Darlaston Medical Centre

Updated 21 November 2017

Darlaston Medical Centre is registered with the Care Quality Commission (CQC) as partnership provider in Darlaston, Wednesday, 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 patient list is approximately 4,033 of various ages registered and cared for at the practice. 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:

• Two GP partners (one male and one female), and one male salaried GP.
• A nurse practitioner, a practice nurse and a health care assistant (all female).
• A practice manager and an administrator supported by reception staff and a secretary.

The practice is open between 8.30am and 6.30pm every weekday except Thursday, when the practice is open between 8am and 4pm. During the in hours periods when staff do not answer the telephones, the calls are answered by WALDOC and information about patients passed back to the practice. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to the out of hours service, via the NHS 111 service when the practice is closed.

The practice is registered as a teaching practice for trainee nurses.

Updated 21 November 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Darlaston Medical Centre Dr Ali and Dr Syed Surgery on 9 August 2016. A total of three breaches of legal requirements were found and the practice was rated as requires improvement overall.

We issued requirement notices in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safe care and treatment.
• Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Safeguarding service users from abuse and improper treatment.
• Regulation 17 HSCA (RA) Regulations 2014 Good governance.

You can read the report from the comprehensive inspection on 9 August 2016 by selecting the 'all reports' link for Darlaston Medical Centre Dr Ali and Dr Syed Surgery on our website at www.cqc.org.uk

We undertook an announced comprehensive inspection on 10 October 2017 to check that the practice now met legal requirements. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had made improvements to the safety systems and processes in place to minimise risks to patient safety. Processes were in place to ensure that repeat prescriptions for high risk medicines were monitored and that patients had regular reviews and blood monitoring.
• The practice had reviewed the emergency medicine available to the staff and the full range of emergency medicines was now available.
• The practice had strengthened their procedures to follow up children who failed to attend hospital appointments and had introduced an electronic template to assist staff to record relevant information.
• A legionella risk assessment had been completed and regular monitoring was taking place.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect although
• Information about services and how to complain was available. The practice had introduced a system for recording and acting upon verbal complaints.
• Patients told us that they were able to get appointments when they needed them. They told us both emergency and routine appointments were available, although they may have to wait for an appointment with their GP of choice.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had invested in a hearing loop system.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Improvements had been made to the governance procedures in place, including the follow up of children who did not attend appointments.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

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

The provider should:

• Consider reviewing and updating the fire risk assessment.
• Ensure evidence of completed induction programmes is available.
• Review the results of the national GP patient survey regarding patient satisfaction with their interactions with GPs.
• Consider providing information leaflets in different languages.
• Consider developing a practice meetings schedule.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 November 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was similar to the CCG and national averages. For example, the percentage of patients on the diabetes register, in whom a specific blood test to get an overall picture of what a patients average blood sugar levels had been over a period of time was recorded as 70% compared with the CCG average of 79% and the national average of 78%. However, the practice exception reporting rate of 6% was lower than the CCG average of 10% and England average of 13%.
• The practice offered a service for patients requiring anti-coagulation therapy (blood thinning medicine). Patients were able to have their blood tested and prescribed the required dosage at the practice, rather than having to attend the hospital.
• Diabetic patients who needed to start on insulin were able to start this treatment at the practice, removing the need to referral to hospital.
• All these patients had a named GP and there was a system to recall patients for 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.

Updated 21 November 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found 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 did not attend hospital appointments.
• 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 worked with midwives and health visitors to support this population group The practice co-hosted weekly antenatal clinics with the community midwives and liaised with the health visitors as required.
• The practice’s uptake for the cervical screening programme was comparable with the CCG and England average.
• Family planning services were available.

Updated 21 November 2017

The practice is rated as good for the care of older people.

• 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.
• Annual health checks were provided for patients who lived in care homes and were carried out by the nurse practitioner and pharmacist.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 21 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations 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.
• Telephone consultations were available for all patients, but especially for those working age patients or students.
• Patients were able to receive travel vaccines available on the NHS as well as those only available privately.

Updated 21 November 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.
• Seventy four percent of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, compared to the national average of 84%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. Patients were invited for an annual health check and review.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 21 November 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice had 19 patients on their learning disability register. These patients were invited for an annual review with the GP and offered longer appointments.
• Homeless people were supported to register at the practice by using the practice address.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed 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.