Archived: Dartmouth Medical Centre

Updated 8 January 2018

Dartmouth Medical Centre is located in a purpose built building in West Bromwich, an area of the West Midlands, with a branch surgery at Central Clinic in Tipton, West Midlands. During the inspection we also visited the branch surgery. The practice has a General Medical Services contract (GMS) which ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care and is a nationally agreed contract. The practice also provides some enhanced services such as childhood vaccination and immunisation schemes. The practice sits within NHS Sandwell and West Birmingham 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.

The provider was a GP partner at another nearby practice (Linkway Medical Centre) and planned to merge both practices. The process had been started with adoption of policies from Linkway Medical Practice. There were monthly clinical governance meetings between the practice manager at Dartmouth, the provider and the business manager from Linkway Medical Centre to help with the process.

The practice provides primary medical services to approximately 3,200 patients in the local community. The practice is led by the GP provider (male), two salaried GPs (both female) and a regular locum GP (male). There is a practice nurse and the non-clinical team consists of administrative and reception staff and a practice manager.

The practice is open to patients between 8am and 6.30pm Monday to Friday except on Wednesday when it closed at 1pm. However, patients are able to access appointments at the branch surgery.

The practice had hub working arrangement with five other local surgeries and extended hours appointments are available 6.30pm to 8pm on Monday to Friday. Appointments on Saturdays were available between 9am to 12pm. On Sundays from 10am to 12.30pm.

Telephone consultations are available if patients requested them; home visits were also available for patients who are unable to attend the surgery. When the practice is closed, primary medical services are provided by Primecare, an out of hours service provider and information about this is available on the practice.

Updated 8 January 2018

Letter from the Chief Inspector of General Practice

We had previously inspected Dartmouth Medical Centre in 10 January 2017 whilst registered under the previous provider. Following this inspection the practice was rated as inadequate and placed into special measures. Since the January 2017 inspection there has been a change to the registered provider. The current provider registered with the CQC in April 2017.

We carried out this announced comprehensive inspection at Dartmouth Medical Centre on 25 October 2017. Overall the practice is rated as good. Our key findings across all the areas we inspected were as follows:

• The provider had a clear vision to improve the practice and promote good outcomes for patients. They were prioritising areas of quality and patient safety and had developed a business plan to support improvement. Strategies had been implemented to minimise risks to patient safety in areas such as patient records and medicines management. However, exception reporting for some indicators remained high. Since the inspection the practice have reviewed the exception reporting rates and found where the errors were occurring and we have received assurances that this has now been rectified.

• On the day of inspection we found documentation for learning reviews were unclear, but since the inspection we have received evidence to confirm that all patients had been reviewed appropriately.

• The practice had a system in place to ensure action was taken following hospital communication and the process was auditable.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice was proactive in working with other health and social care professionals to safeguard some of the practices most vulnerable patients.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Single cycle audits demonstrated reference to appropriate national guidance.

• Information about services and how to complain was available.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff members were able to provide examples where a caring and responsive service had been delivered to patients.
• There was a clear leadership structure and staff felt supported by management. The provider planned to merge the practice with another nearby practice (Linkway Medical Practice) where they were a partner and the process had been started through the adoption of policies and procedures and joint management meetings.

The areas where the provider should make improvement are:

• Improve achievement on the GP patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 January 2018

The provider was rated as good for people with long-term conditions.

• The nurse and the GP provider had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The GP provider had taken over the practice in April 2017. Data available from the practice showed there was good progress being made against the current QOF year (2017/18). However, exception reporting for some indicators remained high. Since the inspection the practice have reviewed the exception reporting rates and found errors which contributed to the high exception reporting. We received assurances that this had now been rectified.
• 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. However, there was a risk that action following hospital communication could be missed as the process was not auditable. Since the inspection the practice had submitted evidence to demonstrate that a system had been put in place to ensure all hospital communication was acted on and auditable.
• Medicines audits we looked at demonstrated reference to recognised professional standards and guidelines, including National Institute for Health and Care Excellence (NICE) best practice guidelines.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. 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. For example the practice worked with a community diabetes specialist nurse to support patients with complex diabetic needs.

Updated 8 January 2018

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

• From the sample of documented examples we reviewed we found 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. The practice had carried out an audit of the safeguarding register to ensure all relevant patents were on the list appropriately.
• Data provided by the practice showed that they were on course to achieve relatively high immunisation rates in line with previous published data.
• Appointments were available outside of school hours for children and baby changing facilities were available.
• We saw positive examples of joint working with midwives and health visitors. The midwife held an antenatal clinic every week at the practice.
• The GPs and the practice nurse we spoke with were able to demonstrate an understanding of the Gillick competency test and their duties in fulfilling it. The Gillick competency test is used to help assess whether a child under the age of 16 has the maturity to make their own decisions and to understand the implications of those decisions.

Updated 8 January 2018

The provider was rated as goof for older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• 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.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. For example, the practice engaged with social services to ensure patients and their relatives received appropriate support health and social care.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. The practice offered in-house counselling which helped patients to improve their confidence and regain independence.

Updated 8 January 2018

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, the practice offered access to appointments from 8am to 8pm Monday to Friday as well as Saturday and Sunday appointments through hub working arrangements.
• The practice was offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.

Updated 8 January 2018

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

• The current QOF achievement for mental health so far this year was 32/50 QOF points. However, this was unpublished and unverified data.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. We saw appropriate care plans were in place.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. The practice had improved its process to ensure only the GP provider could add or change medicines on patient records.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia. The GPs and the practice nurse were able to demonstrate working knowledge of the Mental Capacity Act deprivation of liberty safeguarding (DoLS).

Updated 8 January 2018

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. The practice offered longer appointments for patients with a learning disability. However, care plans were not always being populated following review of these patients to demonstrate that a review had been carried out to ensure effective care. Since the inspection we had received evidence to confirm that 11 out of 12 patients on the learning disability register had undergone reviews.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed 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.
• The practice’s computer system alerted GPs if a patient was also a carer. There were 60 patients on the practices register for carers; this was 2% of the practice list. There was support available for carers. They were offered health checks and the flu vaccination.