Archived: Dr J.R. Naik and Partners Also known as Streetly Surgery

Updated 30 November 2016

The Oaks Medical Centre Streetly is located in Sutton Coldfield, West Midlands situated in a converted house, providing NHS services to the local community. The Oaks Medical Centre Streetly is part of a multipartnership practice run by five partners known as Dr J.R. Naik and Partners. The multipartnership with includes The Oaks Medical Centre merged with Dr Ratnam in April 2015 to form The Oaks Medical Centre Streetly. Systems and processes are shared across both sites.

Based on data available from Public Health England, the levels of deprivation (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by The Oaks Medical Centre Streetly are higher than the national average.

The patient list across both sites is approximately 13,500 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 spread across two floors of a multipurpose building with lift access to the second floor. 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 is shared across both sites and comprises of five GP partners (three male and two female), five salaried GPs and three GP registrars (GPs in training). The nursing team includes four advanced nurse practitioners, four practice nurses and three health care assistants (HCA). Non-clinical staff consists of a practice manager, an Information Technology (IT) manager a reception manager, three team leaders, administration and reception staff.

The practice is open between 8am and 6pm Mondays, Wednesdays and Fridays; 8am and 1pm Tuesdays and Thursdays. The practice closes for lunch between 1pm and 2pm on Mondays, Wednesdays and Fridays.

GP consulting hours are from 9am to 11.50am and 3pm to 5.30pm on Mondays, Wednesdays and Fridays; 9am to 1pm Tuesdays and Thursdays. Extended consulting hours are offered fortnightly on Wednesdays and Thursdays 7am. The practice has opted out of providing cover to patients in their out of hours period. During this time services are provided by Badger.

Updated 30 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Oaks Medical Centre Streetly on 16 August 2016. Overall the practice is rated as good. There are two surgery locations that form the practice; these consist of the main practice at Shady Lane Great Barr and the branch practice at Chester Road Streetly. Both locations have separate CQC registrations; we have therefore produced two reports. There is one patient list and systems and processes are shared across both sites. The data included in this report relates to both locations. During the inspection we visited both sites.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed with the exception of a completed Disclosure and Barring Service (DBS) check for non-clinical staff who carried out chaperoning duties.
• There were arrangements in place to respond to emergencies and major incidents.
• 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 effective care and treatment; with the exception of formal training for staff who carried out chaperoning duties.
• There was a programme of continuous clinical audits, which demonstrated quality improvement and staff were actively engaged to monitor and improve patient outcomes.
• 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 introduced an electronic call management system; this improved the phone access which enable the practice to reduce the volume of missed appointments’.

• Patient feedback from the comment cards we received were positive, for example patients felt GPs were caring, supportive and patients felt listened to. However

• Information about services and how to complain was available and easy to understand. The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice where the practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. The practice expanded the clinical team in order to respond to population needs. For example:

• The practice held a health awareness event in March 2016 where guest speakers from health organisations and charities such as, Diabetes UK, Alzheimer’s society and Heart care were available. During the weekend patients were provided with the opportunity to speak to health care specialists to increase their knowledge in certain areas of health.

The areas where the provider should make improvement are:

• Ensure that staff undertaking chaperoning duties receive a Disclosure and Barring Service check and sufficient training to carry out this role.

• Ensure that recruitment procedures are operated effectively. For example the practice should ensure

• Explore ways of improving the uptake of national screening programs such as breast and bowel cancer screening.

• Explore ways of improving the amount of care plan, medication and face to face review carried out on patients with a learning disability.

• Ensure information for carers are available within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 November 2016

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

• Overall performance for diabetes related indicators was below the national average. For example, 83% compared to the CCG and national average of 90%. Unverified data provided by the practice showed that influenza immunisation for patients diagnosed with diabetes during 2015/16 was 86%.

• The practice employed a specialist diabetic nurse who provided in-depth care and insulin initiation was available on site. The practice nurse actively carried out pre-diabetes screenings to identify patients at risk and offered support and advice to these patients

• Longer appointments and home visits were available when needed.

• The practice referred into services such as the Desmond Diabetic Programme, Chronic Obstructive Pulmonary Disease Team, Expert Patient and Heart Rehabilitation Programme. Written management plans were in place for patients with long-term conditions and those at risk of hospital admissions.

• 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.

Updated 30 November 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. We saw positive examples of joint working with health visitors and safeguarding teams.

• The practice held a nurse-led child health and immunisation clinic and vaccination rates were relatively high for all standard childhood immunisations. Processes for encouraging parents of young children to attend the practice were in place. For example, the practice sent one year and four year birthday cards; non-attenders were followed up with a further invitation and a telephone call.

• 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 for patients aged 25-64 in the preceding five years was 75%, which was above the CCG average of 69% and comparable to the national average of 82%. The practice provided unverified data from August 2016, which showed that 80% of eligible patients were screened.

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

• Staff we spoke with provided positive examples of joint working with midwives, health visitors and school nurses.

Updated 30 November 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The patient participation group (PPG) supported the practice to promote the uptake of flu vaccinations. Data provided by the practice showed that their uptake of flu immunisations for over 65s in the last 12 months was 76%.

• Health care assistants (HCA) carried out nursing and care home visits; any concerns were then referred to the advanced nurse practitioner or GP. The practice had a well-established call and recall system for this population group to ensure reviews were taking place at least annually.

Updated 30 November 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.

• 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 responded to patient feedback by offering extended clinic hours on Tuesdays, Wednesdays and Thursdays from 7am to 8pm, and Wednesdays from 6.30pm to 7.30pm.

• The practice held a health awareness weekend and also actively participated in national campaigns such as no smoking days.

• The practice acted as a hub provider for sexual health services available to registered and non-registered patients.

Updated 30 November 2016

• 78% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%. Unverified data provided by the practice showed that 81% had their care plans reviewed.

• Performance for patients with a mental health related disorder who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was below the national average. The practice identified this and staff we spoke with told us that the practice were working closer with the community mental health team (CMHT) to increase patient engagement.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A community psychiatric nurse attended the practice weekly and the practice invited the Alzheimer’s society to their health awareness day.

• The practice carried out advance care planning for patients with dementia. The practice offered opportunistic dementia screening.

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

• The practice had a comprehensive 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.

Updated 30 November 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 provided data which showed that 17% of patients with a LD have had a care plan, 51% medication and face to face review in the last 12 months.

• The practice offered longer appointments for patients with a learning disability.

• 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.

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

• 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. The practice also provided carers with a detailed carers pack. Data provided by the practice showed that 35% of carers had received a flu vaccination.