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Inspection Summary


Overall summary & rating

Good

Updated 10 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Walji and Colleagues on 1 June 2016. Overall the practice is rated as good.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed. The practice carried out an annual significant event audit to ensure learning from significant events was embedded.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. The GPs were leads in different areas and had weekly meetings to discuss concerns and share learning.

  • There was a clear leadership structure and staff felt supported by the GPs and the practice manager. The practice proactively sought feedback from staff and patients which it acted on. There was a very pro-active Patient Participation Group (PPG) of which we met with four members during the inspection.

  • The practice was aware of and complied with the requirements of the Duty of Candour.

  • Risks to patients were assessed and well managed.

  • Patients described staff as caring and helpful. Patients commented that they were treated with dignity and respect

  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

  • Patients 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.

  • Staff had also attended education sessions in female genital mutilation (FGM) and Identification and Referral to Improve Safety (IRIS) which was domestic violence training.

We saw areas of outstanding practice:

  • The practice had been involved in the Irish Project from 2000 onwards, which involved proactive outreach work in the local community to identify and target vulnerable patients for care and treatment. Initially this project was initiated by the Primary Care Trust (PCT) but the practice continued this as a voluntary project. As a result of this project 324 undiagnosed serious diseases were picked up by the practice such as COPD, depression, asthma, arthritis and cancer. The practice was then able to refer patients where this was needed and to start patients on the correct treatment such as having x-rays, blood tests, counselling and psychotherapy.

  • Staff told us that there was a practice charity fund which was used to pay for help for patients where emergency support was needed, for example providing a bag of essential items for those requiring unexpected hospital admissions. Therefore when the practice became aware that patients might benefit from this the fund was used for this purpose.

  • Staff told us about examples of when the GPs supported patients by paying for their taxis to get to hospital when an ambulance was not required.

However, there was an area of practice where the provider should make improvements:

The provider should:

  • Consider documenting verbal complaints so that any trends can be identified and lessons learned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 August 2016

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.

  • Lessons were learned and communicated widely to support improvement. When things went wrong patients received reasonable support, accurate information and a written apology. They were told about any actions to improve processes.

  • Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

Effective

Good

Updated 10 August 2016

The practice is rated good for providing effective services.

  • National patient data showed that the practice was in line with average scores for the locality on the whole. Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above the national average. The practice had achieved 99.7% of the total number of points available which was above the CCG average of 97% and above the national average of 95%.

  • Staff had received training appropriate to their roles and the practice believed in developing and training their staff.

  • We saw evidence of appraisals and personal development plans for staff.

  • Staff routinely worked with multidisciplinary teams to improve outcomes for patients and to meet the range and complexity of patients’ needs.

  • The practice also carried out NHS health checks for patients aged 40-74 years. 326 patients were eligible to have NHS health checks in the last year. 335 health checks were carried out in the last year as the practice carried out extra health checks if it was deemed appropriate by the practice nurses and GPs.

Caring

Good

Updated 10 August 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in January 2016 showed patients rated the practice higher than average for several aspects of care. For example, 96% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 95% and the national average of 95%.90% of patients said they found the receptionists at the practice helpful compared to the CCG average of 86% and the national average of 87%.

  • All of the 42 patient Care Quality Commission comment cards we received were positive about the service experienced. Patients said they felt the practice offered a high quality service and staff were helpful, caring and treated them with dignity. The practice looked after a local bail hostel catering for patients with complex psychosocial needs. The feedback we received was very positive about the care the GP partner provided to patients at the bail hostel indicating they were flexible, approachable and always contactable.

  • The practice looked after residents at a local sheltered accommodation. We spoke with the manager of the accommodation who described the GPs as first class doctors.

  • Patients we spoke with told us that they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Staff told us that there was a practice charity fund which was used to pay for help for patients where emergency support was needed, for example providing a bag of essential items for those requiring unexpected hospital admissions. Therefore when the practice became aware that patients might benefit from this the fund was used for this purpose.
  • Staff shared examples of when the GPs had paid for taxis to get to hospital for patients when they could not afford to and when an ambulance was not required. Staff also gave examples of when GPs at the practice had paid for groceries for patients who had no money.

