Alpha Medical Practice

Updated 19 July 2017

Alpha Medical Practice is a long established practice located in the Alum Rock of Birmingham in the West Midlands. There are approximately 5120 patients registered and cared for at the practice. The levels of deprivation in the area served by the practice are below the national average, ranked at one out of 10, with 10 being the least deprived. The practice serves a diverse population and 98% of its population are Pakistani and Bangladeshi. The practice also serves a higher than average younger population. 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 senior GP partner and a female GP partner. There is also a female salaried GP, a male locum GP and a female locum GP. Both locum GPs have worked at the practice on a long term basis. The nursing service is provided by four locum nurses who have worked at the practice on a long term basis. The practice also employs a physician’s associate and a healthcare assistant.

The GP partners and practice manager form the management team. They are also supported by a team of six support staff that cover reception, secretarial and administration roles.

The practice is open between 8am and 6:30pm and offers appointments between 9:30am and 12:30pm and then from 4pm to 6:30pm during weekdays. There is a GP on call between 8am and 9:30am and during the day between 12:30pm and 4pm. The practice offers extended hours every Monday from 6:30pm until 9pm. There are also arrangements to ensure patients receive urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 19 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Alpha Medical Practice on 31 May 2017. Overall the practice is rated as good.

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

• During our inspection we received positive feedback from patients and staff. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. Significant events, incidents and complaints were used as opportunities to drive improvements.

• Although we saw that was shared learning during meetings, we found that the locum nurses and locum GPs could not always attend the meetings; these clinicians worked at the practice on a regular basis.

• The practice took a proactive approach to understanding the needs of different groups of people, this included identifying patients with different cultural needs in order to offer them support where needed. For example, the practice had tailored their end of life care to meet the specific cultural and religious needs of their population.

• The practice was committed to working collaboratively with other services and healthcare professionals. For instance, the practice worked closely with a pharmacist from the clinical commissioning group to significantly improve antibiotic prescribing rates. The practice was also working with Cancer Research UK to improve cancer screening rates.

• Carers were offered a range of support including annual reviews and flu vaccinations, 1% of the practice’s list had been identified as a carer.

• On the day of our inspection the practice could not provide assurance to support that the long term locum nurses received regular supervision and that they were all annually appraised. Shortly after our inspection took place, the senior GP partner provided assurance regarding peer support plans for the nurses and had successfully arranged to have peer support for nursing provided by the local clinical commissioning group (CCG) which was due to commence on 5 June 2017.

• There were accessible facilities in the practice for patients with mobility needs. The practice had a hearing loop for patients with hearing impairments. There were translation services available at the practice and some staff members could also speak a variety of languages including Punjabi and Urdu. Information was made available to patients in a variety of formats and in different languages. The practice also utilised its text messaging and online appointment service for deaf patients to book appointments and to request translation services where needed.

• In addition to patients aged 40 and over, the practice opportunistically screened patients for diabetes. This resulted in the practice’s high rates of diabetes diagnosis and above average QOF performance for diabetes care. The practice also took part in various diabetes research projects such as an integrated diabetes care model with Heart of England NHS Foundation Trust. An analysis of the project highlighted improvements in diabetic management and a total of 70 patients were discharged from secondary care after joint intervention by primary and secondary care.

The areas where the provider should make improvements are:

• Strengthen the clinical oversight of long term locum clinicians, gain assurance that peer support and supervision is in place where needed and ensure that learning is formally shared with long term locum staff to support the practice’s learning culture.

• Continue to identify carers in order to offer them support where needed.

• Ensure that a tighter monitoring process is implemented to support the practice nurses when administering vaccines using patient group directions (PGDs).

• Continue to focus on improving cancer screening rates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 July 2017

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

• Staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice was able to deliver services such as insulin and other injectable initiation in house for patients with diabetes, as the senior GP partner specialised in diabetes care.

• In addition to patients aged 40 and over, the practice opportunistically screened patients for diabetes. This resulted in the practice’s high rates of diabetes diagnosis; data provided by the practice highlighted that the practice had the highest diagnosis rate in the area. QOF performance for overall diabetes related indicators was 96%, compared to the CCG average of 91% and national average of 92%.

