• Data for 2015-2016 informed us that the cervical and breast screening rates were in line with local and national averages.

Updated 7 April 2017

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

• There was a higher than average number of older patients registered with the practice. The practice offered personalised care to meet the needs of this population group.

• Nationally reported data showed the practice had good outcomes for conditions commonly found in older patients. For example, the review rate for patients who had chronic obstructive pulmonary disease was 98%, compared with a CCG average of 90% and national of 89%.

• Staff were responsive to the needs of older patients, including offering home visits and rapid access appointments for those with enhanced needs, health checks and vaccinations.

• The care of older people was managed in a holistic way. Regular multidisciplinary meetings were held that promoted provision of seamless and up to date care.

• Practice staff worked with other agencies and health providers to provide patient support. For example, Age UK.

Updated 7 April 2017

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

• The practice nurse provided extended hours from 6pm until 8pm every Tuesday. The practice nurse told us they mainly saw patients for reviews of their diabetes and for cervical screening. We saw that the uptake of this service was good.

• Telephone consultations were available for those patients who found it difficult to attend the practice or if they were unsure whether they needed a face to face appointment.

• Online services were available for booking appointments and ordering repeat prescriptions.

• Health promotion advice was available and there was a full range of health promotion material available in the practice. The practice website gave advice to patients about how to treat minor ailments without the need to be seen by a GP.

• Staff actively encouraged patients to attend for health screening, such as, breast and bowel cancer.

• NHS health checks were offered to all patients between the ages of 40 and 74 years. This was an opportunity to discuss any concerns patients had and for clinical staff to identify early signs of medical conditions. The uptake since April 2016 was 150, this represented 89% of the Public Health target set for this group.

Updated 7 April 2017

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

• Patients who experienced poor mental health were offered an annual physical health check.

• Data for 2015-2016 showed that 100% of patients who experienced poor mental health had agreed care plans in place;

• GPs carried out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. This enabled staff to put a care package in place that provided health and social care support systems to promote patients well-being.

• Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experienced poor mental health, including those with dementia.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• Referrals to other health care professionals were made when necessary such as; the mental health team and Birmingham Healthy Minds who offered advice and support.

Updated 7 April 2017

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

• The practice held a register of patients living in vulnerable circumstances including those who had a learning disability.

• Health reviews of all 18 patients who had a learning disability had been carried out for 2015-2016.

• Practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• There was a process in place to signpost vulnerable patients to additional support services.

• Staff knew how to recognise signs of abuse, the actions they should take and their responsibilities regarding information sharing.

• There was a clinical lead for dealing with vulnerable adults and children.

• The practice had identified 3% of their patients as carers and maintained a register. Clinical staff offered guidance to carers, signposted them to support groups and offered them the influenza vaccination each year.