Archived: Church Road Surgery

Updated 28 July 2017

Church Road Surgery is based in Sheldon area of the West Midlands. There are two surgery locations that form the practice; these consist of the main practice at Church Road and a branch practice Tile Cross Surgery. There are approximately 11,480 patients of various ages registered and cared for across the practice and as the practice has one patient list, patients can be seen by staff at both surgery sites. Systems and processes are shared across both sites. Church Road surgery is a purpose built building that was constructed in 1996. The branch practice, Tile Cross surgery is situated in a renovated house; we did not visit this site during the inspection.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes. The practice runs an anti-coagulation clinic for the practice patients. The area served has higher deprivation compared to England as a whole and ranked at three out of ten, with ten being the least deprived.

The practice has undergone significant changes in staffing with the resignation of four partners and a practice nurse in January 2016 and the retirement of another practice nurse. Since the changes to the clinical team, the GP partners have recruited three salaried GPs and two practice nurses. There are now currently two GP partners (one male, one female) and three female salaried GPs. The practice also uses regular long term locums. The nursing team consists of four nurses and two health care assistants. The non-clinical team consists of a practice manager, assistant practice manager, administrative and reception staff. The clinical staff worked across both sites.

The practice is open to patients between 7.30am and 6.30pm Monday to Friday. Extended hours appointments are available 7.30am to 8am every weekday. Emergency appointments are available daily. Telephone consultations are also available and home visits for patients who are

unable to attend the surgery. The out of hours service is provided by Badger Out of Hours Service and NHS 111service and information about this is available on the practice website.

The practice is part of NHS Solihull Clinical Commissioning Group (CCG) which has 38 member practices. The CCG serve communities across the borough, covering a population of approximately 238,000 people. A CCG is an NHS Organisation that brings together local GPs and experienced health care professionals to take on commissioning responsibilities for local health services.

The practice was previously inspected on 5 May 2016 and was rated overall as requires improvement, with requires improvement rating for Safe, Effective and Responsive domains, Inadequate in the Well-Led domain and Good in the Caring domain. .

Updated 28 July 2017

Letter from the Chief Inspector of General Practice

We first inspected Church Road surgery on 6 May 2016 as part of our comprehensive inspection programme. The overall rating for the practice was requires improvement, with well led rated as inadequate. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Church Road surgery on our website at www.cqc.org.uk. During the inspection in May 2016 we found the practice required improvements in a number of areas. The areas which required improvement related to appropriate processes which were not in place to mitigate risks in relation to the safety and quality of the services. Feedback had not been sought from service users to demonstrate improvement to services. Following the inspection the practice wrote to us to say what they would do to meet the regulations.

We undertook this planned comprehensive inspection on 30 March 2017 to check that the practice had followed their action plan and to confirm that they had made the required improvements. Overall we found some improvements had been made to the concerns raised at the previous inspection. However, concerns relating to effective processes to manage risk and monitor patient outcomes had not been established. As a result of the inspection findings the practice is rated as requires improvement.

Our key findings were as follows:

• The practice had no system in place to receive alerts from the Medical and Healthcare products Regulatory Agency (MHRA) alerts.
• On the day of inspection, the practice did not have an effective system in place for the recall of patients on high risk medicines.
• There was no system in place to ensure clinical staff were up to date with NICE guidelines.
• The practice did not have an effective system in place to monitor expiry dates of medicines carried by GPs.

• Emergency medicines were easily accessible to staff in a secure area of the practice, but we found that some staff were not aware of their location.

• Staff we spoke with did not know the process for reporting significant events. We found that no events had been recorded in the significant events log since May 2016.
• Quality performance data showed patient outcomes was lower than local and national averages in 2015/16. Unverified data provided by the practice for 2016/17 showed some improvement, but the recall system to review patients with long term conditions was not effective in monitoring patients.
• At the previous inspection in May 2016, 1% of the practice list were registered as carers. The practice attributed the low numbers to coding errors.
• Complaints were actioned by the practice; however we were unable to evidence any learning or improvements made following patient feedback.
• At the previous inspection the provider did not have risk assessments or disclosure and barring checks (DBS) for reception staff who acted as chaperones. We found this had been acted on and the appropriate DBS checks were now in place.
• Staff immunisation status identified as not being in place at the inspection in May 2016 had been recorded and we saw evidence to confirm that the practice had ensured all staff were up to date with the recommended immunisations for working in general practice.
• At the inspection in May 2016 we found staff had not had appraisals and communication with all staff was identified as an area for improvement. At this inspection we found staff had received appraisals and departmental meetings were now taking place on a regular basis.
• Patient Specific Directions (PSD) were found not to be in place at the inspection in May 2016. These had been implemented for the administration of vaccines by the health care assistant.

