Archived: Dr Abraham Thomas Also known as Croft Surgery

Updated 30 December 2016

Dr Abraham Thomas also known as Croft Surgery is located in Walsall, West Midlands situated in a multipurpose modern built Private Finance Initiative (PFI) owned building, providing NHS services to the local community.

Based on data available from Public Health England, the levels of deprivation in the area served by Dr Abraham Thomas are below the national average, ranked at two out of 10, with 10 being the least deprived. Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial. Based on Public Health England data the estimated ethnicity of the practice patient population are 4% mixed, 12% Asian, 3% black and 1% other non-white ethnic groups. The practice serves a higher than average patient population aged from birth to nine years old, 25 to 34, and 45 to 50. The practice serves a below average of patients aged 65 to 85 and over.

The patient list is approximately 4,450 of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The surgery is situated on the ground floor of a multipurpose building shared with other health care providers. Parking is available for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staffing comprises of two male GPs, one female GP, one practice nurse, one advance nurse practitioner (independent & supplementary prescriber), one health care assistant (HCA), a practice manager, a secretary and four receptionists. The practice is also an approved training practice and provided training to medical students. There were one female trainee GP registrar (GPs in training).

The practice is open between 8am and 8pm on Mondays, 8am and 6.30pm Tuesdays, Thursdays, Fridays; 7am and 6pm on Wednesdays.

GP consulting hours are from 8am to 8pm on Mondays, 8am to 6.30pm Tuesdays, Thursdays, Fridays; 7am to 6pm on Wednesdays. The practice has opted out of providing cover to patients in their out of hours period. During this time, services are provided by NHS 111.

Updated 30 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Abraham Thomas’s practice, also known as Croft Surgery on 4 October 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were assessed, well managed and the practice adopted a range of processes, which enabled staff to take appropriate actions in the event of safety concerns.

• The practice had well established and effective systems, processes and practices in place to keep patients safe and safeguarded from abuse.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audits demonstrated quality improvement in a number of areas.

• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• The practice worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

• Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice improved their appointment systems, which improved patient access and experience.

• 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.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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. The practice proactively sought feedback from staff and patients, which it acted on.

• The practice had a clear vision which had quality and safety as its top priority. Staff were clear about the vision and their responsibilities in relation to it.

• The practice had strong and visible clinical and managerial leadership and governance arrangements. Staff used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. For example, the practice held a variety of health awareness days to raise patients’ awareness of various health related issues; implemented a new appointment system based on local feedback and shared their knowledge with other practices.

There were an area of practice where the provider should make improvements. For example:

• Establish processes to increase the identification of carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 December 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the national average. For example, 86% had a specific blood glucose reading within acceptable range in the preceding 12 months (01/04/2014 to 31/03/2015) compared to the CCG and national average of 78%. With an exception reporting rate of 18%, compared to CCG average of 9% and national average of 12%.

• Following publication of NICE guidelines regarding the risk of Hypoglycaemia (an abnormally low level of sugar “glucose” in the blood) the practice sent letters to at risk patients advising of the importance of self-monitoring their blood sugars, particularly if driving for long periods and invited patients to attend a consultation with clinicians to discuss this further.

• Longer appointments were available, for example, 20 minutes’ were allocated for diabetic reviews and surgery-initiated home visits were scheduled at regular intervals when needed.

• All these patients had a named GP and 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.

• The Advanced Nurse Practitioner offered evening appointments until 6.30pm aimed to help working patients manage their long-term conditions.

• At the time of inspection the practice were in the process of populating a list of patients at risk of developing diabetes. We saw that the practice had planned a health awareness day in November 2016 where a team from the local lifestyle service were invited to advise patients on topics such as healthy eating and exercise.  

Updated 30 December 2016

• There were systems in place 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 A&E attendances.

• Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

• The practice’s uptake for the cervical screening programme was 81%, which comparable to the CCG average of 81% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• Immunisation rates were for all standard childhood immunisations. To enhance uptake the practice offered flexible appointment times. The practice nurse proactively contacted patients who failed to attend and alerts were placed on patient’s records.

