Archived: The Wharf Family Practice

Updated 29 November 2017

Phoenix Primary Care Limited is registered with the Care Quality Commission (CQC) as an organisation with primary care services across the country. The Wharf Family Practice (which is part of Phoenix Primary Care Limited) is located in Walsall, West Midlands, providing NHS services to the local community. The practice has an Alternative Provider Medical Services contract (APMS). APMS contracts are contracts between NHS England and general practices for delivering general medical services with a number of additional services. The contract is time limited.

The Wharf Family Practice is part of the NHS Walsall Clinical Commissioning Group (CCG). The practice provides GP services in an area considered as one of the more deprived within its locality. Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial.

The patient list is approximately 3700 of various ages registered and cared for at the practice. The practice serves a higher than average patient population aged between 0 and 15 years and aged between 20 and 45 years. The practice also had a lower than average patients registered aged 40 and over.

The staffing consists of:

• Two female salaried GPs plus locum GPs
• A male nurse practitioner, a female practice nurse and female health care assistant (HCA).
• A practice manager supported by administration and reception staff.

The practice is open between 8am and 6.30pm Monday to Friday and appointments were available during these times. The practice offers extended hours on Mondays and Thursdays from 6.30pm to 8pm. In addition, extended opening hours were also provided on Saturdays from 9am to 12pm.

The practice has opted out of providing out-of-hours services to their own patients and this service is provided by another provider.

Updated 29 November 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at The Wharf Family Practice on 30 August 2016. The overall rating for the practice was good with requires improvement for providing effective services. We found one breach of legal requirement and as a result we issued a requirement notice in relation to:

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance

The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for The Wharf Family Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 26 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 30 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The effective domain is now rated as good and overall the practice remains rated as good.

Our key findings were as follows:

• The practice had improved the governance procedures in place to ensure patients with long term conditions were effectively managed. Action had been taken to address errors in the reporting system.
• The GPs and named senior nurses were responsible for completing the coding on the electronic patient record and were able to clearly describe the rationale for exception reporting.
• Staff had a clear understanding of the recall system for patients with long term conditions.
• The practice had improved their clinical exception rate from for exception reporting 21% to 14%.
• The practice manager had altered some of the standard letters sent to patients inviting them for a review to be more informative about the risks associated with the condition.
• The practice was taking positive action to address areas where results below the expectation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 November 2017

The provider had resolved the concerns for effective identified at our inspection 30 August 2016 which applied to this population group. The population group ratings have been updated to reflect this.

• Improvement had been made to the governance procedures in place to ensure patients with long term conditions were effectively managed.
• Clinical staff were supported by the community diabetic nurse who hosted monthly clinics at the practice.
• Nursing staff had been provided with additional training so they were able carry out all of the required long term condition checks. For example nursing staff had been supported to attend specialist courses in spirometry (a breathing measurement test) and also COPD (chronic obstructive airways disease).

Updated 30 December 2016

• Same day appointments were available for children and those with serious medical conditions.
• 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. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice uptake for cervical screening (83%) was slightly above the CCG average of 81% and the national average of 82%. However, the practice exception reporting was 19% which was above the CCG average of 7% and the national average of 6%.
• Appointments were available outside of school hours and on Saturdays.
• The premises were suitable for children and babies.
• Childhood immunisation rates for the vaccinations given to under two year olds ranged was similar to the CCG average.
• We saw positive examples of joint working with midwives and health visitors.

Updated 30 December 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population. There was a named GP lead for older people and they had developed care plans for these patients.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The consultation rooms were all located on the ground floor. A hearing loop was also available at the practice.
• Flu vaccinations were offered to patients including those patients that were unable to access the practice.
• The practice offered other appropriate vaccinations such as for shingles for patients aged 70 to 79 years.
• The practice offered an enhanced service for unplanned admission to hospital.  

Updated 30 December 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.
• Late opening outside of working hours were available. Appointments on Saturdays were also offered.
• Healthy lifestyle clinics were available such as diet and smoking cessation.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 30 December 2016

• There was a clinical lead for dementia patients. The practice had signed up to the NHS England dementia enhanced service to facilitate timely diagnosis and to offer support.
• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is above the CCG (85%) and national average (84%). The exception reporting was 4% and was below the CCG average of 7% and the national average of 8%.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses who have had a comprehensive care plan documented in the record, in the preceding 12 months. This was above the CCG average of 92% and the national average of 88%. The exception reporting was 7% which was below the CCG average of 9% and the national average of 13%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 30 December 2016

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and carers. However, the practice did not have an agreed process for registering carers. One of the GPs we spoke with had not registered any patients as a carer and was unsure which code they would use on the system.The new practice manager had identified that this was an area for improvement and plans were in place to address the issue which included training for staff to ensure carers were appropriately identified, registered and suitable codes were utilised.
• 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.
• 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.