Archived: Mrs Sarah Banham Also known as Rowley Healthcare

Updated 10 September 2015

Rowley Healthcare is based in the Sandwell and West Birmingham Clinical Commissioning Group (CCG) area. The practice holds a Primary Medical Services (PMS) contract to deliver essential primary care services to approximately 4,250 patients in the local community. The practice operates from a single location in Rowley Regis.

Rowley Healthcare is a nurse-led practice, the provider is also the advanced nurse practitioner (ANP) at the practice. An ANP is a registered nurse who has acquired additional expert knowledge, decision-making skills and clinical competencies for expanded practice. At the time of our inspection, the ANP was on long term leave. The lead GP is a long term male locum. A female locum GP also works at the practice. Other staff employed by the practice included a practice manager, an assistant practice manager, a medical secretary, five reception staff and a cleaner. We saw that a practice nurse had recently been recruited and was due to start at the end of March 2015.

The practice’s patient population profile is similar to the national average with a slightly higher number of female patients between the ages of 40-50. Data from Public Health England shows that the practice is located in an area where income deprivation is higher than the England average.

The practice offers a range of clinics and services including, asthma, family planning, specialist care and diabetes.

The practice opening hours are 8am – 12pm and 2pm – 6pm on Monday, Tuesday, Wednesday and Friday. The practice closes early on a Thursday and the hours of opening are 8.30am – 1pm. During the daytime when the practice is closed between 12pm and 2pm, the telephone lines are covered by ‘Primecare’

The practice has opted out of providing out-of-hours services to their own patients. This service is also provided by ‘Primecare’ who are an external out of hours service contracted by the local CCG.

Updated 10 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rowley Healthcare on 19 March 2015. Overall the practice is rated as requires improvement.

The overall rating for the practice is requires improvement. This is because the safe and well led domains were rated as requires improvement. We found the service was good for caring, effective and responsive domains. It was also rated as requires improvement for providing services for families, children and young people and those of working age, people with long term conditions, older people, people in vulnerable groups and people experiencing poor mental health.

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

• There were systems in place to ensure patients received a safe service although not all of the systems in place were robust.

• There was evidence of clinical audits, significant event analysis and best practice guidance in place to ensure patients’ care and treatment achieved positive outcomes.

• Patients were complimentary about the staff at the practice and said they were caring, listened and gave them sufficient time to discuss their concerns.

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

• The practice was responsive to the needs of the practice population and had a system in place for handling patient complaints and concerns.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from the Patient Participation Group (PPG).

• There were systems in place for assessing and monitoring the quality of service provision.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded although learning from this was not widely shared

• Urgent appointments were available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through the practice when phoning to make an appointment. Some patients acknowledged that this had started to improve as a result of recent changes to the appointment system.

There were areas of practice where the provider needs to make improvements.

The provider must:

• Ensure infection prevention and control audits and risk assessments of the practice are undertaken

• Ensure that the registered provider submits all statutory notifications related to any absence and relevant applications relating to any changes in registration

In addition the provider should:

• Review the current process to ensure information in relation to supervision and training is available for all staff

• Review the recruitment policy and procedure to ensure robust recruitment processes are consistently implemented to include all necessary employment checks for all staff

• Undertake a Disability Discrimination Act (DDA) audit.

• Address the gaps and inconsistencies in training so that staff have the knowledge and skills they need to deliver care safely and effectively such as chaperone duties and staff are aware of Mental Capacity Act (2005) and what this means in practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 September 2015

The practice is rated as requires improvement for the care of people with long-term conditions. This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group.

Patients with long term conditions were reviewed by the GPs and the nurses to assess and monitor their health condition so that any changes to their treatment could be made. An alert had been set up on the computer system to ensure timely reviews were carried out. The practice had clinics where staff reviewed and managed patients with diabetes. Health checks and medication reviews took place and repeat prescriptions were accessible.

Updated 10 September 2015

The practice is rated as requires improvement for the care of families, children and young people. This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group.

At the time of our inspection, a practice nurse was not in post. However, we were told that a nurse from another practice was temporarily carrying out the six week baby checks at another location three miles away from this practice. Antenatal clinics were being held at the practice on a weekly basis by a midwife. The practice immunisation rates for the standard childhood immunisations were mostly near the average for the area. Limited appointments were available outside of school hours.

Updated 10 September 2015

The practice is rated as requires improvement for the care of older people. This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group.

The practice offered personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in end of life care. All patients over 75 had care plans in place with a named GP. This is an accountable GP to ensure patients over the age of 75 years received co-ordinated care. Patients in this age group were also offered quarterly health reviews and had access to a dedicated phone line. A coffee morning for all patients was also hosted by the practice one morning a week although this was not very well attended.

Updated 10 September 2015

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group.

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The age profile of patients at the practice was mainly those of working age and students but there was no representation of these groups within the patient participation group (PPG). The practice offered extended opening hours for appointments one day a week. The practice website allowed repeat prescriptions to be ordered online but there were no facilities for booking appointments via the practice website.

Updated 10 September 2015

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Data for 2013/2014 showed that 100% of patients with poor mental health at the practice had a comprehensive, agreed care plan documented in their record compared to a national average of 85%. The practice had told patients experiencing poor mental health how to access various support groups and made referrals as appropriate.

The practice carried out advance care planning for patients with dementia. Patients were proactively identified for dementia screening depending on their health, age and other circumstances which would put them in a high risk category. Once identified, they were offered a dementia assessment. Most of the staff had not received formal training on the Mental Capacity Act (2005) or were aware of what this meant. However, when interviewed, staff were able to give examples of how a patient’s best interests were taken into account if a patient did not have capacity to make a decision.

Updated 10 September 2015

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group.

The practice had worked to identify all patients who were likely to be at high risk of unplanned admissions and created a case management register. The practice also held a register of patients living in vulnerable circumstances including those with a learning disability. We were shown packs that had been developed by the practice that presented information in a format that was accessible for patients with learning disabilities. The practice had carried out annual health checks for people with a learning disability and offered them longer appointments.

Staff were aware of how to recognise signs of abuse in vulnerable adults and children. Staff were also 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.