• There were systems in place for ensuring all new babies were registered with the practice within three to four weeks, however where parent’s choice were to register children at another practice, health visitors were informed.

• We saw positive examples of joint working with midwives, health visitors and school nurses. For example, first antenatal contact were provided by GPs and subsequent follow up were arranged in liaison with the practice in-house midwifery team.

• The practice held a Chlamydia afternoon where patients under the age of 25 were invited. The practice encouraged uptake by offering free cinema tickets to patients who attended and were screened, however attendance was low. The practice had taken action to address this by providing a second day. To improve uptake staff explained that they sent letters to all eligible patients.  A lead sexual health nurse attended the practice to provide information, advice and screening for Chlamydia and Gonorrhoea.

Updated 30 December 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Data provided by the practice showed that 91% of patients over the age of 75 had received a health check and all patients had a named GP.

• The practice was responsive to the needs of older people, and offered surgery-initiated home visits at regular intervals, which included assessments of daily living needs, health hazards and fire risks; with referrals to occupational health or social services as necessary. S ame day appointments for those with enhanced needs were also available.

• Data provided by the practice showed that 40% of patients aged 65 and over had subscribed to electronic prescribing system (EPS). Pharmacists received paperless prescriptions and delivered medications to patients’ homes.

• A dedicated ‘hot-line’ phone number was issued to care homes for residents at risk of hospital admission. Patients discharged were proactively contacted by a clinician within three working days of discharge.

• The practice was accessible to those with mobility difficulties.

• The practice held a health awareness day to increase; this resulted in 76% of patients over the age of 65 receiving a flu vaccination. The practice also facilitated a Aortic Aneurysm Screening clinic screenings (a screening to detect swelling of the main blood vessel that runs from the heart, down through the abdomen to the rest of the body), for over 65s where the practice had capacity to screen up to 23 Walsall residents.

Updated 30 December 2016

• The needs of the working age population, those recently retired and students 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, early appointments from 7am and late evening appointments until 8pm were available one day per week.

• For accessibility, telephone consultation appointments were available with either a GP or Advanced Nurse Practitioner. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years. Data provided by the practice showed that 64% of patients had been invited for a health check in the past three years and 26% had attended. Data also showed that 98% had been offered smoking cessation advice and 57% had their blood pressure checked in the last 12 months.

• Data from the national GP patient survey indicated that the practice were above local and national average regarding phone access and comparable regarding opening times.

• Reception staff received customer service training; the July 2016 national GP patient survey showed that results relating to the helpfulness of receptionists were above local and national averages.

• The practice operated a virtual Patient Participation Group to ensure they received feedback from this patient group. Data provided by the practice showed that 300 patient were enrolled to the virtual PPG. Staff explained that they sent emails and received  feedback.

Updated 30 December 2016

• Nationally reported data for 2014/15 showed 90% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months. This was above the local and national average.

• Performance for mental health related indicators was above the national average. For example, 93% had an agreed care plan documented in the record, in the preceding 12 months compared to CCG average of 92% and national average of 88%. With a 17% exception reporting rate, compared to CCG average of 5% and national average of 12%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice worked closely with the community psychiatric nurse (CPN) and had enhanced access to a consultant psychiatrist to discuss cases over the telephone. Regular clinical meetings with the consultant psychiatrist and mental health care teams were held. Data provided by the practice showed that 100% had received a face-to-face review in the past 12 months.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia and there was a designated lead responsible for this population group.

Updated 30 December 2016

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability (LD).

• The practice offered longer appointments for patients with a learning disability and worked closely with the community learning disabilities nurse. Data provided by the practice showed that 93% of patients with a LD had a care plan in place, had a medication and a face-to-face review in the past 12 months.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice worked with the local addiction service to manage the general health care of patients receiving interventions for substance and alcohol dependency.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Interpretation facilities were provided by an external service. In addition, two clinicians were able to converse in other languages, including Punjabi, Hindi, Urdu, German and French.

• Staff we spoke with knew how to recognise signs of abuse in vulnerable adults and children.

• Carers of patients registered with the practice had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Data provided by the practice showed that 1% of the practice list were carers; 100% had received a health check in the last two years.