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Inspection summaries and ratings from previous provider


Overall summary & rating

Good

Updated 30 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Oaks Medical Centre on 16 August 2016. Overall the practice is rated as good. There are two surgery locations that form the practice; these consist of the main practice at Shady Lane Great Barr and the branch practice at Chester Road Streetly. Both locations have separate CQC registrations; we have therefore produced two reports. There is one patient list and systems and processes are shared across both sites. The data included in this report relates to both locations. During the inspection, we visited both sites.

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; there were arrangements in place to respond to emergencies and major incidents.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • There was a programme of continuous clinical audits, which demonstrated quality improvement and staff were actively engaged to monitor and improve patient outcomes.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services because of feedback from patients and from the patient participation group. For example, the practice introduced an electronic call management system; this improved the phone access, which enables the practice to reduce the volume of missed appointments’.
  • On the day of the inspection patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment; however, the national GP patient survey showed that questions relating to patient’s involvement in decisions were below local and national average.
  • Information about services and how to complain was available and easy to understand. The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. The provider was aware of and complied with the requirements of the duty of candour.
  • Patients spoken to during the inspection said they found it hard to make a routine appointment with a named GP and felt this did not represent continuity of care; this was consistent with the national GP patient survey results. However, patients said urgent appointments were available the same day.

We saw one areas of outstanding practice where the practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. The practice expanded the clinical team in order to respond to population needs. For example:

  • The practice held a health awareness event in March 2016 where guest speakers from health organisations and charities such as, Diabetes UK, Alzheimer’s society and Heart care were available. During the weekend, patients were provided with the opportunity to speak to health care specialists to increase their knowledge in certain areas of health.

The areas where the provider should make improvements are:

  • Ensure that recruitment procedures are operated effectively. For example, the practice should ensure

  • Explore ways of improving the uptake of national screening programs such as breast and bowel cancer screening.

  • Explore ways of improving the amount of care plan, medication and face-to-face review carried out on patients with a learning disability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 November 2016

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses, which were well documented.

  • The practice used every opportunity to learn from incidents, which were shared across both practice sites to support improvement. Learning was based on a thorough analysis and investigation.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. Patients were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • On the day of the inspection the premises was observed to be clean and tidy; the practice carried out an infection control audit within the last 12 months.

  • Risks to patients were assessed and well managed; there were arrangements in place to respond to emergencies and major incidents. The practice upskilled staff members to ensure adequate cover were available at all times to meet patients’ needs.

Effective

Good

Updated 30 November 2016

  • Our findings during the inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • Data from the Quality and Outcomes Framework (QOF) showed variations in patient outcomes; for example, there were areas where the practice performed above and below the local and national average. During 2015, the practice merged with another practice where QOF performance were not equal. The practice were aware of this and taking appropriate actions.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • The practice had a programme of continuous clinical and internal audits. The clinical audits demonstrated quality improvement and staff were actively engaged to monitor and improve patient outcomes.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment; and they worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • There was evidence of appraisals and personal development plans for all staff.

Caring

Good

Updated 30 November 2016

  • Data from the national GP patient survey showed the practice was comparable to local and national average for its satisfaction scores regarding consultations with GPs and nurses.

  • Patients we spoke to during the inspection said they were treated with compassion, dignity and respect and they felt involved in decisions about their care and treatment.

  • Information for patients about the services available was easy to understand and accessible.
  • During the inspection, we saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice held a carers’ list, and carers had access to health check and advice to enable them to maximise their own health needs. The practice also provided a comprehensive carers pack, which directed carers to various avenues of support.

Responsive

Good

Updated 30 November 2016

  • On the day of the inspection patients said they found it hard to make a routine appointment with a named GP and there was no continuity of care, however urgent appointments available the same day. The practice were aware of this and as a result implemented a range of measures to improve appointment availability.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice held health awareness events where guest speakers from health organisations and charities such as, Diabetes UK, Alzheimer’s society and Heart care were available.

  • The practice implemented suggestions for improvements and made changes to the way services were delivered because of feedback from patients and the patient participation group. For example, the practice extended their clinic times to increase access for working patients. The practice also installed a new telephone system, which enable the practice to monitor and manage phone lines during busy periods.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 30 November 2016

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework, which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. For example, the practice were pursuing improvements following the merger with another practice where performance were not equal.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active and there were well documented evidence of where the PPG had been involved in improving how the practice was run.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 30 November 2016

  • 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 below the national average. For example, 83% compared to the CCG and national average of 90%. Unverified data provided by the practice showed that influenza immunisation for patients diagnosed with diabetes during 2015/16 was 86%.

  • The practice employed a specialist diabetic nurse who provided in-depth care and insulin initiation was available on site. The practice nurse actively carried out pre-diabetes screenings to identify patients at risk and offered support and advice to these patients.

  • Longer appointments and home visits were available when needed.

  • The practice referred into services such as the Desmond Diabetic Programme, Chronic Obstructive Pulmonary Disease Team, Expert Patient and Heart Rehabilitation Programme. Written management plans were in place for patients with long-term conditions and those at risk of hospital admissions.

  • 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.

Families, children and young people

Good

Updated 30 November 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. We saw positive examples of joint working with health visitors and safeguarding teams.

  • The practice held a nurse-led child health and immunisation clinic and vaccination rates were relatively high for all standard childhood immunisations. Processes for encouraging parents of young children to attend the practice were in place. For example, the practice sent one year and four year birthday cards; non-attenders were followed up with a further invitation and a telephone call.

  • Staff we spoke with were 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 for patients aged 25-64 in the preceding five years was 75%, which was above the CCG average of 69% and comparable to the national average of 82%. The practice provided unverified data from August 2016, which showed that 80% of eligible patients were screened.

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

  • Staff we spoke with provided positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 30 November 2016

  • 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.

  • The patient participation group (PPG) supported the practice to promote the uptake of flu vaccinations. Data provided by the practice showed that their uptake of flu immunisations for over 65s in the last 12 months was 76%.

  • Health care assistants (HCA) carried out nursing and care home visits; any concerns were then referred to the advanced nurse practitioner or GP. The practice had a well-established call and recall system for this population group to ensure reviews were taking place at least annually.

Working age people (including those recently retired and students)

Good

Updated 30 November 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.

  • 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 responded to patient feedback by offering extended clinic hours on Tuesdays, Wednesdays and Thursdays from 7am to 8pm, and Wednesdays from 6.30pm to 7.30pm.

  • The practice held a health awareness weekend and also actively participated in national campaigns such as no smoking days.

  • The practice acted as a hub provider for sexual health services available to registered and non-registered patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 November 2016

  • 78% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, which was below the national average of 84%.

  • Performance for patients with a mental health related disorder who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was below the national average. The practice identified this and staff we spoke with told us that the practice were working closer with the community mental health team (CMHT) to increase patient engagement.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A community psychiatric nurse attended the practice weekly and the practice invited the Alzheimer’s society to their health awareness day.

  • The practice carried out advance care planning for patients with dementia. The practice offered opportunistic dementia screening.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a comprehensive 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.

People whose circumstances may make them vulnerable

Good

Updated 30 November 2016

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability (LD). The practice provided data, which showed that 17% of patients with a LD have had a care plan, 51% medication and face-to-face review in the last 12 months.

  • 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. For example, the practice worked with the local addiction service to manage the general health care of patients receiving interventions for substance and alcohol dependency.

  • 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.

  • 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. The practice also provided carers with a detailed carers pack. Data provided by the practice showed that 35% of carers had received a flu vaccination.