GPS Healthcare - Tanworth Lane

Updated 25 February 2019

GPS Healthcare was founded in 2015 by merging six existing GP surgeries. GPS Healthcare has one registered location at Tanworth Lane Surgery. There are also five branch sites; Meadowside Family Health Centre, Knowle Surgery, Park Surgery, Village Surgery and Yew Tree Medical Centre. During this inspection we visited Tanworth Lane Surgery, Knowle Surgery, Park Surgery, Village Surgery and Yew Tree Medical Centre.

GPS Healthcare’s registered location is 198 Tanworth Lane in Shirley, Solihull. There is one patient list and patients registered with the provider can choose to be seen at any of the branches.

The provider is registered with CQC to deliver the Regulated Activities; diagnostic and screening procedures, surgical procedures, maternity and midwifery services and treatment of disease, disorder or injury. These are delivered from all sites.

GPS Healthcare is situated within the Birmingham and Solihull (BSoL) Clinical Commissioning Group (CCG) and provides services to 40,400 patients, approximately 20% of the population of Solihull, under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

The area served has low deprivation compared to England overall. Based on data available from Public Health England, the levels of deprivation in the area served by GPS Healthcare ranked at nine out of ten, with ten being the least deprived.

The group of practices is served by 19 GP partners and a team of an additional 125 staff including clinical and non-clinical.

There are a higher than average number of patients aged of 65 and over, and fewer patients aged over 5 to 18 years, than the national average. The National General Practice Profile states that 87% of the practice population is white with a further 9% of the population being from Asian background and a further 4% originating from black, mixed or other non-white ethnic groups. Information published by Public Health England. Male life expectancy is 82 years compared to the national average of 79 years. Female life expectancy is 86 years compared to the national average of 83 years.

Surgerys are open from 8am to 6.30pm although Village and Knowle are closed on Wednesday afternoons from 1pm, cover is provided at any of the other GPS sites. Extended hours appointments were available via the local hub and specifically at Tanworth Lane between 6.30pm and 8pm Mondays and Fridays, Saturday and Sunday 10am to 1pm. Patients requiring a GP out of normal hours are advised to contact NHS 111.

Updated 25 February 2019

We carried out an announced comprehensive inspection at GPS Healthcare on 5 December 2018 as part of our inspection programme. In addition, we inspected four of the five branch sites on 11 and 12 December 2018.

At the last inspection in May 2017 we rated the practice as good overall.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm. Although systems and process to promote consistency across the organisation were in place, they were not always applied consistently in practice. Some areas such as the management of safety alerts, elements of performance monitoring and the system for monitoring patients on high risk medicines required embedding further.
• There was an open and transparent approach to safety and a system in place for recording, reporting and learning from significant events. The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse and for identifying and mitigating risks of health and safety.
• The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines and best practice.
• Staff were encouraged and given opportunities to train or study for additional qualifications to enhance their roles.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. The practice considered innovative ways of providing appropriate care to vulnerable and hard to reach groups of patients.
• Patients could access care and treatment in a timely way during normal surgery hours or via the extended hours hub.
• There were clear responsibilities, roles and systems of accountability to support effective governance. Partners held specific roles as part of the executive board for which they were accountable.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care.
• The vision of the organisation took into account the changing landscape of the local health and social economy.

Whilst we found no breaches of regulations, the provider should:

• Continue to embed new systems and processes in relation to the monitoring of patients on high risk medicines.
• Continue to monitor the process for receiving all safety alerts.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 10 July 2017

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. For example, the latest published QOF results showed 90% of patients with chronic obstructive pulmonary disease (COPD) had received a review in the past 12 months, this was in line with the the local average of 89% and the national average of 90%.
• The nursing team held regular meetings to discuss chronic long term conditions and we saw evidence of a recent respiratory meeting which highlighted good practice and areas to review for improvement. This included an agreement by the nursing staff that all patients with COPD had a 30 minute appointment slot where possible due to the complexity of their condition.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The provider ran a leg ulcer service across the six sites for GPS Healthcare registered patients and also the local community.

• The practice held anti-coagulation clinics every week to monitor patients on warfarin.

• The provider supported DiCE clinics on a regular basis for patients with diabetes. Diabetes in Community Extension (DiCE) clinics are community based clinics held by specialist nurses and consultants to support patients with complex diabetes.

Updated 10 July 2017

• There were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice’s uptake for the cervical screening programme was 78% which was comparable to the national average of 81%.

• We saw examples of joint working with midwives and the community midwife ran antenatal clinics two mornings a week.

Updated 10 July 2017

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. This included flu and shingles vaccinations for patients who were unable to attend the surgery.

• The practice had been a pilot site for the Care Navigator Service, in conjunction with Age UK Solihull. The Care Navigator Service offered support to older people to find solutions to issues they may face and assists them to navigate and access relevant services that could meet their needs.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• Data provided by the practice showed 291 patients on the palliative care register across the six sites and we saw evidence to support that patients were discussed at six weekly meetings and their care needs were co-ordinated with community teams.

Updated 10 July 2017

• The needs of the working age population had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Patients were able to access any of the six practices across Solihull from 8am to 6.30pm. This was facilitated by the use one clinical system allowing access to patient records. Telephone consultations were available at the request of patients.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. This included referrals to the stop smoking service.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. This included stop smoking clinics across GPS Healthcare for patients and the local community.

• The practice’s uptake for the cervical screening programme was 78% which was comparable to the national average of 81%.
• Data provided by the practice showed 85% of patients who were currently registered as smokers had received support to quit smoking.
• The practice made use of texting to remind patients of their appointment and an electronic prescribing service.

Updated 10 July 2017

• There were 386 patients on the dementia register. The latest published QOF data for 2015/16 showed 81% of patients had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations, this included health awareness events to support patients and their families. For example, the practice had held a dementia friends evening which was accessible by all patients from the six surgeries. All staff had received dementia awareness training and were now dementia friends.

• The provider had piloted a new community dementia diagnosis pathway to support for the Memory Assessment Service and the Alzheimer’s Society. The pilot was created to support patients and their carers through the processes of screening and diagnosis giving patients and their carers access to clinical dementia experts, as well as a package of support.

• The practice supported a local dementia care home and offered weekly ward rounds and domiciliary visits. Feedback from the home reflected the support and care offered by the staff and GPs to the patients.

• Data provided by the practice showed 322 patients on the mental health register. The latest published QOF data for 2015/16 showed 89% of patients had a comprehensive, agreed care plan documented in their medical record in the last 12 months, which was comparable to the national average of 89%.

• Patients who needed mental health support were referred to the Improving Access to Psychological Therapies (IAPT) services. IAPT held a clinic at Meadowside practice each week and clinics were also available at other sites within GPS Healthcare every day.

Updated 10 July 2017

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Data provided by the practice showed 208 patients on the learning disability register and 85% had received an annual review.

• The practice held a register of 389 carers, which represented 0.9% of the whole practice list. There was a carers information board which detailed support available, this also included information for young carers. Carers were invited for flu vaccinations and the practice had supported a carers event in conjunction with Solihull carers to offer support and advice to carers from the age of 13 years old.

• All staff had received training on carers and MacMillan cancer support.

• End of life care patients received a priority service. All sites worked to the Gold Standard Framework and the practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.