• The practice also took part in various diabetes research projects. This included piloting an integrated diabetes care model with Heart of England NHS Foundation Trust. A total of 154 patients were seen as part of the project, across four local practices. An analysis of the project highlighted that overall, patient baseline glycaemic control had improved considerably. Furthermore, after joint intervention by primary and secondary care a total of 70 patients were discharged from secondary care.

• We saw evidence that multidisciplinary team meetings took place on a regular basis with regular representation from other health and social care services. We saw that discussions took place to understand and meet the range and complexity of people’s needs and to assess and plan ongoing care and treatment.

Updated 19 July 2017

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

• 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.

• Immunisation rates for under two year olds were below national standards in some areas and high in others. For example, 88% of children had received a pneumococcal conjugate booster vaccine compared to the national standard of 90%. However 91% of children had received their MMR (measles, mumps and rubella vaccine) compared to the national standard of 90%.

• Immunisation rates for five year olds ranged from 95% to 98% compared to the CCG average of 83% to 95%.

• The practice offered urgent access appointments for children, as well as those with serious medical conditions. There was also a weekly maternity clinic available for those who needed to see the midwife as well as weekly clinics with the health visitor.

• Clinicians had direct access to a paediatric hotline which enabled discussions to take place with a consultant; this helped with efficient care planning, admission avoidance and reduced delays when caring for children and when referring them to secondary care if needed.

Updated 19 July 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

• 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 and shingles vaccines were also offered to patients at home, who could not attend the surgery. A phlebotomy service (taking blood for testing) was available in the practice and at home for housebound patients who could not attend the practice.

• Reports provided by the practice demonstrated that the practice’s flu uptake was above average for patients aged 65 and over. For example 83% of patients aged 65 and over had received a flu vaccination, compared to the CCG average of 65%.

Updated 19 July 2017

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

• Patients could access appointments and services in a way and at a time that suited them. Appointments could be booked over the telephone, face to face and online. The practice offered extended hours every Monday from 6:30pm until 9pm.

• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group. Data from 2015/16 showed that the practice’s uptake for the cervical screening programme was 80%, compared to the CCG average of 79% and national average of 81%.

• 2015/16 cancer data from Public Health England highlighted that breast cancer screening rates and bowel cancer screening rates were below local and national averages. To improve this, the practice approach the local clinical commissioning group (CCG) and participated in a Cancer Research UK project which was initiated by the CCG. We saw that the practice had started to work through the action plan developed in May 2017 to make improvements; we also saw that a comprehensive education pack had been developed for patients to access screening information at the practice.

• Patients had access to appropriate health assessments and checks. Practice data highlighted that they identified and offered smoking cessation advice to 91% of their patients and 3% had successfully stopped smoking.

Updated 19 July 2017

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

• The practice regularly worked with other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia.

• Staff highlighted that they didn’t have as many patients on their dementia register due to the practice’s demographics of mostly younger and working age people. However the practice continually monitored their dementia register and actively screened patients for dementia where appropriate.

• 96% of patients diagnosed with dementia had their care plans reviewed (in a face-to-face review) in the preceding 12 months, compared to the CCG average of 87% and national average of 88%.

• Performance for mental health related indicators was 88% compared to the CCG average of 91% and national average of 92%. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. 

Updated 19 July 2017

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

• The practice regularly worked with other health and social care organisations in the case management of vulnerable people. Multi-disciplinary team (MDT) meetings took place on a regular basis with regular representation from other health and social care services. Vulnerable patients and patients with complex needs were regularly discussed during the MDT meetings.

• There were 29 patients registered at the practice with a learning disability. Practice data highlighted that 80% received medicines reviews where eligible within a 12 month period and there was an ongoing programme of recalling patients in for annual reviews.

• We saw that the practice’s palliative care register was regularly reviewed; practice data highlighted that all of the patients on the palliative care register had a care plan in place.

• The practice told vulnerable patients about how to access various support groups and voluntary organisations. The practice offered a cultural sensitive IAPT (Improving Access to Psychological Therapies) service to patients. Carers were also signposted to support services such as the carer’s hub.

• The practice utilised its text messaging and online appointment service for deaf patients to book appointments and to request translation services where needed.