Great Barr Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as Inadequate. At this assessment, the rating has changed to Requires Improvement.

The service was previously in breach of legal regulation in relation to:

• Patients with long term conditions were not being reviewed regularly to ensure they received the appropriate care and treatment.

At the last assessment we found that the management of patients with long term conditions needed improving, patients’ needs were not always assessed and care and treatment was not always delivered in line with current legislation and evidence-based guidelines. We also found there was limited clinical oversight and a lack of supervision.

At this assessment, we found some improvements, however these required further strengthening to ensure all people’s needs were assessed, health conditions were monitored to improve the outcomes for people and there was effective clinical supervision in place.

Patients received care and treatment that supported them to live healthier lives including being supported to undertake national screening programmes and vaccinations. The majority of patients who required monitoring underwent regular checks on their health.

Multi-disciplinary meetings were held where the needs of patients with complex conditions or those approaching the end of life could be discussed, reviewed and planned for.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At the last assessment in November 2024, we found staff were carrying out clinical assessments without the appropriate qualifications or clinical supervision. At this assessment, some systems had been implemented to monitor staff competencies, however we found this required further strengthening to ensure all staff carrying out clinical reviews had the competencies, knowledge or skills and had completed the relevant training. We also found on speaking with some staff they were unaware of the recommended clinical guidelines for the management of long term conditions.

During the remote clinical review, we found patients with long term conditions were not being assessed appropriately. We carried out a clinical search to identify people with diabetes who had a HbA1c of 75 and over. A haemoglobin A1C (HbA1C) test is a blood test that shows your average level of blood glucose over time. We reviewed a random sample of 5 clinical records and found one of the non-clinical staff was coding annual diabetic reviews, however they were not clinically trained in this area and we were unable to gain assurances of clinical oversight. Non-clinical staff can do part of a review in preparation for the GP or trained practice nurse; however, the overall diabetic review requires a clinically trained person to complete. We also found patients with a raised HbA1c were not having their blood tests repeated in a timely manner to check if they had improved or their medicines needed adjustments.

Further reviews of the clinical system showed people with asthma were not receiving adequate assessments when presenting with an exacerbation of asthma. We found inadequate examinations had been completed and people had not been followed up in line with national clinical guidance. We also found asthma reviews were not effective or were overdue.

We found the provider held registers which were reviewed to prioritise care for their most clinically vulnerable patients. However, on reviewing a random sample of records for patients with a Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) in place we found no evidence to demonstrate these had been actioned appropriately.

Further improvements were seen in the assessment of people’s needs with an increase in the number of points awarded through the Quality and Outcomes Framework (QOF). QOF is used to demonstrate a practice’s achievements in monitoring clinical areas. Evidence provided showed significant increases in some clinical domains. For example, in 2023/24 the practice had achieved 26.32% for dementia reviews. Unverified data for 2024/25 showed 100% achievement in this clinical area.

All requests for appointments were triaged by the duty doctor who prioritised patients who reported symptoms that could be considered a clinical emergency. Patients were told when they needed to seek further help and what to do if their condition deteriorated.

Reception staff were aware of the needs of the local community and the provider used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

Systems were in place to identify individuals with caring responsibilities, who were offered an annual review. All patients with a learning disability were invited to attend an annual health assessment.

There were appropriate referral pathways to make sure that patients’ needs were addressed. We spoke with staff who were able to describe the process for coding of correspondence and care and treatment records for people.

Staff we spoke to were aware of the workflow and clinical staff were able to demonstrate how the practice provided further education and support to patients. We found that staff had the appropriate skills and training to carry out reviews where appropriate.

