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Inspection Summary


Overall summary & rating

Good

Updated 18 January 2019

At our previous inspection, we rated the practice as requires improvement for providing safe care and treatment. This was due to concerns that were identified relating to emergency medicines, premises risk assessment and mitigation and due to a breach in regulation of the Health and Social Care act 2012 relating to medicine safety alerts. At this inspection, the practice was able to demonstrate improvement and we rated the practice as good for providing safe care and treatment and overall.

The key questions at this inspection are rated as:

Are services safe? – Good

We carried out an announced focused follow-up inspection at Balsall Heath Health Centre on 26 November 2018.

At this inspection we found:

  • The practice had embedded system to ensure that they received, disseminated and learned from medicine safety alerts. Examples we looked at demonstrated that they had been actioned and discussed.
  • The practice was able to demonstrate that they held appropriate emergency medicines, in line with guidance and that they had developed a system to ensure they stayed in date and in stock.
  • Risk at the practice was identified, assessed and mitigated appropriately and the practice demonstrated that they were seeking assurances from the owners of the building that actions outside of their direct control were being completed.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Inspection areas

Safe

Good

Updated 18 January 2019

At our previous inspection at Balsall Heath Health Centre on 31 October 2017, we rated the practice as requires improvement for providing safe services. We identified some concerns relating to the receiving of and acting on medicine safety alerts. The previous inspection also identified that the systems and processes in place to support risk identification and mitigation, and management of emergency medicines, would benefit from strengthening.

At this inspection, we rated the practice as good for providing safe services, because they were able to demonstrate that all areas that had been identified had been addressed appropriately.

We rated the practice as good for providing safe services.

Safety systems and processes

The practice had clear systems to keep people safe.

  • There was an effective system to manage infection prevention and control.
  • The practice had arrangements to ensure that facilities and equipment were safe and in good working order.
  • Arrangements for managing waste and clinical specimens kept people safe.

Risks to patients

There were systems to assess, monitor and manage risks to patient safety.

  • The practice was equipped to deal with medical emergencies and staff were suitably trained in emergency procedures.
  • Staff we spoke with understood their responsibilities to manage emergencies on the premises and to recognise those in need of urgent medical attention. When there were changes to services or staff the practice assessed and monitored the impact on safety.

Appropriate and safe use of medicines

The practice had reliable systems for appropriate and safe handling of medicines.

  • The systems for managing and storing medicines, including vaccines, medical gases, emergency medicines and equipment, minimised risks.
  • We saw that patients’ health was monitored in relation to the use of medicines and followed up on appropriately. Patients were involved in regular reviews of their medicines.

Track record on safety

The practice had a good track record on safety.

  • There were comprehensive risk assessments in relation to safety issues.
  • The practice monitored and reviewed safety using information from a range of sources.

Lessons learned and improvements made

The practice learned and made improvements when things went wrong.

  • Staff we spoke with understood their duty to raise concerns and report incidents and near misses. Leaders and managers supported them when they did so.
  • There were systems for reviewing and investigating when things went wrong. The practice learned and shared lessons, identified themes and took action to improve safety in the practice.
  • The practice acted on and learned from external safety events as well as patient and medicine safety alerts. We saw that searches had been conducted and that actions that were appropriate had been taken. The practice was also able to demonstrate that they had shared learning throughout the staff team through meetings and discussion.

Please refer to the evidence tables for further information.

Effective

Good

Updated 1 December 2017

  • Multi-disciplinary team (MDT) meetings and palliative care meetings took place on a regular basis. Vulnerable patients and patients with complex needs were regularly discussed during the meetings.
  • We saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews. During our inspection we saw examples of audits which were used to drive improvements in patient care and to improve systems and processes in the practice.
  • The practice used the information collected for the Quality and Outcomes Framework (QOF) and performance against national screening programmes to monitor outcomes for patients. Data on how the practice was currently driving demonstrated that the practice was meeting QOF targets in most areas at the time of our inspection.
  • The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. The practice also reviewed their patients’ attendances at the local Accident and Emergency department.

Caring

Good

Updated 1 December 2017

  • We saw that staff were courteous and helpful to patients both attending at the reception desk and on the telephone and that people were treated with dignity and respect.
  • One percent of the practice’s register had been identified as carers. The practice offered health reviews and flu vaccinations for anyone who was a carer. The practice displayed a range of supportive information for carers and there was information in place for carers to take away, we saw that carers were signposted to carer support services.
  • On the day of our inspection patients told us they were satisfied with the care provided by the practice and said their dignity and privacy was respected.
  • Although areas of the national GP patient survey published in July 2017 were below average, information and evidence provided by the practice following our inspection demonstrated improvements and improved satisfaction in relation to providing a caring service.

