High Street Surgery

Updated 22 November 2017

High Street Surgery is registered with the Care Quality Commission (CQC) as partnership provider in Cheslyn Hay, Staffordshire. The practice is part of the NHS Cannock Chase Clinical Commissioning Group. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

Following the merger the practice population has increased by approximately 2,000 to 7,400 registered patients. The practice age distribution is higher than CCG and national averages for patients aged 65 years and over and lower for patients aged 18 years and under. The practice has a lower percentage (0.7%) of unemployed patients compared to the CCG average (3.5%). The percentage of patients with a long-standing health condition is 53%, which is lower than the CCG average of 58%.

High Street Surgery and Landywood Lane Surgery merged on 1 July 2017. The registration of Landywood Lane Surgery with the Care Quality Commission was cancelled on 11 July 2017. One of the GPs who worked at Landywood Lane Surgery retired at the time of the merger, and the other GP has joined High Street Surgery as a partner.

The practice operates from two sites. The main site is High Street Surgery – Cheslyn Hay, with a branch site in Great Wyrley. The practice sites are located as follows:

• Main Site: High Street, Cheslyn Hay, Walsall, WS6 7AB
• Branch Site: Wardles Lane, Great Wryley, Walsall, WS6 6EW

The staffing consists of:

• Three GP partners (three male) plus locum GPs and Advance Nurse Practitioners.
• Two practice nurses, and health care assistant and a phlebotomist.
• A practice manager, branch manager, reception staff, secretary and data input clerk.

The main site is open between 8am and 6.30pm Monday to Friday. The branch site is open between 8am to 1pm and 3.30pm to 6.30pm every day except Fridays when they close at 1pm. Extended hours appointments are available between 6.30pm and 7.45pm on Tuesday at the main site, and on Wednesday at the branch site. The practice does not routinely provide an out-of-hours service to their own patients but patients were directed to the out of hours service, via the NHS 111 service when the practice is closed.

The practice provides a number of specialist clinics and services. For example long term condition management including asthma, diabetes and high blood pressure. It also offers services for child health developmental checks and immunisations, travel vaccinations and NHS health checks.

Updated 22 November 2017

Letter from the Chief Inspector of General Practice

We previously undertook a comprehensive inspection of High Street Surgery on 26 January 2016. The overall rating for the practice was Good with the Safe domain being rated as Requires Improvement. We found two breaches of legal requirements and as a result we issued requirement notices in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.
• Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Fit and Proper Persons Employed

The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for High Street Surgery on our website at www.cqc.org.uk.

High Street Surgery and Landywood Lane Surgery merged on 1 July 2017. We previously undertook a comprehensive inspection of Landywood Lane Surgery on 22 September 2016. The practice was rated as Inadequate overall and placed into special measures. We found three breaches of a legal requirements and as a result we issued requirement notices in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Safe Care and Treatment.
• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance
• Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Fit and Proper Persons Employed

The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Landywood Lane Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection on 5 October 2017. Overall the combined practice is now rated as good.

Our key findings were as follows:

• The management team had undertaken a review of both services following the merger. This included working practices, policies and procedures and the overall governance framework. The management team recognised and identified the challenges and had developed an action plan to address these.
• The practice had an overarching governance framework which supported the delivery of the strategy and good quality care. The management recognised that the framework needed to implemented and become embedded across both sites. Staff at the branch site were being supported through the implementation and cross site working was also being introduced.
• There was a clear leadership structure and staff felt supported by management. The leadership and management provided to staff who previously worked at Landywood Lane Surgery had been strengthened following the merger.
• Staff from the merged practice spoke positively about the changes that had taken place since the merger. They told us they felt supported by the management team from High Street Surgery, and efforts had been made to bring both teams together as one new team.
• Improvements had been made to how the practice provided safe services. There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The same policy and procedure had been adopted across both sites. Recruitment procedures had been strengthened and appropriate recruitment checks were undertaken. All staff had received Disclosure and Barring Service (DBS) checks.
• Staff were aware of current evidence based guidance. NICE guidance was a standing agenda item at monthly clinical meetings which all clinical staff were expected to attend. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. There were plans to review the results for both practices to identify any areas were improvements could be made.
• Improvements had been made to the availability of information for patients on how to complain at the branch site. Information about how to complain was available and evidence from examples reviewed showed the practice responded quickly to issues raised
• Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• Patient feedback on comment cards was generally positive about the merger and the increased availability of appointments. Comments included being able to see a GP on a Friday afternoon, and being able to book a diabetic review any day rather than just one.
• The provider was aware of the requirements of the duty of candour. The example we reviewed showed the practice complied with these requirements.

There were also areas of practice where the provider should make improvements.

The provider should:

• Continue to review and update the policies and procedures and share these with staff.
• Continue to monitor and encourage the uptake of the
• Ensure that all uncollected prescriptions are reviewed by the GPs before being destroyed.
• Provide additional fire marshals at the branch site.
• Assure themselves that the legionella risk assessment, water temperatures and running of water outlets is carried out at the branch site.
• Formalise the system for recording verbal complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 November 2017

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

• Nursing staff had lead roles in long-term disease management with support from the GP partners.
• Performance for diabetes related indicators was similar to the CCG and national averages. For example, the percentage of patients on the diabetes register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 92% compared with the CCG average of 82% and the national average of 78%.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met.
• Annual reviews visits were organised at home for those patients who were unable to attend the practice.
• 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 22 November 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Appointments were available outside of school hours and the premises were suitable for children and babies
• The practice worked with midwives, health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. Six week baby checks and post-natal checks were carried out by the GPs at the same time.
• Three out of the four indicators for uptake rates for the vaccines given to under two year olds were all above the national expected coverage of 90%, ranging from 91% to 94%. However, the percentage of children aged two who received the measles, mumps and rubella (MMR) vaccine was 88%. The uptake rates for vaccines given to five year olds were comparable to the national average and ranged from 92% to 96%.
• The practice’s uptake for the cervical screening programme was 83%, which was comparable with the CCG average of 82% and the national average of 81%.
• The practice offered in-house contraceptive services.

Updated 22 November 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice worked closely with social services and community nursing services to support older patients.

Updated 22 November 2017

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

• The needs of these populations 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, extended opening hours.
• 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.
• Telephone consultations were available for all patients, but especially for those working age patients or students.
• The practice enabled students at university to either re-register or be seen as temporary patients during out of term times.

Updated 22 November 2017

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

• The practice was a dementia friendly practice and a member of reception staff had been recruited as a dementia champion.
• The practice carried out advance care planning for patients living with dementia.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia.
• The practice had 49 patients on the dementia register. Eighty two percent of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the England average.
• The practice had 34 patients on the severe mental health register and these patients were offered an annual review.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Performance for mental health related indicators was comparable to the local CCG and national averages. For example, the percentage of patients experiencing specific mental health conditions with an agreed care plan documented in the preceding 12 months was 86% which was comparable to the local CCG average of 90% and national average of 89%.
• Patients at risk of dementia were identified and offered an assessment. The practice recognised it had a lower than average prevalence of patients diagnosed with dementia and was actively reviewing patients to ensure they were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 November 2017

The practice is rated as 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 with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice had 30 patients on their learning disability register. These patients were invited for an annual review with the GP and offered longer appointments. The specialist learning disability nurse supported patients at appointments if required.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.