Archived: Church Lane Medical Centre

Updated 15 October 2015

Church Lane Medical Centre is a two GP partnership practice based in an adapted residential property that has been extended to provide primary care services. The practice is the main location with one branch practice at Bromford Medical Centre, Bromford Drive, Birmingham. The combined registered patient list size for both practices is approximately 5080 patients with about 3800 patients who are seen regularly at Church Lane. This inspection focused on Church Lane Medical Centre.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some enhanced services. Enhanced services require an enhanced level of service provision above what is normally required under the core GP contract.

The practice is open Mondays, Tuesdays, Thursdays and Fridays between 8.30am to 6:30pm, and on Wednesdays between 8.30am to 1pm. When the practice is closed during core hours general medical cover is provided by an external GP provider. Extended hours surgeries are offered on Mondays and Tuesdays when the practice is open early morning at 6:30am to 8am.

The practice has opted out of providing out-of-hours services to their own patients for when the practice is closed. This service is provided by ‘Badger’ the external out of hours service.

There are six GPs at the practice, this includes two GP partners (male and female). At the time of the inspection, the senior GP partner was not working in a clinical capacity and had an administrative role. There was one salaried GP (male) and three regular locum GPs (two male and one female). The practice employs two advance nurse practitioners (one of whom has joint role as a practice nurse), one practice nurse and two health care assistants all of whom are female. With the exception of the main GP partner all of the clinical staff work on a part time basis. There are also four reception staff, one administrative staff and a practice manager.

One of the partners was new to the practice and had not registered with the Care Quality Commission (CQC), a partner had also left the practice and had not cancelled their registration. We discussed this with the senior GP partner and the practice manager who assured us this would be completed. A condition of the CQC registration condition is that the practice has the correct partnership arrangement in place and that the provider informs the CQC of any changes to the partnership.

We reviewed the most recent data available to us from Public Health England for the year 2013-2014. This showed that the practice is located in an area in Birmingham that has a high deprivation score and proportion of people who are unemployed compared to the national average. The practice demographics indicate a high proportion of patients of White British ethnicity and a higher than the national average practice population aged 0 to 4 years and those with caring responsibilities. The practice has a below average practice population aged 75 years and over.

The practice achieved 96.1 % of points for the Quality and Outcomes Framework (QOF) for the last financial year 2013-2014. This was slightly above the average practice score nationally. The QOF is the annual reward and incentive programme which awards practices achievement points for managing some of the most common chronic diseases, for example asthma and diabetes. However, the practice had a higher than national average rate of clinical exception reporting at 10% compared to the national average of 7.8%. The QOF includes the concept of ‘exception reporting’ to ensure that practices are not penalised where, for example, patients do not attend for review, or where a medication cannot be prescribed due to a contraindication or side-effect. The most recent QOF data that we reviewed for the year 2013-2014 showed areas in which the practice achievement was below the national average. For example, the practice score for depression assessments was 52%, this was below the national average by 34%. The practice score for the management of hypertension (high blood pressure) was 81.8%, this was below the national average by 6.6%.

We also reviewed the most recent data from the General Practice Outcome Standard (GPOS) for the year 2013-2014. The standards aim to improve quality, access and patient experience in general practice, and to reduce the variation that exists across England. They are focused on an evidence based approach and agreed definition of general practice. Data from the GPOS showed a number of areas where the practice was not in line with the national average. For example, emergency admissions for people with long term conditions was higher than the national average with a value of 34 compared to the national average of 23. The practice was below the national average for depression assessments with a value of 69 compared to the national average value of 88.7. The practices detection rates for cancer and identification rates for chronic obstructive pulmonary disease (COPD) (lung disease) was also below the national average.

Updated 15 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Lane Medical Centre on 4 June 2015. Overall the practice is rated as inadequate.

We found the practice inadequate for providing safe, effective, caring, responsive and well-led services. It was also inadequate for providing services for the six population groups. These are, people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health. This is because the concerns which led to these ratings apply to everyone using the practice, including all of the population groups.

Our key findings were as follows

• Patients were at risk of harm because systems and processes were not in place to keep them safe. Recruitment checks and safeguarding procedures were not robust. Risks such as fire and legionella had not been assessed and managed.

• The arrangements in place to identify, review and monitor patients with some long term conditions and at risk groups were not effective. The most recent national data for the year 2013-2014 showed the practice was below the national average for areas such as depression assessments and the management of hypertension (high blood pressure). The practices detection rates for cancer and identification rates for chronic obstructive pulmonary disease (COPD) (lung disease) was also below the national average.

• Patients told us they felt listened to and supported by staff. However, confidentiality was not always maintained in the patient waiting area and there were examples of staff not treating patients in a respectful and considerate manner.

