Archived: Tudor Practice

Updated 8 September 2016

The Tudor Practice is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

The practice is registered with the Care Quality Commission to provide primary medical services. The practice has a general medical service (GMS) contract with NHS England. Under this contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care.

The practice is located in a suburban area of Birmingham with a list size of approximately 7,500 patients. The premises are purpose built for providing primary medical services and co-owned and shared with another practice. There are also private consulting suites located within the premises.

Based on data available from Public Health England, the practice is located in an affluent area and is within the top 20% of the most affluent areas nationally. The practice population is predominantly white British. Compared to the national average the practice population had a higher proportion of patients over the age of 40 years and less patients aged between 20 years and 40 years than the national average.

Practice staff consist of four partners (two male and two female), four nurses (including one nurse practitioner), one health care assistant, a practice manager and a team of administrative staff.

The Tudor Practice is open from 8am to 6.30pm Monday to Friday. In addition the practice opens 6.30pm to 8.30pm one day each week (alternating between a Wednesday and Thursday evening) for extended opening. Appointment times vary between the clinical staff but usually ranged from 8.30am to 12.30pm and 2.30pm to 6pm. When the practice is closed services are provided by an out of hours provider (BADGER).

The practice is a training practice for qualified doctors training to become GPs and a teaching practice for final year medical students.

The practice has not previously been inspected by CQC.

Updated 8 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Tudor Practice on 17 June 2016. Overall the practice is rated as good.

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. The practice used learning from incidents to improve services.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• Feedback from patients about their care was consistently positive.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example redesigning services to better support patients in primary care and reduce hospital admissions.
• 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, changes to the appointment system to improve access.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders to meet changing needs in primary care and secure future services for patients.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw areas of outstanding practice including:

• The practice had been a key player in developing a successful scheme to reduce unplanned admissions in collaboration with two other practices. The scheme extended beyond the local enhanced scheme by including all patients over 70 years. The senior partner formed a steering group with the other practices involved and employed a service redesign expert to support the project. During the initial stages they visited and listened to a wide range of stakeholders and patients to identify and address challenges faced by organisational boundaries. The organisations were brought together through organised networking events to improve working relationships and understanding of roles. As part of service redesign software was developed to enable the practices to view their patients in the system and intervene as appropriate. The practice initially employed two but now has three community matrons to facilitate hospital discharges and put in place appropriate packages of care to minimise the risk of readmission to hospital. The practices involved maintain a blog to support communication across the partnership. Through this programme of service redesign the practice has made demonstrable improvements to patient outcomes and experiences as well as benefiting the local health economy in facilitating early safe discharge from hospital. To date the practice has reduced the average number of hospital deaths by 90, saved 5800 hospital bed days and reduced admission spend by £1.2 million. As a result of this success three further practices have joined the scheme which covers a population of 64,000. The scheme has led to a fall in hospital readmissions by more than 6 admissions on average each week and the facilitation of early safe discharge for over 200 patients among the participating practices.

The areas where the provider should make improvement are:

• Review and implement ways in which the identification of carers might be improved so that they may receive support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Patients with long term conditions received a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. Unplanned admission meetings took place monthly to review patients’ needs and update care plans as necessary.
• The practice sought ways to improve attendance for health reviews for example, those with respiratory conditions were being recalled earlier in the year to avoid winter when there were higher levels of illness. Text messaging was being explored to try and communicate with patients who did not attend to identify any potential issues. Audits had also been undertaken during 2015 and 2016 to identify and actively follow up patients whose blood test results had indicated poor diabetic control but did not attend for a review. The audit had resulted in improved attendance (83% to 95%) and improvements in blood results for 11 out of the 16 patients actively targeted.
• Overall performance for diabetes related indicators (2014/15) was 97% which was higher than the CCG average and national average of 89%.
• The practice was participating in a heart failure project in conjunction with five practices to improve the management of patients at risk of heart failure. Patients at high risk were referred to heart failure nurses who helped support them in self-management. Of the 50 patients on the practice’s heart failure register 32 have been seen by the heart failure nurse.
• The practice had sought to improve coding of patients at risk of developing diabetes so that these patients could receive better support and advice. Between 2014 and 2015 coding had improved from 58% to 96% based on blood results within the pre-diabetic range.
• Patients with chronic obstructive pulmonary disease (COPD) were given self-management plans which advised them what to do if experiencing specific symptoms.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions for example insulin initiation, electrocardiographs (ECGs), ambulatory blood pressure monitoring and spirometry.

