Hollymoor Medical Centre

Updated 30 January 2017

Hollymoor Medical Centre is located in Northfield suburb of Birmingham. The practice holds a General Medical Services (GMS) contract, a nationally agreed contract commissioned by NHS England. There are 8,853 registered patients.

There is a higher than average proportion of patients of both sexes from new-born to 4 years old, female patients aged between 30 and 34 years and slightly higher than average females aged 85 or more registered with the practice.

The practice is managed by five GP partners (one male, four female) and they are supported by one experienced salaried GP. The practice employs two practice nurses who carry out reviews of patients who have long term conditions such as asthma and hypertension. They also provide cervical screening and contraceptive services. A third practice nurse is employed as a specialist in diabetes and provides a weekly clinic for patients who have complex needs. There are two health care assistants (HCAs) who carry out duties such as, phlebotomy (taking blood for testing), health checks and vaccinations. There is a practice manager, an office manager, a deputy office manager, a quality and targets continuity manager, three senior receptionists, six receptionists and two secretaries.

The practice employs an advanced nurse practitioner who provides care for older patients including home visits. They also carry out weekly visits to two care homes. In total the advanced nurse practitioner cares for 1962 patients who are 60 years of age or more. In August 2016 the advanced nurse practitioner established a monthly clinic for patients with dementia.

Weekly clinics are held for substance misuse by external professionals. These are supported by lead a GP from the practice.

The practice offers a range of clinics for chronic disease management, diabetes, heart disease, cervical screening, contraception advice, joint injections and vaccinations.

There is a large dedicated parking area for patients including disabled spaces. The premises are step free and suitable for access by wheelchair users. There is a toilet that is adapted for use by people who have restricted mobility. The premises include a lift for use by those who have restricted mobility. There are eight consulting rooms and a minor surgery suite.

The practice is a designated training practice for trainee GPs. These are qualified doctors who are learning the role of a GP.

The practice is open from 7am until 6.30pm every weekday with the exception of Wednesdays when the practice closes at 1pm.

Appointments times vary between GPs:

• From 7am until 12pm on a GP rota basis and from 8am until 12.30pm.

• From 1.30pm until 4.30pm and from 3pm until 6pm.

• Requests for home visits may be contacted by telephone to enable GPs to prioritise which patients should be visited first.

The practice has opted out of providing GP services to patients out of hours. During these times GP services are provided by South Doc. When the practice is closed, there is a recorded message giving out of hours’ details. The practice leaflet includes contact information and there are out of hours’ leaflets in the waiting area for patients to take away with them. Information was also on the practice website.

Updated 30 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hollymoor Medical Centre on 30 November 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded. Significant events were investigated and acted on when necessary.

• Risks to patients were assessed and well managed. There were safe systems for prescribing medicines. Clinical staff processes ensured that patients received safe and appropriate care and this was clearly documented.

• Staffing levels were monitored to ensure they matched patients’ needs. Safe arrangements were in place for staff recruitment that protected patients from risks of harm. Senior staff were seeking to recruit a second salaried GP.

• Staff had received training appropriate to their roles and any further training had been identified and planned to enhance their skills and patient care.

• Patients told us they were treated with compassion, dignity and respect and they were involved in decisions about their treatment. They said they were satisfied with standards of care they received.

• Most patients said they found it easy to make an appointment and there was continuity of care, with all urgent appointment requests accommodated the same day. Some patients told us they sometimes had difficulty in getting through to the practice by telephone and in making appointments.

• Information about how to make a complaint was readily available and easy to understand. Complaints were dealt with in a timely way and appropriately.

• The practice had good facilities and was well equipped to assess and treat patients.

• There was a clear leadership structure and staff told us they felt well supported by senior staff. Management proactively sought feedback from patients which it acted on. The governance system monitored the quality of practice wide performance. The practice had a written five year forward plan dated September 2016 that took into account the probable future increase of registered patients.

We saw some areas of outstanding practice including:

• Patients who received end of life care were given a bypass telephone number to enable them to get through to the practice immediately.

• The advanced nurse practitioner had a special interest and qualifications in dementia care. The practice had introduced a monthly clinic for patients who had dementia. The service had been well received and had led to many requests for information.

