Archived: The Keys Family Practice

Updated 2 March 2017

The Keys Family Practice is located in Willenhall, West Midlands. The keys Family Practice is part of Phoenix Primary Care, which is a general medical services provider comprising of 12 GP practices operating in the Midlands, Bedfordshire and Herefordshire. Phoenix merged with The Practice Group in May 2016.

Based on data available from Public Health England, the levels of deprivation in the area served by The Keys Family Practice are below the national average, ranked at two out of 10, with 10 being the least deprived. Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial. Based on Public Health England data the estimated ethnicity of the practice patient population are 4% mixed, 12% Asian, 3% black and 1% other non-white ethnic groups.

The practice population group form birth to ages 85 plus were comparable to local and national averages for most age groups. For example, 9% of patients’ registered were aged from birth to four years old compared to CCG average of 7% and national average of 6%. 15% of patients were aged 65 plus compared to local and national averages of 17%.

The patient list is approximately 4,700 of various ages registered and cared for at the practice. Services to patients are provided under a Personal Medical Services (PMS) contract with the Clinical Commissioning Group (CCG). PMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The surgery is situated on the ground floor of a multipurpose building shared with other health care providers. Parking is available for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staffing comprises three salaried GPs, one female and two male, two practice nurses, two Health Care Assistant, one practice manager and a team of administrative staff.

The practice is open between 8am and 8pm Mondays and Thursdays, between 8am and 6.30pm Tuesdays, Wednesdays and Fridays; and between 8am and 12pm on Saturdays.

GP consulting hours are from 8.15am to 7.10pm on Mondays, Wednesdays and Fridays, Tuesday’s consulting hours are from 8.15am to 6.30pm and Thursdays are from 8.15am to 1pm. The practice has opted out of providing cover to patients in their out of hours period. During this time, services are provided by NHS 111 and Walsall Urgent Care Centre.

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Keys Family Practice on 5 December 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.
• Risks to patients were assessed and well managed in most areas, with the exception of systems for monitoring locum recruitment checks and systems in place for managing pathology results. Following the inspection the practice provided evidence of where they had gained assurance that appropriate recruitment checks for locums had been carried out.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audits demonstrated quality improvements and staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Although the practices performance relating to national screening was below local and national averages in some areas the practice demonstrated actions taken to increase breast and bowel cancer screenings.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• Patients are able to access appointments and services in a way and at a time, that suits them, with urgent appointments available the same day. Results from the July 2016 national GP patient survey showed that patients were satisfied with how they could access care and treatment.
• The practice demonstrated innovative approaches to providing integrated care. For example, the practice provided a contingency service to manage the overflow of patients accessing urgent care services during the 2015 Christmas period.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Clinical staff attended local community venues to provide basic life support training.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. There were clear systemic processes in place and a strong learning culture with development opportunities for all staff. The practice was well organised and made full use of their resources to respond to population needs. We saw areas of outstanding practice which were:

• The practice effectively used media and work with other health care professionals to respond to the needs of specific patient population groups to support the promotion of health needs such as self-directed diabetes care and management. The practice identified a high prevalence of registered Punjabi patients diagnosed with diabetes. The practice secured funding with Walsall CCG and worked closely with the community diabetes services and a National TV channel to develop an educational program for patients regarding diabetes care. The programme was developed in mixed English and Hindi languages to reach out and capture wider audiences such as Hindi, Punjabi and Urdu speaking audiences. We were told that the programme was now used by the community diabetes service when delivering educational events.
• The practice proactively worked with community services such as the local fire service to offer vulnerable patients safe and well visits and delivered basic life support training to children and adults in local community settings.

The areas where the provider should make improvement are:

• Consider in the absence of infection control training how non clinical staff maintain up to date knowledge to enable them to fulfil the requirements’ of their role.
• Continue exploring ways of encouraging the uptake of national screening programmes such as bowel and breast cancer.
• Consider how assurance is gained and recorded from agencies to demonstrate that appropriate recruitment checks are in place for all locum GPs.
• Ensure roles are defined and accountability made clear to enable effective management of pathology results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 March 2017

The practice is rated as 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.

