Archived: Black Country Family Practice

Updated 29 June 2017

Black Country Family Practice is part of the NHS Sandwell and West Birmingham Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

The practice is registered with the Care Quality Commission to provide primary medical services. It has a general medical service (GMS) contract and under this contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care. The practice is located in an urban area of the West Midlands in purpose built premises. It has a list size of approximately 14,000 patients. The premises are owned by NHS property services and shared with the local hospital trust that provide phlebotomy and x-ray services on site and with district nurse and health visiting teams.

Based on data available from Public Health England, the area served by the practice has higher levels of depravation than the national average and is within the most deprived 20% nationally.

The practice currently has three GP partners (one male and two female) and three salaried GPs (all female) as well as a team of locum GPs. There is a team of seven nurses (including two nurse practitioners). Other practice staff includes two physician’s assistants and a team of administrative staff which includes a practice manager who supports the daily running of the practice.

The practice is open from 8am to 6.30pm Monday to Friday. In addition the practice is open on a Monday and Wednesday morning between 7am and 8am and a Tuesday and Thursday evening between 6.30pm to 8pm for extended opening. When the practice is closed services are provided by an out of hours provider (Primecare).

Updated 29 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Black Country Family Practice on 22 July 2016. The overall rating for the practice was Good. However, for providing responsive service the practice was rated as requires improvement. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Black Country Family Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 May 2017 to confirm that the practice had carried out their plan to improve in areas that we identified in our previous inspection. This report covers our findings in relation to those improvements made since our last inspection on 22 July 2016.

At our previous inspection on 22 July 2016, we rated the practice as requires improvement for providing responsive services. The national GP patient survey showed that patient’s satisfaction with how they could access care and treatment was significantly below local and national averages. The practice was able to demonstrate improvement in some of the areas identified. In other areas the practice had considered options to improve and was planning to implement improvement strategies. We also saw one area where the practice had not explored any strategies to improve. This was in regards to improving telephone access.

• During our previous inspection in July 2016 we received mixed feedback on access to appointments. Some patients said they had difficulties obtaining an appointment. At this inspection we were told that one of the GP partners had recently retired and the practice was unable to recruit another GP. This posed further challenges to meet patient needs. After considering a number of options to improve, the practice planned to join a corporate provider which would enable the surgery to access further resources to help effectively meet patient needs.

• During our previous inspection we saw that the practice achievement on the GP national patient survey were particularly low for ease of getting through on the telephone. At this follow up inspection the practice was unable to demonstrate that they had explored any strategies to improve. The practice assured us that they intended to carry out a patient survey to understand problems around telephone access to better understand the issues so that informed decisions could be made.
• When we inspected the practice in July 2016, results from the national patient survey showed many patients waited longer to be seen for their appointment than the CCG average. To improve, one of the GP partners had piloted an approach by blocking off 15 minutes off in the morning and in the afternoon to help them catch up. Data we looked at showed improvements had been achieved and the practice was planning to implement this for other GPs.
• During our previous inspection we found information relating to making a complaint was not easily available as there were no notices or leaflets on display. At this inspection we saw posters displayed in different parts of the reception and waiting areas.

• During our previous inspection we saw that the practice had identified 111 patients as carers (0.8% of the practice list). At this follow up inspection we saw 132 (1% of the practice list) had been identified as carers.

In addition the provider should:

•  Explore ways to improve telephone access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice was participating in a case manager project which it had successfully obtained funding. There were three case managers (originally four) who undertook follow up of all patients with an unplanned admission to hospital or had attended the accident and emergency department. The case managers also provided first contact with this group of patients should they have any concerns.
• Overall performance for diabetes related indicators (2014/15) was 90% which was higher than the CCG average of 85% and national average of 89%. For the more complex cases, a specialist diabetes team from secondary care ran clinics at the practice.
• All these patients had a named GP and received regular review to check their health and medicines needs were being met. There were specific clinics for patients with diabetes, asthma, heart problems and rheumatology.
• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice provided services to support the management and monitoring of patients with long term conditions. These included insulin initiation, visiting specialist diabetes team for more complex cases, Disease modifying antirheumatic drugs (DMARD) monitoring, 24 hour blood pressure monitoring, spirometry and electrocardiographs (ECGs).

Updated 8 September 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 did not attend childhood immunisations and had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• During the past 12 months the practice had received funding for a paediatric case manager to support those with chronic conditions and unplanned admissions. However, the paediatric case manager had recently left.
• The practice was accessible to push chairs and had baby changing facilities.
• Same day child appointments and appointments outside of school hours were available. Asthma reviews were also offered outside school hours.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 80% and the national average of 82%.
• We received positive feedback from health visitors who also worked in the same building. The practice notified them of any new patients and regularly met to discuss children at risk.
• Baby development and postnatal checks were available as well as regular midwife clinics.

Updated 8 September 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice supported approximately 200 patients across 15 care and nursing homes and sheltered accommodation. Feedback from these services was positive.
• The practice offered flu and pneumonia vaccines to patients in this population group and were flexible to try and improve uptake for example, Saturday clinics during flu season or home visits.
• The practice met regularly as part of a multi-disciplinary team to discuss and plan the needs of patients at end of life.
• The practice was participating in a case manager project to support and follow up all patients that had an unplanned admission to hospital.
• The practice worked with local service to support patients in this population group for example in relation to fall prevention.

Updated 8 September 2016

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

• 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.
• Extended opening hours for the convenience of patients who worked or with other commitments during the day were available on four days a week. Both doctors and nurses provided appointments within extended opening hours. Telephone appointments were also available.
• 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 offered travel vaccinations including yellow fever.
• Smoking cessation and health trainer appointments were available.

Updated 8 September 2016

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

• Nationally reported data for 2014/15 showed 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG and national average of 84%.
• National reported data for (2014/15) showed 89% of patients with poor mental health had comprehensive, agreed care plan documented, in the preceding 12 months which was comparable to the CCG average 86% and national average 88%.
• The was an attached psychiatrist from secondary who ran clinics from the practice.

Updated 8 September 2016

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 and had identified 53 patients to date. The practice also held registers for patients with a learning disability and those with carer responsibilities.
• The practice offered longer appointments for patients with a learning disability.
• There were 43 patients on the practice’s learning disability register. There was a dedicated nurse for undertaking health reviews for patients with a learning disability, 60% had been carried out within the last 12 months.
• The practice had signed up to the IRIS project to support victims of domestic abuse and staff had received training for this.
• The practice participated in a shared care scheme and had a dedicated drug worker for patients who misused substances.
• Patients with no fixed abode could register with the practice using the practice address.
• The practice signposted those with caring responsibilities to various support locally available.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.