Portway Family Practice

Updated 14 June 2017

Portway Family Practice is based in Oldbury area of the West Midlands. There are approximately 3900 patients of various ages registered and cared for at the practice. Portway Family Practice has been long established in Tividale, Oldbury and is situated in Portway Leisure Centre. Portway Lifestyle Centre is a leisure facility in Sandwell, it is a sports, health and wellbeing centre for the whole community and centre of excellence for people with disabilities.

The Care Quality Commission carried out an inspection on 18 July 2014 at the previous premises of the practice in Tividale. We had received information which led us to visit to review the safety and suitability of the premises. The previous premises were not fit for purpose due to poor access and a number of burglaries. The move to the leisure centre had been planned for September 2013 but had been delayed. The practice moved to Portway Leisure Centre in November 2014.

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 childhood vaccination and immunisation schemes. The area served has higher deprivation compared to England as a whole and based on data available from Public Health England; the levels of deprivation in the area served by Portway Family Practice are above the national average and ranked at three out of ten, with ten being the least deprived.

There are two GP partners (both male). The nursing team consists of two practice nurses and one health care assistant. The non-clinical team consists of a practice manager and administrative and reception staff.

The practice is open to patients between 8am and 6.30pm Monday to Friday, except on Thursday afternoon when it closes at 1pm. On Thursdays when the practice is closed patients can access appointments at a local surgery, due to a mutual agreement between the provider and the local practice. This service was well advertised within the waiting area, at reception and on the practice website. Extended hours appointments are available on Saturday morning from 8.30am to 11.30am. 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 Primecare Out of Hours Service and NHS 111service and information about this is available on the practice website.

The practice is part of Sandwell & West Birmingham Clinical Commissioning Group (CCG) which has 91member practices. The CCG serve communities across the borough, covering a population of approximately 559,400 patients. 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.

Updated 14 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Portway Family Practice on 10 May 2017. 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 and a system in place for reporting and recording significant events and incidents and the practice used the local reporting system to keep the clinical commissioning team up to date of all events.
• The practice had defined systems and processes in place to minimise risks to patient safety including an effective system in place to demonstrate what action had been taken with alerts received, this included alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• The practice had some immunisation records for staff, but we found there was no system in place to ensure all staff were up to date with routine immunisations. Since the inspection we have received evidence to show that a new policy had been implemented for the recording staff immunisation and all staff have had a review of their immunisation status and vaccines where appropriate. Risk assessments had been completed where required.
• The patient participation group was not currently active. Members of the group told us they needed support to pull the group together. We saw information on display to encourage new patients to join.
• The practice had adapted clinical templates following NICE guidelines to suit their practice population to ensure the needs of the patients were being met.
• Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patient feedback from CQC comment cards and patients we spoke with were positive about the care received.
• The practice encouraged staff to develop their roles and the practice manager had been nominated by the clinical commissioning group for a local ‘Rising Star’ award to highlight the dedication they had applied to the new role of manager.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff, which it acted on, but the participation group told us that meetings had not been regular and they felt they lacked leadership. There was a notice on display in the waiting area to encourage new members to join.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Encourage patients to join the patient participation group and continue to support the current members in the group.
• Continue to identify carers in order to provide further support where needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 June 2017

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. For example, the latest published QOF results showed 90% of patients with chronic obstructive pulmonary disease (COPD) had received a review in the past 12 months, in comparison to the local average of 88% and the national average of 90%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• The practice supported DiCE clinics on a regular basis for patients with diabetes. Diabetes in Community Extension (DiCE) clinics are specialist clinics provided in the community by a consultant and specialist nurse to monitor patients with complex diabetes needs.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met and the practice had adapted their clinical protocols following national guidance to ensure the needs of their practice population 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.

Updated 14 June 2017

• There were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice’s uptake for the cervical screening programme was 83% which was comparable to the national average of 81%.
• We saw examples of joint working with midwives and the midwife ran antenatal clinics two mornings a week.

Updated 14 June 2017

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any addional needs.
• Data provided by the practice showed five patients on the palliative care register and we saw evidence to support that all patients were discussed at monthly meetings and their care needs were being co-ordinated with community teams.

Updated 14 June 2017

• The needs of the working age population had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours on Saturday mornings.
• 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. This included referrals to the stop smoking service.
• Data provided by the practice showed 82% of patients who were currently registered as smokers had received support to quit smoking.
• The practice made use of texting to remind patients of their appointment and an electronic prescribing service.

Updated 14 June 2017

• There were 19 patients on the dementia register. The latest published QOF data for 2015/16 showed 83% of patients had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to 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 living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia and had access to support services through the Esteem team for patients with mild to moderate mental health problems and complex social needs and a counsellor offered a clinic once a week to support patients with mental health needs. (The Sandwell Esteem Team is part of the Sandwell Integrated Primary Care Mental Health and Wellbeing Service (the Sandwell Wellbeing Hub) in the West Midlands. The hub is a holistic primary and community care-based approach to improving social, mental and physical health and wellbeing in the borough of Sandwell).
• Data provided by the practice showed 22 patients on the mental health register. The latest published QOF data for 2015/16 showed 85% of patients had a comprehensive, agreed care plan documented in their medical record in the last 12 months, which was comparable to the national average of 89%.

Updated 14 June 2017

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Data provided by the practice showed 40 patients on the learning disability register and 23 had received an annual review. We saw that the health care assistant was reviewing the patient lists to encourage patients to attend their appointments.
• The practice held a register of 42 carers, which represented 1% of the practice list. There was a carers information board which detailed support available, this also included information for young carers.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice supported two learning disability homes. One of the homes had moved to new premises outside of the practice catchment area, the GPs continued to offer care to the ten patients at the home. On speaking with the manager of the home, she told us that the service received from the practice was excellent and the GPs were very supportive.
• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.