The service did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

At the last assessment, we found the systems in place to monitor people’s health conditions were ineffective and needed strengthening to ensure all patients received the appropriate care and treatment. At this assessment we found further improvements were required. We carried out a review of people with long term conditions and found 42 patients had been prescribed 2 or more steroids due to an exacerbation of asthma. We reviewed a random sample of 5 clinical records and found people had not always been adequately assessed at the time of prescribing the steroids or after in line with evidence-based guidance. Further review of the clinical consultations showed inadequate history of the presenting concern had been recorded and some patients had not been examined. We found some clinical staff who were carrying out the reviews, had no formal training or qualifications in asthma and were unaware of the recommended guidance on following up patients following an asthma exacerbation. On one occasion the wrong dose of steroids had been prescribed by one of the clinical team. A further review of the clinical records showed people were being referred to the local pharmacy for assessment without the patient being seen or assessed by the practice. The Pharmacy First services provided at the pharmacy do not include asthma exacerbation management.

Further reviews showed improvements in other areas of long-term condition management in comparison to our previous findings. We found no cases of potential missed diagnosis of diabetes and the monitoring of patients with hypothyroidism had significantly improved. Following the last assessment in November 2024, the practice had reviewed their pathology filing procedures and had introduced a protocol to assist the clinical team when filing blood results for diabetes to prompt them to review the results were in line with clinical guidelines of diabetes diagnostic ranges. The practice reflected that this new way of working had improved monitoring of potential diabetes risks and had improved patient outcomes.

Leaders told us they had reviewed the systems in line with good practice standards and were reviewing quality improvement through audits and checking care is consistently provided in line with guidance.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

At the last assessment in November 2024, we found no evidence to demonstrate safeguarding concerns were shared or palliative care patients were regularly discussed with community teams. At this assessment we found systems were in place to share information about patients electronically with other services and the provider had implemented a structured approach to meetings ensuring information was shared with the appropriate teams to maintain the care of patients in the community.

Staff told us that they had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support and they had enough information to plan and refer people and receive subsequent results and information following referral.

There were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care. Regular meetings were held with multi-disciplinary teams to ensure care was co-ordinated effectively.

The primary care network (PCN) helped to support the practice by providing links to pharmacists, dieticians, mental health practitioners and social prescribers. People were able to receive co-ordinated care between the practice and the primary care network.

At the last assessment we found there was a lack of systems and processes in place and this had impacted on people received regular reviews and identifying people who may have needed extra support. This included people at risk of developing a long-term condition and carers. We were not assured that people had access to appropriate health assessments and checks.

At this assessment, we found improvements had been made, however we found a continued lack of clinical oversight to ensure systems were regularly monitored. We were unable to gain assurances that there was an effective system in place for monitoring staff carrying out health assessments and the appropriate reviews and advice had been provided. There were alerts on clinical records to show who were vulnerable and required ongoing monitoring, however the recall system needed strengthening to ensure all people with complex health needs and long-term conditions were regularly reviewed and received support to manage their health needs.

We found people with caring responsibilities were offered regular health checks and there was regular engagement with community services and referral pathways in place. The practice website detailed information and links for health promotion, health conditions and common health questions. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. The practice website detailed information and links for health promotion, health conditions and common health questions.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

At the last assessment in November 2024, we found inconsistent approaches to monitoring people’s care and treatment. Some patients had not received an annual review and were not being appropriately monitored to ensure their high-risk medicines and long-term conditions were regularly reviewed. At this assessment we found improvements had been made in the monitoring of people’s medicines and regular reviews were now in place for the majority of patients, however we continued to identify concerns in the lack of supervision of staff carrying out clinical roles. This included patients with asthma and diabetes.

The provider was performing below the national average for cervical screening targets. The practice continued to strengthen systems and had processes in place to recall patients and implement flagging procedures aimed at promoting opportunistic uptake.

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We saw evidence that consent was obtained for patients so that they understood their rights around consent to the care and treatment they were offered. Following the assessment, the results of the latest national GP patient survey were published which demonstrated that 83% of patients were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment. This was a decline in the 2024 results where the practice had achieved 93%.

We found that the practice had coded Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) on people’s clinical records where appropriate. However, on reviewing a random sample of 4 records we found no evidence in 3 records to demonstrate that a DNACPR record had been completed.

All staff had completed training on mental capacity and understood legislation when considering consent and decision making.