Archived: Falcon Medical Centre

Updated 21 April 2016

Falcon Medical Centre is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

Falcon Medical Centre is registered with the Care Quality Commission to provide primary medical services. The practice has a general medical service (GMS) contract with NHS England. Under the GMS contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care.

The practice is located in a purpose built accommodation. Based on data available from Public Health England, deprivation in the area served is higher than the national average. The practice has a registered list size of approximately 2000 patients.

The practice is open between 8.15am to 12.15pm Monday to Friday and between 4.30pm and 7.30pm on a Monday, 4pm to 5.45pm on a Tuesday, Thursday and Friday. The practice closes on a Wednesday afternoon. Consulting hours are 8.30am to 11.30pm Monday to Friday, 4.30pm and 7.30pm on a Monday, 4pm to 5.45pm on a Tuesday, Thursday and Friday. When the practice is closed patients receive primary medical services through other out-of-hours providers.

The practice is a single handed practice. Staffing includes the principal GP (male), two part time long term locum GPs (male and female), a practice nurse (female), health care assistant and a team of administrative staff which included a practice manager who support the daily running of the practice.

The practice has not previously been inspected by CQC.

Updated 21 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Falcon Medical Centre on 28 January 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not implemented well enough to keep them safe. For example, risks relating to staffing, infection control, the premises, equipment and unforeseen events were not well managed to ensure appropriate mitigating action was taken.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Appropriate recruitment checks were not consistently in place for staff who worked at the practice.
• We identified infection control risks including the inappropriate storage of outside equipment in treatment rooms.
• Ongoing disputes in relation to the premises meant there were risks to business continuity and maintenance issues going unaddressed. There were no definite plans in place to manage this risk.
• There was a chaotic approach to staff training and some staff undertook roles and responsibilities for which there was limited evidence of supervision and opportunities to maintain and update those role specific skills.
• Staff did not demonstrate a good understanding in their responsibilities to information governance.
• The majority of patients said they were happy with the service they received and that they were treated with dignity and respect.
• Information about how to complain was available but complaints were not consistently well managed.
• Patients found it easy to make an appointment with same day urgent appointments available.

The areas where the provider must make improvements are:

• Ensure robust systems are in place for identifying and managing risks to the service and patients. Including risks relating to staffing, infection control, the premises, equipment and unforeseen events.
• Ensure recruitment arrangements include all necessary employment checks for all staff working at the practice.
• Ensure robust processes are in place for the management of infection prevention and control in the practice.
• Ensure staff receive appropriate support, training and supervision to ensure they are competent for their roles and responsibilities undertaken.
• Review complaints process to ensure complaints are consistently handled in a timely manner.
• Review the business continuity plan to ensure that staff have access to all the necessary information required in the event of disruption to the service.

The areas where the provider should make improvement are:

• Review emergency medicines to ensure they cover potential medical emergencies.
• Establish systems so that all clinical staff can access and have opportunities to discuss with others new and best practice guidance.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take 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 practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 April 2016

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

The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, some examples of good practice.

• All clinical staff including the practice nurse and health care assistant had lead roles in chronic disease management.
• Nationally reported outcome data for patients with diabetes was below the CCG and national average overall (83% compared with the CCG and national average 89%).
• Home visits, longer appointments and same day appointments were available for those who needed them.
• Personalised care plans were in place for those with the most complex care needs.
• Patients identified with long term conditions were invited for regular reviews of their health condition to ensure their health and care needs were being met.

Updated 21 April 2016

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

The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, some examples of good practice.

• Immunisation rates for most standard childhood immunisations were higher than the national average.
• Nationally reported data found 79% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months, this was higher than both the CCG average of 74% and national average of 75%. Asthma review clinics were being run in school holidays to encourage attendance.
• The practice’s uptake for the cervical screening programme during 2014/15 was 80% which was comparable to the CCG average of 79% and national average of 82%.
• Appointments were available outside of school hours and the premises were accessible for pushchairs. However, there were no designated baby changing facilities available.
• Six week mother and baby checks were carried out at the practice.

Updated 21 April 2016

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

The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, some examples of good practice.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mixed. For example, outcomes for patients with COPD, diabetes and heart failure were lower than the CCG and national averages but higher for stoke and hypertension.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was higher than the CCG and national averages at 76%. Shingles vaccination was also available for eligible patients.
• Home visits were available for older people when needed.
• The practice was accessible to patients with mobility difficulties.
• The practice undertook visits at two large nursing homes. There was mixed feedback from these homes relating to the quality of care provided.
• Multidisciplinary team meetings were held to discuss those with end of life care needs, these were attended by the practice nurse.

Updated 21 April 2016

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

The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, some examples of good practice.

• Online booking of appointments was not available. Appointments could only be booked by telephone or in person, however there were extended opening on a Monday for the convenience of patients who worked or had other commitments during the day. Patients rated access to services higher than CCG and national averages.
• Patients on repeat medicines could have their prescriptions sent to their chosen pharmacy for convenience.
• The practice offered some health promotion and screening that reflected the needs for this age group. Health checks for were offered to patients aged 40-74 years. Practice data told us that they had undertaken 338 health checks during 2014/15.
• Travel vaccines were available (with the exception of Yellow Fever).

Updated 21 April 2016

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

The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, some examples of good practice.

• Nationally reported outcome data for patients with poor mental health was above the CCG and national average overall (100% compared with the CCG average of 92% and national average 93%).
• The principal GP had experience of working within the child and adult mental health services enabling them to support this group of patients within the primary care setting.
• The practice was aware of support services available for patients with poor mental health such as Birmingham Healthy Minds where patients could receive advice, counselling and support.
• 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG average of 82% and national average of 84%.

Updated 21 April 2016

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

The provider was rated as inadequate for safety and for well-led and requires improvement for effective and responsive. The issues identified as inadequate overall affected all patients including this population group. There were, however, some examples of good practice.

• The practice had identified some patients who were living in vulnerable circumstances, for example, there was a register for patients with a learning disability and carers within the practice had been identified.
• The practice told us that it offered longer appointments for patients who needed them.
• A carers hub had been set up by the practice in conjunction with the mental health trust which met every two months and provided support for patients’ health and wellbeing. The carers hub was a pilot project open to carers registered with this and two other practices within the locality.
• Staff 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.