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

Importantly, the provider must:

• Have an embedded system in place to act on safety alerts and national guidance.
• Monitor quality and outcome framework (QOF) indicators and national targets to ensure patient reviews are up to date and completed.
• Ensure processes are in place for handling complaints and patient feedback is acted on. Implement a system to share learning of actions taken and lessons learnt with the staff.

In addition the provider should:

• Continue to review appointment access to increase availability of appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 July 2017

The practice is rated as requires improvement for safe, effective, responsive and well led services; this affects all six population groups.

• Nursing staff had lead roles in chronic disease management. The latest QOF results (2015/16) showed performance for chronic pulmonary obstructive disease (COPD) indicator was 40%, which was lower than the CCG and national average of 96%. The practice attributed the low QOF scores to low exception reporting.
• We found the recall system for patients with long term conditions was not effective and we found examples of patients who had not received a regular review.
• Longer appointments and home visits were available when needed and patients who were housebound received reviews and vaccinations at home. For example, phlebotomy (the taking of blood) was carried out by the Health Care Assistant for warfarin monitoring.
• 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. For example the practice worked with a community diabetes specialist nurse to support patients with complex diabetic needs.
• We saw minutes of meetings to support that joint working took place and that patients with long term conditions and complex needs were discussed as part of the practices multi-disciplinary team meetings (MDT) meetings.
• Data provided by the practice showed 792 patients were on the diabetic register and 72% had received a flu vaccination. This was lower than the national average of 95%.

Updated 28 July 2017

The practice is rated as requires improvement for safe, effective, responsive and well led services; this affects all six population groups.

• The practice’s uptake for the cervical screening programme was 74% which was lower than the national average of 82%.
• The practice held nurse-led baby immunisation clinics and vaccination targets were in line with the national averages.
• Urgent appointments were available for children and were also available outside of school hours.
• The premises were suitable for children and babies. We saw positive examples of joint working with midwives and health visitors and the midwife held an ante natal clinic twice a week at the practice.
• There were systems in place to identify and follow up children living in disadvantaged circumstances, including policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.

Updated 28 July 2017

The practice is rated as requires improvement for safe, effective, responsive and well led services; this affects all six population groups.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included vaccinations for those patients who were unable to attend the practice.
• The practice carried out twice weekly ward rounds at the local nursing home.
• The practice worked closely with multi-disciplinary teams so patients conditions could be safely managed in the community.
• Data provided by the practice showed 51% of patients aged 75 years and over had received a health check.

Updated 28 July 2017

The practice is rated as requires improvement for safe, effective,  responsive and well led services; this affects all six population groups.

• 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. This included early morning appointments from 7.30am to 8am Monday to Friday.
• 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.
• It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• Results from the national GP survey in July 2016 showed 53% of patients were satisfied with the surgery’s opening hours which was lower than the local average of 75% and the national average of 76%.

Updated 28 July 2017

The practice is rated as requires improvement for safe, effective, responsive and well led services; this affects all six population groups.

• The practice had 96 patients on the dementia register and 78% had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.
• 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 and offered same day appointments.
• The practice held a register of patients experiencing poor mental health but a low number had received a regular review. Data provided by the practice showed 94 patients on the mental health register and the latest QOF results (2015/16) showed 26% had had care plans agreed in the past 12 months, which was lower than the national average of 89%.

Updated 28 July 2017

The practice is rated as requires improvement for safe, effective, responsive and well led services; this affects all six population groups.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and the practice informed vulnerable patients about how to access various support groups and voluntary organisations and signposted patients to relevant services available.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Data provided by the practice showed 43 patients were on the learning disability register and 81% of these patients had care plans in place.
• 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.
• At the previous inspection, the practice held a register of carers and had 170 carers registered, which represented 1% of the practice list. We spoke with the GPs and they attributed the low numbers to coding errors on the clinical system.