Responsive

Good

Updated 1 December 2017

  • Appointments could be booked over the telephone, face to face and online. The practice was part of a local GP federation called My Healthcare, this enabled patients to access services across five local practice up to 12 hours a day including early mornings and evenings, Monday to Friday and at varied times on weekends.
  • There were facilities in place for people with disabilities and for people with mobility difficulties. There were translation services available and we saw that there was a hearing loop in place during our inspection.
  • The results from the most recently published national GP patient survey highlighted that some responses were below local and national averages in relation to access. . However, information and evidence provided by the practice following our inspection demonstrated improved satisfaction in relation to providing a caring service with improved access to services.

Well-led

Good

Updated 1 December 2017

  • There was evidence of quality improvement and we saw examples of audits which were used to drive improvements in patient care and to improve systems and processes in the practice.
  • Staff spoke positively about working at the practice; they demonstrated a commitment to the practice and to providing a high quality service to patients.
  • There was a clear staffing structure, staff were aware of their own roles and responsibilities. Staff had lead roles across key areas such as safeguarding, clinical governance, end of life care and palliative care.
  • Practice meetings were used as an opportunity for staff to learn about the performance of the practice. The practice also encouraged feedback from staff and members of the patient participation group (PPG) during formal meetings, as well as through practice surveys.
Checks on specific services

People with long term conditions

Good

Updated 1 December 2017

  • We saw evidence that multidisciplinary team meetings took place on a regular basis and 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.

  • 2016/17 QOF performance for overall diabetes related indicators was 95% compared to the CCG and the national average of 91%.

  • During our inspection we saw evidence of a repeated audit demonstrated improvement in blood monitoring and management for diabetic patients.

  • The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were at high risk of admission to hospital had personalised care plans in place.

  • The practice advised patients to bring all medicines to their appointments when attending for chronic disease reviews, to ensure that thorough reviews took place and to aid safe monitoring and management of medicines. 

Families, children and young people

Good

Updated 1 December 2017

  • The practice operated an effective system for scheduling childhood immunisations and ensuring appropriate actions were taken if immunisation appointments were missed or risk factors identified. The practice regularly engaged with the health visitor.

  • There were baby changing facilities at the practice. The practice offered urgent access appointments for children, as well as those with serious medical conditions.

  • During school holidays the practice operated walk-in sessions for children that needed to be seen.

  • Public Health England data for 2016/17 showed that the practice’s cervical screening uptake was 98% compared to the CCG average of 98% and the national average of 96%, with a 7% exception rate. 

Older people

Good

Updated 1 December 2017

  • The practice 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.

  • Patients had access to appropriate health assessments and checks. The practice offered annual reviews to patients aged 65 and over.

  • The practiced offered personalised care plans for patients over the age of 75. These patients had a named GP and a care co-ordinator in place at the practice. 

Working age people (including those recently retired and students)

Good

Updated 1 December 2017

  • Appointments could be booked over the telephone, face to face and online.

  • The practice was part of a local GP federation called My Healthcare, this enabled patients to access services across five local practice up to 12 hours a day including early mornings and evenings, Monday to Friday and at varied times on weekends.

  • Patients who may be in need of extra support were identified and supported by the practice. This included patients requiring advice on their diet, smoking and alcohol cessation.

  • Patients had access to appropriate health assessments and checks, including health checks for new patients and NHS health checks for people aged 40–74.

People experiencing poor mental health (including people with dementia)

Good

Updated 1 December 2017

  • 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. Patients with complex needs and patients experiencing poor mental health were regularly discussed during MDT meetings.

  • 2016/17 QOF performance for overall mental health related indicators was 100% compared to the CCG average of 99% and the national average of 98%, with an exception rate of 3%.

  • All patients on the practice’s mental health register had a comprehensive care plan documented in the record, which was agreed between individuals, their family and/or carers as appropriate.

  • 2016/17 QOF performance for dementia related indicators was 100% compared to the CCG average of 88% and the national average of 84%. At the point of our inspection 100% of patients with dementia had a care plan in place and all of these patients were up to date with relevant blood tests, care plans had also been reviewed during annual face to face reviews. 

People whose circumstances may make them vulnerable

Good

Updated 1 December 2017

  • There were facilities in place for people with a disability and for people with mobility difficulties. There were hearing loop and translation services available.

  • The practice offered annual reviews and flu vaccinations for vulnerable patients including carers and patients with a learning disability.

  • Vulnerable patients were regularly reviewed and discussed as part of the Multi-disciplinary team (MDT) meetings to support the needs of patients and their families.

  • There were longer appointments available at flexible times for people with a learning disability, for carers and for patients experiencing poor mental health.