Updated 8 September 2016

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, for example, children and young people who had a high number of A&E attendances or repeatedly failed to attend for child immunisations. Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours with both GPs and nursing staff and the premises were suitable for children and babies.
• The practice routinely met with the health visitor to discuss the needs of children at risk and carried out child health surveillance checks.
• A range of contraceptive services were available at the practice including the fitting of intra-uterine devices.

Updated 8 September 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Patients over the 75 years were allocated a named GP to support their needs and care plans were in place for those with complex care needs.
• The practice had been a key player in developing a successful scheme to reduce unplanned admissions in all patients over 75 years in collaboration with two other practices. Through service redesign, the practice had taken an active role in both prevention of admission and facilitating early safe discharge. To date the scheme had achieved significant benefits with 90 less hospital deaths, 5800 hospital bed days saved and reduced admission spend by £1.2 million by the practice. It had also resulted in improved working relationships across organisational boundaries. As a result of the success three further practices had joined the scheme now covering a population of 64,000.
• The practice had also been proactive in participating in other successful pilot schemes within the CCG which benefited elderly patients and complemented the unplanned admissions scheme. This included the elderly care support nurse project in which a nurse was specifically employed (and shared between six local practices) to review all patients over 75 years to identify and help address any unmet care and support needs. The practice has also participated in the ambulance triage scheme in which the GPs provide advice to paramedics and support patients in primary care as an alternative to accident and emergency.
• The practice was responsive to the needs of older people, and offered home visits including domiciliary blood tests for those who were unable to attend the practice due to their clinical needs.
• The practice was accessible to patients with mobility difficulties and a wheelchair was available if needed.
• Flu and shingles vaccinations were available to patients in this age group.
• The practice met on a monthly basis as part of a multi-disciplinary team to discuss and review the care of those with end of life care needs.

Updated 8 September 2016

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

• 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 (for booking appointments and ordering repeat prescriptions).
• A range of health promotion and screening that reflects the needs of this age group were available. Patients could access NHS health checks and patient uptake of national screening programmes was high.
• Extended opening hours were available once a week on alternate Wednesday and Thursdays to support those who worked, this included appointments with both GPs and nurses.

Updated 8 September 2016

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

• Nationally reported data for 2014/15 showed 78% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was slightly below the CCG average 82% and national average 84%.
• National reported data for (2014/15) showed 94% of patients with poor mental health had comprehensive, agreed care plan documented, in the preceding 12 months which was above to the CCG average 89% and national average 88%.
• The practice had a named nurse for mental health reviews.
• The practice was able to signpost patients to support services.

Updated 8 September 2016

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

• The practice held register of patients living in vulnerable circumstances such as patients with a learning disability.
• Annual health checks for patients with learning disabilities were undertaken by the Advanced Nurse Practitioner, 68% were completed within the last 12 months. The practice offered longer appointments for patients with a learning disability.
• Patients on the learning disability registered received patient passports which enabled them to record important information including likes and dislikes should they move between services.
• Information was available that informed vulnerable patients and those with caring responsibilities about how to access various support groups and voluntary organisations.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.
• Practice staff told us that they had protocols in place for patients with no fixed abode to obtain care and treatment at the practice.
• We received several comments from patients and their carers of compassionate care they had received at times when they had been vulnerable. For example in the provision of end of life care, patients with learning disabilities and with poor mental health.