Limestone Surgery

Updated 24 June 2016

Drs Cox, Pinto and Rigby are based at Cross Street Health Centre which is a long established practice located in the Dudley area of the West Midlands. There are approximately 4495 patients of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice 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.

The clinical team includes three GP partners, a salaried GP, two practice nurses and a health care assistant. The GP partners and the practice manager form the practice management team and they are supported by a team of five staff members who cover secretarial, administration and reception duties.

The practice is open for appointments between 8:30am and 6:30pm during weekdays. There is a GP on call in the morning between 8am and 8:30am. The practice offers extended hours on Mondays and Wednesdays until 7:30pm. There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 24 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cross Street Health Centre on 25 May 2016. Overall the practice is rated as good.

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

• We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect, and maintained confidentiality. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice offered a range of clinical services which included care for long term conditions and services were planned and delivered to take into account the needs of different patient groups to ensure flexibility, choice and continuity of care.

• The practice was proactive in identifying and managing significant events. Opportunities for learning from internal and external incidents were maximised.

• Performance data across some areas was below average, including uptake for cervical screening and for identifying and supporting patients who would benefit from smoking cessation advice.

• The practice had identified the need to take a more proactive approach in managing medication reviews. During our inspection we saw data to demonstrate that some improvements had been made in this area and that an ongoing piece of work was in place to ensure that regular reviews were taking place as appropriate.

• All patients who were registered with the practice had a named GP and patients could access appointments and services in a way and at a time that suited them.

• Staff spoken with demonstrated a commitment to providing a high quality service and throughout our inspection we noticed a theme of positive feedback from staff.

• There was a systematic approach to working with other organisations to improve patient care and outcomes. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

• A programme of continuous clinical and internal audit was used to monitor quality and to make improvements.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

We saw an area of outstanding practice:

• Approximately 39% of the practice population were non-English speaking patients. We saw how the practice had started to utilise a local Integrated Plus scheme to specifically support their non-English speaking patients. As a result, these patients were supported in a variety of ways such as signposting them to befriending services used by others who did not have English as a first language. These patients were helped to use public transport in order to attend appointments in secondary care.

The areas where the provider should make improvements are:

• Continue to identify carers and ensure that all carers are captured on the computer system, in order to provide further support where needed.

• Continue to explore ways to engage with patients who do not attend for cervical screening, in order to ensure screening is taking place as appropriate and improve uptake.

• Continue to engage with patients and work on improving overall medication reviews and ensure that regular reviews are taking place as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 June 2016

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

• The practice offered a range of clinical services which included care for long term conditions.

• Performance for overall diabetes related indicators was 94%, compared to the CCG average of 88% and national average of 89%.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The percentage of patients with hypertension having regular blood pressure tests was 100%, with an exception rate of 0%. Staff we spoke with highlighted that approximately 20% of the practices list size had hypertension.

Updated 24 June 2016

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

• 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.

• Childhood immunisation rates for under two year olds ranged from 87% to 100% compared to the CCG averages which ranged from 40% to 100%. Immunisation rates for five year olds ranged from 87% to 100% compared to the CCG average of 93% to 98%.

• The practice offered urgent access appointments for children.
• The practice’s uptake for the cervical screening programme was 71%, compared to the national average of 81%. Staff explained that they had a large number of patients from ethnic minority groups and felt that this impacted on the practices performance for cervical screening. To improve this this practice had contacted the local cytology department for advice and had requested some multilingual information specifically on cytology.

Updated 24 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Immunisations such as flu vaccines were also offered to patients at home, who could not attend the surgery.
• The practice worked with the local Dudley Council for Voluntary Service (CVS) team to help to provide social support to their patients who were living in vulnerable or isolated circumstances. This included members of the practices older population.

Updated 24 June 2016

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

• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group. The practice offered a range of clinical services which included minor surgery, family planning, travel and well person clinics.

• Practice data highlighted that since January 2015, 15 patients had been identified as needing smoking cessation advice and support; these patients had been given advice and 6 (40%) had successfully stopped smoking.

• Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations with a GP at times to suit patients. The practice offered text messaging reminders for appointments to remind patients of their appointments in advance.
• The practice offered extended hours on Mondays and Wednesdays until 7:30pm for those who could not attend the practice during core hours.

Updated 24 June 2016

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

• There were longer appointments available at flexible times for people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• Data showed that appropriate diagnosis rates for patients identified with dementia were 100%, with an exception rate of 0%. The data provided by the practice highlighted that 96% of their eligible patients had care plans in place and 96% had received a medication review in a 12 month period.

• Performance for mental health related indicators was 100%, with an exception rate of 0%. Data provided by the practice highlighted that 86% of these patients had care plans in place, these patients were regularly reviewed and 86% of their eligible patients had received a medication review in a 12 month period with further reviews planned.
• The practice also supported patients who were experiencing poor mental health by referring them to a gateway worker who provided counselling services on a weekly basis in the practice

Updated 24 June 2016

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

• The practice offered longer appointments for patients with a learning disability. Information was available in a variety of formats including practice leaflets in large print and brail for people with a visual impairment.
• There were 21 patients on the practices learning disability register, 14% of these patients had care plans in place and 42% of the eligible patients had received a medication review in a 12 month period
• There was a register which contained 37 patients from vulnerable groups, including patients with drug or alcohol dependency these patients were frequently reviewed in the practice and 56% had received a review in a 12 month period.
• Staff highlighted that they had a number of patients registered with the practice who were asylum seekers and a number of patients who did not have English as a first language. We saw how the practice utilised a local Integrated Plus scheme to specifically support their non-English speaking patients.