Birchills Health Centre

Updated 23 January 2018

Dr Avtar Suri’s practice is registered with the Care Quality Commission (CQC) as an individual provider operating a GP practice (Birchills Health Centre) in Walsall, West Midlands. The practice is part of the NHS Walsall Clinical Commissioning Group. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

The practice operates from Birchills Health Centre, 23 – 27 Old Birchills, Birchills, Walsall, WS2 8QH.

The practice provides primary medical services to 4,757 patients in the local community. The practice has a higher than average patient population aged five to 45, and below average for ages 45 years and above. 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 staffing consists of:

• One male lead GP and two female salaried GPs.
• One female practice nurse and one female healthcare assistant
• One practice manager / business development manager supported by a deputy, secretary and reception staff.

The practice is a training practice for qualified doctors training as GPs and a teaching practice for medical students.

The practice is open to patients between 8.30am and 6.30pm every week day except Wednesday, when it is open from 8.30am to 1.30pm. Extended hours appointments are available 6.30pm to 7.30pm on a Thursday. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. When the practice is closed, primary medical services are provided by an out of hours service provider via the NHS 111 telephone service and information about this is available on the practice website.

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; for example, the Childhood Vaccination and Immunisation Scheme. Further details can be found by accessing the practice’s website at www.birchillshc.co.uk

Updated 23 January 2018

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr Avtar Suri on 10 November 2016. The overall rating for the practice was good with requires improvement for providing safe services. We found two breaches of legal requirement and as a result we issued two requirement notices in relation to:

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 – Good Governance
• Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Staffing

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Avtar Suri on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 12 December 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 10 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The safe key question is now rated as good and overall the practice remains rated as good.

Our key findings were as follows:

• The practice had improved their recruitment procedures. The relevant information was recorded in the two staff files reviewed.
• The immunisation status of all staff for Hepatitis B had been established and recorded on a spreadsheet.
• All staff who acted as chaperones were trained in the role and had Disclosure and Barring Service (DBS) checks completed.
• The practice had invested in an on-line training system for staff.Clinical and non-clinical staff had completed infection control training.
• The practice had reviewed the system in place for recording and acting on significant events and incidents. Five significant events had been recorded during 2017. We saw that these had been acted on appropriately and lessons learnt shared with staff.
• The practice had introduced a log to record all alerts received. The alerts were shared with the clinicians, who signed the log to say they had received and acted upon the alerts. However, the log did not record the action taken as a result of the alert.
• We noted during our previous inspection that the practice had lower than average results for the national screening programmes and childhood vaccination programme. The practice was aware of the low results for the national screening programmes and had taken action to improve these. A member of reception staff had been trained to follow up patients who did not take part in the screening programmes.
• The practice was part of a local initiative to encourage participation in the bowel screening programme. This initiative involved following up patients who failed to respond or responded inappropriately to the screening kit. The practice identified these patients on a monthly basis, contacted them, encouraged participation and ordered a new screening kit if required.
• The practice’s uptake for the cervical screening programme was 79% (up from 78%), which was close to the 80% coverage target for the national screening programme. Staff told us they were committed to proactive opportunistic targeting and used the alerts on the electronic records to remind reception staff to encourage patients to book appointments for the screening programmes. The practice had introduced a text message service for patients who did not attend their appointment or who were overdue. The service included an option to text back and so far, three patients had replied to the text message.
• The practice manager told us they were being supported by the breast screening team to encourage participation in the national breast screening programme. The screening team were going to send letters out on behalf of the practice to patients who failed to attend their first appointment. The practice also used the text messaging service for patients who did not attend their breast screening appointment.
• Posters informing patients about breast screening and when the mobile scanning unit was next due in the area were on display in the waiting room.
• Childhood immunisations were carried out in line with the national childhood vaccination programme. The practice had improved their uptake rates for the vaccines given and these were in line with the target percentage of 90% or above. The immunisation rates for two year olds ranged from 97% to 99%. The practice manager told us that the new patient registration form specifically asked for information regarding childhood immunisations given in other countries. The practice also asked for evidence to support what vaccines had been given.

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

• Record the action taken as a result of the safety or medicine alerts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 February 2017

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Data provided by the practice showed 33% of the practice population had a long term condition.
• Longer appointments and home visits were available when needed.
• 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. We saw evidence that meetings were held every two months.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions, this included weekly diabetic clinics to support patients with complex diabetes needs.

Updated 3 February 2017

• 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.
• The practice supported the local women’s refuge and offered rapid access appointments and support through the community psychiatric nurse.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The midwife provided antenatal care every week at the practice.
• Childhood immunisation rates for under two year olds ranged from 67% to 99% compared to the CCG averages which ranged from 74% to 99%. Immunisation rates for five year olds ranged from 67% to 98% compared to the CCG average of 73% to 99%.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children. The practice held safeguarding meetings every two months.
• The practice’s uptake for the cervical screening programme was 78% which was lower than the national average of 82%.

Updated 3 February 2017

• 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 blood tests and vaccinations for those patients who were unable to access the practice.
• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice worked closely with multi-disciplinary teams so patients’ conditions could be safely managed in the community.

Updated 3 February 2017

• 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 as well as a full range of health promotion and screening that reflects the needs for this age group, including access to blood tests during evening surgery.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice offered extended hours to suit their working age population, with later evening appointments available once a week and an electronic prescribing service (EPS).
• Results from the national GP survey in July 2016 showed 75% of patients were satisfied with the surgery’s opening hours which was comparable to the local average of 77% and the national average of 76%.

Updated 3 February 2017

• The latest published data from the Quality and Outcomes Framework (QOF) of 2015/16 showed 77% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 78%. Current unpublished data supplied by the practice has shown all patients on the dementia register have had a care review since April 2016.
• 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.
• A counselling support service was offered once a week by a community psychiatric nurse to support patients with mental health needs.
• Data supplied by the practice showed 51 patients were on the mental health register and the latest published QOF data (2015/16) showed 97% had care plans agreed, which was higher than the national average of 78%.
• Staff had a good understanding of how to support patients with mental health needs and dementia and a community psychiatric nurse held a clinic once a week to support patients.

Updated 3 February 2017

• The practice held a register of patients living in vulnerable circumstances including homeless people, people who had to move between areas and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability. Data provided by the practice showed that 30 patients were on the learning disability register and eight had received their annual health checks. The practice sent regular appointments to patients and was actively trying to reduce the number of patients who did not attend their health checks.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients and held meetings with the district nurses and community teams every two months.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and the Citizens Advice Bureau held an advice clinic each week at the practice to offer advice and signpost patients to relevant services available.
• 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.
• The practice’s computer system alerted GPs if a patient was also a carer. There were 174 patients on the practices register for carers; this was 4% of the practice list.