• Overall performance for diabetes related indicators was above local and national average. For example, 99% compared to CCG average of 93% and national average of 90%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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.

• The practice offered a range of services in-house to support the diagnosis and monitoring of patients with long-term conditions including spirometry, phlebotomy and followed recognised asthma pathways.

• The practice also operated a weekly clinic to monitor patient prescribed specific high-risk medicines such as Warfarin (a blood thinner used to prevent heart attacks, strokes and blood clots in veins and arteries).

• The practice worked closely with Walsall CCG community diabetes services and a National TV channel to develop an educational program for patients regarding diabetes care. We were told that the programme is now used by the community diabetes service when delivering educational events. 2014/15 overall performance for diabetes care showed that the practice achieved 100%, 2015/16 data showed an overall achievement of 99%.

• Data provided by the practice showed that 71% of patients with a long-term condition received a flu vaccination in the past two years.

Updated 2 March 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, 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 attending for their eight-week baby checks were seen by the GP prior to immunisation clinics. Patients who missed these appointments were closely monitored and referred to the Health Visiting Team.

• The practice was accessible for pushchairs, had baby changing facilities and supported breast-feeding.

• Staff we spoke with was able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

• The practice’s uptake for the cervical screening programme was 90%, which was above the CCG average of 81% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• A full range of contraceptive services were available along with referrals to family planning clinics. Staff we spoke with were able to demonstrate the use of Gillick competencies (a framework used to decide whether a child aged 16 years or younger is able to consent to his or her own medical treatment, without the need for parental permission or knowledge)  when prescribing to under age patients.   

Updated 2 March 2017

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. All patients had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. A dedicated hotline number was shared with care homes, ambulance services and carers for ease of access.

• The practice worked with community colleagues such as community matron, hospital admission avoidance nurse practitioner and trained nurses at local nursing homes to manage the care of older patients.

• The practice worked closely with the local fire service who attended the practice flu campaign days where elderly patients were offered free fire inspections at their home and provided patients with smoke detectors.

• The practice provided health promotion advice and literature which signposted patients to local community groups and charities such as Age UK. Data provided by the practice showed that 88% of patients aged over 75 received a health check in the last three years.

• The practice was accessible to those with mobility difficulties.

• The pharmacy team carried out medication reviews to reduce polypharmacy (the use of four or more medicines).

Updated 2 March 2017

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.

• For accessibility, telephone consultation appointments were available. Extended weekday evening clinics as well as Saturday morning appointments for patients who could not attend during normal weekday opening hours were available.

• 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.

• The practice offered travel vaccinations available on the NHS and staff sign posted patients to other services for travel vaccinations only available privately such as yellow fever centre (able to provide vaccination for a tropical virus disease transmitted by mosquitoes which affects the liver and kidneys).

• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.

• Following consultations with patients, 30% of appointments were kept for on the day booking. Data from the July 2016 national GP patient survey indicated that the practice was above local and national average regarding phone access and opening times.

Updated 2 March 2017

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

• The practice carried out advance care planning for patients with dementia. Nationally reported data for 2015/16 showed 90% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months. This was above the local and national average.

• Nationally reported data for 2015/16 showed comprehensive, agreed care plan documented in the preceding 12 months.This was above the CCG and national average, with a 6% exception reporting rate.

• The practice regularly worked with multi-disciplinary teams (MDT) in the case management of patients experiencing poor mental health, including those with dementia. The practice was able to access a consultant psychiatrist via phone to discuss cases and we saw evidence of MDT meetings, which took place within the practice.

• The practice offered flexible access to a practice based mental health worker who carried out referrals to psychological therapies.

• 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.

• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia and there were a designated lead responsible for this population group.

Updated 2 March 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 homeless people, travellers and those with a learning disability. Longer appointments were available for patients with a learning disability.

• An alert system was used to identify patients at risk or with special requirements that needed additional support.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, they provided a shared care service in partnership with the local addiction service for patients with opiate dependency allowing them to obtain their medicine at the surgery.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff we spoke with 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.

• Carers of patients registered with the practice had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Data provided by the practice showed that 2% of the practice list were carers.