Responsive

Good

Updated 10 August 2016

The practice is rated good for providing responsive services.

  • The practice responded to the needs of its local population and engaged well with Birmingham South Central 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 practice was well equipped to meet the needs of their patients. Information about how to complain was available and easy to understand. Learning from complaints was shared and discussed at practice meetings. The practice scored above average in terms of access in the National GP Patient Survey published in January 2016. For example: 88% of patients said they could get through easily to the surgery by telephone compared to the CCG and national average of 73%.

  • The practice offered daily telephone triage which meant that patients had direct access to a GP between 9am and 4.30pm Monday to Friday. This system meant that patients would get through to the GP automatically via the switchboard. Patients we spoke with on the day of the inspection told us how helpful they found this service.

Well-led

Good

Updated 10 August 2016

The practice is rated good for being well-led.

  • It had a clear vision and strategy to deliver high quality care and promote good outcomes for patients.

  • Staff told us there was an open culture and they were happy to raise issues at practice meetings.

  • The partners were visible in the practice and staff told us they would take the time to listen to them. One of the lead GPs was on the board of the CCG.

  • Staff we spoke with said there was a no blame culture which made it easier for them to raise issues. The practice proactively sought feedback from staff and patients, which it acted on and had an active virtual Patient Participation Group (PPG). A PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care. We met with four members of the PPG on the day of the inspection.

  • The practice was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty.

Checks on specific services

People with long term conditions

Good

Updated 10 August 2016

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

  • Nursing staff and GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients with long term conditions were on a register and invited for annual reviews. There were trained clinical leads for each long term condition.

  • The practice was signed up to the Cardiovascular Disease Local Improvement Scheme and had achieved very high points last year and are on target to repeat it this year.

  • Quality and Outcomes Framework (QOF) performance in relation to long term conditions was consistently good.

  • The practice had signed up to a number of local initiatives including the Pre-Diabetes Local Improvement Scheme (LIS) to educate patients and try and reduce the incidence and impact of diabetes. The practice referred patients to the Health Exchange to advise patients about lifestyle changes, weight loss and exercise.

  • In house Electrocardiograms (ECG) screening to record electrical activity of the heart to detect abnormal rhythms and the cause of chest pain was available. The practice offered routine monitoring to identify patients at risk of heart attack and offered ambulatory blood pressure, 24 hour ECGs, spirometry and lung function tests so that patients did not need to be referred to hospital for diagnosis.

Families, children and young people

Good

Updated 10 August 2016

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

  • There were systems in place to follow up on children who were considered vulnerable including the use of alerts. The child safeguarding register was reviewed with the health visitors regularly.

  • Appointments were available outside of school hours with GPs and nurses and the premises were suitable for children and babiesWe saw positive examples of joint working with midwives, health visitors and school nurses. Same day appointments were always provided for children aged five and under.

  • Family planning services were offered at the practice and the practice provided comprehensive sexual health services which were run by GPs and practice nurses.

  • Staff had attended education sessions in female genital mutilation (FGM) and Identification and Referral to Improve Safety (IRIS) which was domestic violence training

  • Childhood immunisation rates for the vaccinations given were comparable to the CCG averages. For example, for the vaccinations given to under two year olds ranged from 69% to 92% compared with the CCG average of 79% to 96% and five year olds from 82% to 100% compared with the CCG average of 84% to 95%. In order to increase up take the practice were running drop in clinics on a Wednesday evening up to 8pm with the practice nurses.

Older people

Good

Updated 10 August 2016

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

  • The practice offered personalised care to meet the needs of older patients in its population and had a range of enhanced services for example, unplanned admissions. The GPs met weekly and unplanned admissions were discussed. The practice co-ordinated care via weekly multi-disciplinary team meetings with district nurses and community matrons.

  • The practice worked closely with a non-clinical case manager whereby older people with complex needs could be assigned a visit to look at social needs. The practice adopted the palliative care Gold Standards Framework (GSF).