• Patients reported that appointments were not easily accessible and this was aligned with results from the most recent national GP survey 2014-2015. The complaints procedure was not easily accessible to patients.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements. The practice had not proactively sought feedback from staff or patients and did not have a patient participation group (PPG). Staff told us they had not received regular training, performance reviews and did not have clear objectives.

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

Importantly, the provider must:

• Have effective systems in place for the management of risks to patients and others against inappropriate or unsafe care. This must include establishing robust recruitment processes, adherence to infection prevention and control procedures and completion of risks assessments in areas such as fire and legionella.

• Develop a systematic, proactive approach to identifying and targeting health promotion and preventative care services for patients who would benefit from them. The practice must use national data to assess its performance and to monitor and improve outcomes for patients.

• Ensure that staff have clearly defined roles and responsibilities with appropriate support, training and supervision to ensure they are working within their competencies.
• Establish robust systems for the management and handling of complaints and make information on raising complaints easily accessible to patients and others.

• Ensure robust governance arrangements are in place to assess and monitor the quality of services provided. Ensure audits complete their full cycle in order to demonstrate improvements made to patient outcomes.

• Seek and act on feedback from patients, staff and others to improve the quality of the service provided.

Action the provider should take :

• Ensure patients are always treated in a respectful manner and there are arrangements for patients to discuss issues in private with reception staff.

On the basis of the ratings given to this practice at this inspection, and the concerns identified I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 October 2015

The practice is rated as inadequate for the care of patients with long term conditions. This is because the provider is rated as inadequate overall. The concerns which led to this rating apply to everyone using the practice, including this population group.

The practice manager told us that patients with long term conditions were reviewed in nurse led clinics. However, we saw no evidence that the practice had personalised care plans in place, for example, for patients with a learning disability or a mental health need.

We reviewed the most recent national data from the General Practice Outcome Standard (GPOS) for the year 2013-2014. The standards aim to improve quality, access and patient experience in general practice, and to reduce the variation that exists across England. Data showed that the practice had a higher than the national average rate for emergency admissions for people with long term conditions.

Updated 15 October 2015

The practice is rated as inadequate for families, children and young people. This is because the provider is rated as inadequate overall. The concerns which led to this rating apply to everyone using the practice, including this population group.

There was a lead GP for safeguarding children. However, they were not able demonstrate they had the necessary understanding to enable them to fulfil this role.

Data provided by the practice showed that the practices performance for some childhood vaccinations had reduced from 91% in July 2014 to 60% in March 2015.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children who did not attend their appointments.

There was evidence of joint working arrangements with the midwives and health visitors and systems in place for information sharing.

Updated 15 October 2015

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

We reviewed the most recent national data from the General Practice Outcome Standard (GPOS) for the year 2013-2014. The standards aim to improve quality, access and patient experience in general practice, and to reduce the variation that exists across England. The data showed that identification of some conditions commonly found in older patients were below the national average. For example, the practice was below the national average for identifying patients with chronic obstructive pulmonary disease (COPD). Flu vaccinations for patients over the age of 65 years was slightly below the national average. The practice had not specifically identified patients in this age group who were most vulnerable. We saw care plans that were in a paper format and had not been inputted on to the clinical system to ensure the information could be reviewed and updated with the patient.

Updated 15 October 2015

The practice is rated as inadequate for working age people (including those recently retired and students). This is because the provider is rated as inadequate overall. The concerns which led to this rating apply to everyone using the practice, including this population group.

There were services aimed at this age group such as NHS health checks for those aged between 40 and 74 years. The practice was open extended hours early morning to accommodate the needs of some working age patients.

Updated 15 October 2015

The practice is rated as inadequate for the people experiencing poor mental health (including people with dementia). This is because the provider is rated as inadequate overall .The concerns which led to this rating apply to everyone using the practice, including this population group.

The practice could not provide any examples of a comprehensive agreed care plan for patients with a mental health condition.

We reviewed the most recent national data from the General Practice Outcome Standard (GPOS) for the year 2013-2014. The standards aim to improve quality, access and patient experience in general practice, and to reduce the variation that exists across England. Data showed that the practice was below the national average for depression assessments.

The practice manager told us that dementia checks for patients over the age of 75 years were in progress.

Updated 15 October 2015

The practice is rated as inadequate for vulnerable people. This is because the provider is rated as inadequate overall. The concerns which led to this rating apply to everyone using the practice, including this population group.

The practice manager and senior GP partner told us that they had started the process of identifying patients as part of an enhanced service to avoid unplanned hospital admissions. This service focused on coordinated care for the most vulnerable patients and included emergency health care plans. The aim was to avoid admission to hospital by managing their health needs at home. However, we saw that care plans were in a paper format and had not been inputted on to the clinical system to ensure clinical staff were able to access the information and review and update the plan with patients.

The practice did not have a clear policy or procedure to enable patients living in vulnerable circumstances to be seen or be registered at the practice.