However, there were areas of practice where the provider needs to make improvements.

The provider should:

• Ensure there are effective systems for managing the recall of patients for reviews and other interventions.

• Implement effective systems for the monitoring the actions taken form safety alerts.

• Respond and reply to feedback provided by patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 January 2017

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

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

• A diabetes specialist nurse was employed by the practice for one session per week. They worked alongside the practice nurses who managed patients with diabetes and saw patients who had complex needs. This system also served to enhance the practice nurses skills. Data for 2014-2015 showed that the percentage of patients with diabetes in whom the last IFCC HbA1c (glucose blood test) was 64mmol/mol or less was 76%; which was comparable with the CCG average of 79% and the national average of 78%.

• Longer appointments and home visits were available when needed.

• Patients with long-term conditions had structured annual reviews to check that their health and medicine needs were being met. Where necessary reviews were carried out more often. However, some improvements were needed for managing the recall of patients for reviews.

• Clinical staff worked with health care professionals to deliver a multidisciplinary package of care for patients.

• Where necessary patients in this population group had a personalised care plan in place and they were regularly reviewed.

Updated 30 January 2017

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

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.

• Alerts were put onto the electronic record when safeguarding concerns were raised.

• There was regular liaison and meetings with the health visitor to review those children who were considered to be at risk of harm.

• All children up to the age of 12 years were triaged and if necessary seen the same day.

• Patients and their children told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• A GP offered daily appointments for sexual health.

• Pre-bookable appointments were available outside of school hours from 7am each weekday.

• Childhood vaccinations were in line with the local and national averages.

• Data for 2015-2016 informed us that the cervical screening rate was in line with local and national averages and breast screening was 77% which was above average.

Updated 30 January 2017

The practice is rated good for the care of older people.

• The advanced nurse practitioner had special responsibility for the care of older patients. They offered proactive, personalised care to meet the needs of older patients. Care plans were personalised so that they met individual patients’ needs.

• The advanced nurse practitioner held monthly meetings with the district nurse to ensure that patients received appropriate and coordinated care.

• Staff kept up to date registers of patients’ health conditions and information was held to alert staff if a patient had complex needs.

• Home visits were provided by the advanced nurse practitioner for those who were unable to access the practice.

• Patients with enhanced needs had priority access to appointments.

• Practice staff worked with other agencies and health providers to provide patient support. For example, Age UK.

• Older patients were offered annual health checks and where necessary, care, treatment and support.

Updated 30 January 2017

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

• Extended hours were available and telephone consultations for those patients who found it difficult to attend the practice or if they were unsure whether they needed a face to face appointment.

• Online services were available for booking appointments and ordering repeat prescriptions.

• Health promotion advice was available and there was a full range of health promotion material available in the practice. The practice website gave advice to patients about how to treat minor ailments without the need to be seen by a GP.

• Clinical staff held weekly smoking cessation clinics. External professionals held weekly substance misuse clinics at the practice with a GP in attendance.

• Staff actively encouraged patients to attend for health screening, such as, breast and bowel cancer.

Updated 30 January 2017

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

• Patients who experienced poor mental health were offered an annual physical health check.

• Data for 2014-2015 showed that 93% of patients who experienced poor mental health had agreed care plans in place;

• GPs carried out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. This enabled staff to put a care package in place that provided health and social care support systems to promote patients well-being.

• In August 2016 the advanced nurse practitioner had commenced a monthly clinic for patients who had dementia. They told us this had been well received by patients.

• Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experienced poor mental health, including those with dementia.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• Referrals to other health care professionals were made when necessary such as mental well-being support.

Updated 30 January 2017

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

• The practice held a register of patients living in vulnerable circumstances including those who had a learning disability.

• Health reviews of patients who had a learning disability took place in their own home to reduce their anxiety. There was a high number of patients who had a learning disability and all had received their health check during 2014 to 2015.

• Practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

• There was a process in place to signpost vulnerable patients to additional support services.

• Staff knew how to recognise signs of abuse, the actions they should take and their responsibilities regarding information sharing.

• There was a clinical lead for dealing with vulnerable adults and children.

• The practice had identified 2% of their patients as carers and maintained a register. Clinical staff offered them guidance, signposted them to support groups and offered them the influenza vaccination each year.