  • Patients over the age of 75 were allocated a named GP but had the choice of seeing whichever GP they preferred. There were no set clinics so patients were able to attend at a time convenient for them.

  • Frail elderly patients were always seen on the same day even if no appointments were available. Patients who required an urgent visit were referred to a duty doctor if a GP was not available straight away. Home visits were offered to those patients who were not able to attend the practice.

  • Older patients were able to order prescriptions by telephone as sometimes patients did not want to order online or found it harder to attend the practice. Whenever possible, the practice tried to get tests done while patients were in the practice to save them having to attend for repeated visits.

  • We received very positive feedback about the GPs from the manager of sheltered accommodation who told us the GPs were flexible and responsive to their patients.

  • The practice referred older patients to Gateway. This was a new scheme designed for those who may need additional support with social isolation.

Working age people (including those recently retired and students)

Good

Updated 10 August 2016

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

  • The practice had adjusted the services it offered to ensure they were appropriate to the needs of working age patients. For example practice sent out text messages to remind patients of their appointments and also when there were any health campaigns such as flu vaccinations.

  • Extended hours were available on a Wednesday evening until 8pm. Telephone advice was available each day from a pharmacist or GP if required.

  • Minor surgery and joint injections were available at the practice.

  • The practice’s uptake for the cervical screening in the last five years was 81% which was just below the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

  • There was a daily phlebotomy (blood taking service) with appointments available from 8am for working people. The drop in clinic with nurses until 8pm on a Wednesday had helped the practice with the uptake of cervical screening.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 August 2016

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

  • 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84%.

  • The practice was signed up to the Mental Health Local Improvement Scheme. Longer appointments were available for patients with poor mental health. All staff at the practice had completed the dementia awareness training. Patients on the mental health register and those with dementia had comprehensive care plans and received annual health checks.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Patients were encouraged to see a regular clinician to ensure continuity of care.

  • The practice signposted patients to local support such as a relationship and bereavement counselling service, available from Amman Walk in service and Birmingham Healthy Minds which offered advice and information for patients who were experiencing mental health issues.

  • Home visits were done as required for patients who did not engage with the practice.

People whose circumstances may make them vulnerable

Outstanding

Updated 10 August 2016

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

  • Staff told us that there was a practice charity fund which was used to pay for help for patients where emergency support was needed, for example providing a bag of essential items for those requiring unexpected hospital admissions. Therefore when the practice became aware that patients might benefit from this the fund was used for this purpose.

  • The practice had been involved in the Irish Project from 2000 onwards, which involved proactive outreach work in the local community to identify and target vulnerable patients on the practice list for care and treatment. Initially this project was initiated by the Primary Care Trust (PCT) but the practice continued this as a voluntary project. As a result of this project 324 undiagnosed serious diseases were picked up by the practice such as COPD, depression, asthma, arthritis and cancer. The practice was then able to refer patients where this was needed and to start patients on the correct treatment such as having x-rays, blood tests, counselling and psychotherapy.

  • All patients with a learning disability were offered an annual health check and longer appointments were allocated. The practice had 105 patients on the learning disability register and 79 of these had received their annual health check in the last year.

  • Carers were offered an annual health check. 2% of the practice patient list were registered as carers.

  • Patients whose first language was not English were supported by interpreters. Staff at the practice were able to speak a number of different languages which reflected the needs of the local population.

  • The practice had weekly multi-disciplinary team meetings to identify and manage the on-going care of vulnerable patients,. Palliative care meetings were held quarterly.

  • Staff had attended education sessions in female genital mutilation (FGM) and Identification and Referral to Improve Safety (IRIS) for domestic violence. The practice had information leaflets and posters about these and dealt with these subjects sensitively to protect patients who asked for help or who they believed might be at risk.

  • The practice had patients living at a local bail hostel. The feedback from this service was positive indicating the GP partner was very flexible, approachable and always contactable.

  • The practice hosted services to help patients with finances and benefits. The Citizens Advice Bureau attended the practice every Tuesday and the financial enabler attended every Thursday.