Archived: Stonydelph Health Centre

Updated 11 October 2017

Stonydelph Health Centre is located in Ellerbeck, Tamworth, and is registered with the CQC as a single handed provider. The provider holds a General Medical Services contract with NHS England and is a member of the NHS South East Staffs and Seisdon Clinical Commissioning Group (CCG). A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

The premises is a single storey purpose built health centre shared with two other GP practices and various community nurse services. There is a car park with designated disabled parking spaces. The practice is owned and managed by a female GP who works full time. The GP is assisted by a practice nurse, a physician’s associate, a practice manager, a senior receptionist and team of two reception/administrative staff. There is a reciprocal agreement with another GP in the building to provide cover for GP absence.

The practice had 1,980 registered patients. A small increase of 15 patients since the last inspection. The practice age distribution is higher than CCG and national averages for patients aged 50-65 years and lower for patients aged 65 and over (11% compared to the CCG average of 20% and national average of 17%). The practice has a higher percentage (6%) of unemployed patients compared to the CCG average (3%). The percentage of patients with a long-standing health condition is 61%, which is slightly higher than the CCG average of 55% and the national average of 54%.

The practice is open between 8.30am and 6.30pm Monday to Friday and the telephone lines are open from 8am to 6.30pm. The phone is switched to answering machine between 1pm and 2pm during which time a message instructs patients of an emergency line that can be used to contact the practice. Extended opening hours are provided on a Tuesday evening with a GP from 6.15pm to 7.30pm. There is no telephone access after 6.30pm, however patients can ring prior to this time and book an appointment for late surgery. Routine appointments can be booked in person, by telephone or on-line. Home visits are assessed by a GP to determine whether a home visit is clinically necessary and the urgency of the need for medical attention.

The practice does not provide an out-of-hours service but patients are directed to the out-of-hours service, Staffordshire Doctors Urgent Care when the practice is closed. The practice is approximately 10 miles away from Good Hope Hospital, Sutton Coldfield.

Updated 11 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stonydelph Medical Practice on 6 September 2017. Overall the practice is now rated as Good.

The practice was formerly known as Dr Yannamani and Dr John’s Surgery, and had previously been inspected on 1 December 2015. Following this comprehensive inspection the overall rating for the practice was Requires Improvement. A breach of the legal requirements was found and a requirement notice was served. The practice provided us with an action plan detailing how they were going to make the required

improvements in relation to:

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Good Governance.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Yannamani and Dr John’s Surgery on our website at www.cqc.org.uk.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• There was a formal system in place to log, review, discuss and act on external alerts, such as the Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver care and treatment.
• Patients said they were treated with kindness, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care and access to services as a result of complaints and concerns.
• Data from the national GP patient survey published July 2017 showed patient satisfaction was the same as or above local Clinical Commissioning Group (CCG) and national averages for most areas measured.
• There was a clear leadership structure in place and staff felt supported by the management team. The practice responded positively to feedback from staff and patients.
• The practice had effective procedures for the storage of emergency medicines and regular checks were undertaken to ensure medicines were fit for use.
• Effective systems were in place for identifying and assessing the risks to the health and safety of patients and staff.
• The practice proactively sought feedback from staff and patients, which it acted on.
• Patients found it easy to make an appointment, with urgent appointments available the same day.
• Governance arrangements had improved to include the formalisation of practice staff meetings and a better understanding of practice performance.
• The practice was well equipped to treat patients and meet their needs.
• A programme of clinical audits had been implemented and repeated cycles were planned to monitor quality improvement in patient outcomes. However findings had not always been actioned in a timely manner.

The areas where the provider should make improvements are:

• Identify on the clinical system those patients who are housebound.
• Record that consent has been obtained from the patients when appropriate.
• Implement a call/recall system for those patients with learning disabilities to have annual health checks.
• Review the findings from quality improvement audits to ensure appropriate action is taken.
• Formalise the arrangements for providing pre-booked appointments for male patients to see a male clinician.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 October 2017

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

• There was a system to recall patients for ongoing monitoring or annual reviews to check their health and medicines needs were being met. This was coordinated so that patients with multiple long term conditions were reviewed at a single, longer appointment. Non-attendors were followed up.
• The practice provided care plans and priority access for patients on the admissions avoidance register.
• Performance for diabetes related indicators was comparable to the CCG and national averages. For example, the percentage of patients on the diabetes register, in whom a specific blood test to get an overall picture of what a patients average blood sugar levels had been over a period of time was recorded as 74% compared with the CCG average of 79% and the national average of 78%. The practice exception reporting rate of 14.6% was similar to the CCG average of 10.9% and the national average of 12.5%.
• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care and held .
• Longer appointments and home visits were available when needed.
• The provider used the gold standards framework to coordinate care for patients nearing end of life.

Updated 11 October 2017

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

• There was a dedicated safeguarding lead and all staff had received safeguarding training. For example, the nurse and GP had been trained to level three for safeguarding children.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and children who were at risk, for example, children with protection plans. There was a system to identify young people who had a high number of accident and emergency (A&E) attendances.
• Immunisation rates for the vaccinations given were above standard for childhood vaccinations for children aged two and higher than the Clinical Commissioning Group (CCG) for children aged five. Dedicated baby clinics were held weekly on either a Tuesday or a Friday morning.
• Same day appointments were available for children with urgent medical need.

• Education booklets and leaflets regarding childhood illnesses were available for patients.
• Appointments were available outside school hours and the premises were suitable for children and babies.

• Family planning services was available in addition to lifestyle advice on healthy living.

Updated 11 October 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 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 provided care plans and priority access for patients on a frailty register.
• The practice held a register of housebound patients and their needs were coordinated and communicated to the community healthcare team, but they were not identified on the system.
• The practice followed up on older patients on the hospital admission avoidance register when discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Patients aged 75 years or over had a named GP.

Updated 11 October 2017

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, clinics were provided daily until 7.30pm on a Thursday evening.
• 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.
• Lifestyle advice regarding healthy eating and smoking cessation were available.
• New patient health checks in addition to NHS Health checks for patients aged 40 to 74 years were available.
• The practice allowed the temporary registration of students whilst home on holiday leave.

Updated 11 October 2017

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

• Performance for mental health related indicators was mixed when compared to the local CCG and national averages. For example, the percentage of patients with an agreed care plan documented in the preceding 12 months was 100% compared to the CCG and national averages of 89%. The practice clinical exception rate of 0% which was lower than the local CCG average of 15.5% and the national average of 12.7%. However, the percentage of patients who had a record of their blood pressure in the preceding 12 months was 67% compared to the CCG and national averages of 89%. The practice clinical exception rate of 0% which was lower than the local CCG average of 11.1% and the national average of 9.3%.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the last 12 months was 100%, which was higher than the CCG average of 88% and the national average of 84%. The practice clinical exception rate of 0% was lower than the CCG average of 4.2% and the national averages of 6.8%.
• 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 to signpost patients experiencing poor mental health and were able to refer patients or patients could self-refer to a consortium made up of specialist mental healthcare providers.

Updated 11 October 2017

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

• The practice offered longer appointments for patients with a learning disability and for patients with complex needs.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. A flexible appointment system was used to reduce distress by providing ease of access when attending the practice.
• The practice had 12 patients recorded with a learning disability. None of these patients had received an annual health assessment since 1 July 2016. There were plans to start reviews shortly following the completion of training in September 2017.
• The practice had information available for patients about how to access various support groups and voluntary organisations.
• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable.