Archived: Park Surgery

Updated 8 April 2016

• Park Surgery is located at 278 Stratford Road, Shirley, Solihull, West Midlands, B90 3AF and provides care and treatment for almost 7000 patients.
• There are three full time GP partners and two salaried GPs who work at the practice. One GP is male and four are female. The practice has three practice nurses, two healthcare assistants, a practice manager and a team of administrative staff.
• Park Surgery is also a teaching practice and takes on medical students periodically. There was one medical student at the practice at the time of the inspection.
• The practice has a General Medical Services (GMS) contract. A GMS contract is a contract between NHS England and general practices for delivering general medical services.
• The practice is open between 8am and 6pm Monday to Friday. Appointments take place from 8.30am to 11.40am every morning and 3.20pm to 5.50pm daily. The practice also offers extended hours on a Tuesday from 6pm to 7.15pm and every third Saturday each month the practice opens between 8.30am and 11.30am.
• The practice has opted out of providing out-of-hours services to their own patients and this service is provided by Birmingham and District General Practitioner Emergency Rooms (Badger) medical service. Patients are directed to this service on the practice answer phone message.
• The practice is located in purpose built premises in Shirley, an area with low levels of deprivation and among one of the least deprived areas nationally. The practice population age range closely follows the national average.

This inspection was in follow up to our previous comprehensive inspection at the practice on 6 November 2014 (where the practice was rated as requires improvement overall with one area rated as inadequate). Four regulatory breaches of the Health and Social Care Act 2008 were identified. These breaches related to areas of risk management, infection control, recruitment processes and the practice processes for obtaining consent. Four requirement notices were issued and the practice subsequently submitted an action plan to CQC on the measures they would take in response to our findings.

Updated 8 April 2016

Letter from the Chief Inspector of General Practice

This inspection at Park Surgery on 29 February 2016 was in follow up to our previous comprehensive inspection at the practice on 6 November 2014 (where the practice was rated as requires improvement overall but with safe rated as inadequate).

Four regulatory breaches of the Health and Social Care Act 2008 were identified. These breaches related to areas of risk management or assessment, infection control, recruitment processes and the practice processes for obtaining consent. Four requirement notices were issued and the practice subsequently submitted an action plan to CQC on the measures they would take in response to our findings.

At our inspection on 29 February 2016 we found that the practice had improved. We found that three of the four requirement notices we issued following our previous inspection had been met although one breach relating to risk assessment and management under safe care and treatment remained. However, the practice had improved enough for the practice ratings to have been updated to reflect our recent findings. The practice is now rated as good overall (with the safe domain now rated as requires improvement).

Our key findings across all the areas we inspected were as follows:

• Staff we spoke with understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. We saw evidence to demonstrate that learning was shared amongst staff.
• Risks to patients were assessed and managed, with the exception of those relating to the assessment of staff carrying out chaperoning duties. Not all staff who chaperoned had received chaperone training or a Disclosure and Barring Service check (DBS check). Nor had a risk assessment been carried out to make sure patients were protected. Risk assessments not being in place for some staff had also been identified as an issue at the last inspection on 6 November 2014. Post-inspection we received some information from the practice about how this was being corrected.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients we spoke with told us they were treated with compassion, dignity and respect and most patients also felt they were involved in decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. For example, a poster and information leaflets were available in the patient waiting area as well as complaints form.
• Some patients said they found it difficult to make an appointment with a named GP although urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. There were disabled facilities, hearing loop and translation services available as well as ramped access. A bell was located at the front entrance doors so that wheelchair users were able to request assistance when required. Most consultations were held on the ground floor.
• The practice had carried out clinical audits and re-audits to improve patient outcomes.
• There was a clear leadership structure and staff we spoke with were motivated and felt supported by management. The practice had sought feedback from patients and had an active patient participation group in place.

The areas where the provider must make improvements are:

• Ensure Disclosure and Barring Service check (DBS check) or risk assessments are in place for all staff involved in carrying out chaperoning and all staff undertaking chaperoning are provided with the appropriate training.

In addition the provider should:

• Consider using the national patient survey results to identify areas of improvement. For example the processes for appointments to further identify potential opportunities to reduce appointment waiting times and improve patient access and experiences.
• Consider reviewing the process for infection control and hygiene to ensure it is effective. For example to ensure that hand-gels are always available and soap dispensers were re-filled in both the staff and patient toilets.
• Consider documenting verbal complaints in order to identify reoccurring themes or trends.
• Consider how the practice can further improve the consent process to ensure appropriate consent is always recorded when required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 April 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice had engaged with Solihull CCG health improvement programme which included the ‘Admission Avoidance Scheme.’
• Performance for diabetes related indicators was near the national average (practice average of 79% compared to a national average of 84%).
• Patients had a personalised care plan or structured annual review to check that their health and care needs were being met.
• For those patients with more complex needs patients had a named GP and the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 8 April 2016

• 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.
• Same day appointments were available for children and those with serious medical conditions.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with health visitors.

Updated 8 April 2016

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Online access to appointments and prescription requests was available and patients were also able to submit repeat prescription requests via email.
• Electronic prescribing was available which allowed the patients to collect medication direct from the pharmacist without having to collect the paper prescription beforehand.
• Home visits were available for older patients and patients who would benefit from these including patients who required flu/pneumonia and shingles vaccinations.
• Longer appointments were also available for older people when needed.
• Frail patients were able to have blood tests performed on site rather than at a hospital.
• There were disabled facilities, hearing loop and translation services available as well as ramped access. A bell was located at the front entrance doors so that wheelchair users were able to request assistance when required. Most consultations were held on the ground floor.
• There were marked disabled parking bays near the practice.

Updated 8 April 2016

• The practice offered extended hours one day a week and the third Saturday in each month. The practice told us plans were currently being developed to determine if Saturday service could be offered every week.
• Online access to appointments and prescription requests was available and patients were also able to submit repeat prescription requests via email.

• Health promotion advice was available at the practice.
• The practice’s uptake for the cervical screening was 81%, which was comparable to the national average of 82%. The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening and had similar uptake averages for both when compared to local and national averages.

Updated 8 April 2016

• Performance for mental health related indicators was similar to the national average (practice average of 88% compared to a national average of 89%).
• The practice carried out advance care planning for patients with dementia.
• The practice had informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The GP we spoke with had good knowledge of the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 8 April 2016

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability or dementia and offered annual health checks for these patients.
• The practice offered longer appointments for patient requiring an interpreter or for those with a learning disability.
• The practice had been recently selected by Solihull CCG to support the ‘Syrian Vulnerable Persons Relocation Scheme.’
• The practice had policies that were accessible to all staff which outlined who to contact for further guidance if they had concerns about a patient’s welfare.
• There was a lead member of staff for safeguarding and we saw evidence to show that staff had received the relevant safeguarding training.
• Staff members we spoke with were able to demonstrate that they understood their responsibilities with regards to safeguarding.