Archived: Modality Attwood Green Also known as The Hyman Practice

Updated 17 May 2017

Modality Attwood Green also known as The Hyman Practice is located near the city centre of Birmingham with an approximate patient population of 2900. Modality Attwood Green is located on the second floor of a purpose built health centre in Birmingham, B15 1LZ. Many of the patients include those working within the city centre of Birmingham.

The practice is registered with the Care Quality Commission to provide primary medical services. The practice had joined a corporate provider (Modality) and had applied to the CQC to ensure this was reflected in their registration.

The practice has a general medical service (GMS) contract. 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.

Compared to the national average, the practice has a significantly higher proportion of patients aged between 20 and 40. Conversely the practice has a significantly lower than average patient population between the ages of five to 20 and 35 and over.

Based on data available from Public Health England, the levels of deprivation (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by practice is below the national average, ranked at two out of 10, with 10 being the least deprived.

The practice is open between 8am to 6.30pm Monday to Friday. The practice is also offered early appointments on Mondays from 7am to 8am and provided convenience for many working age patients registered with the practice.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by the external out of hours service provider (Primecare).

Updated 17 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Modality Attwood Green on 2 March 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 to safety and a system was in place for reporting and recording significant events. The practice had recorded and analysed significant events to identify areas of learning, and improvements were made to prevent the risk of further occurrence.

• Arrangements were in place to safeguard children and vulnerable adults from abuse, and local requirements and policies were accessible to all staff.

• Staff spoken with 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 and were involved in their care and decisions about their treatment.

• The practice had joined a corporate provider (Modality) and had applied to the CQC to ensure this was reflected in their registration. Patients we spoke with said there had been some changes to staff members and the way the service was being delivered as a result of the changes.

• Patients told us that they found it easy to make an appointment and there was continuity of care. Urgent appointments were available on the day when necessary.

• Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment.

• Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. The new provider (Modality) held monthly clinical management meetings which were attended by the lead GP. This facilitated management of poor performance and to exchange good practice across the organisation.

• The practice was located on the second floor of a purpose built health centre. The building was accessible and lifts were available for those patients who had difficulty with their mobility.

• There was a clear leadership structure both at corporate level and at practice level and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

• Information about services and how to complain was available in various community languages. Improvements were made to the quality of care as a result of complaints and concerns.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 May 2017

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

• 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 diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was at or below target level, was 94%. This was above the CCG average of 90% and the national average of 91%.
• The practice provided additional diabetic services. A Diabetes Consultant held clinics (mix of face to face and virtual) for more complex cases. This was as part of the Diabetes Inpatient Care and Education (DICE) programme, a CCG funded area of enhanced care.
• Other long term conditions such as chronic obstructive pulmonary disease (COPD), asthma and hypertension showed patient outcomes were above CCG and national averages.
• 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 provider offered services to support the diagnosis and monitoring of patients with long term conditions such echocardiograms (ECG) and spirometry. Health promotion support was also available such as smoking cessation.

Updated 17 May 2017

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.
• The practice was located on the second floor of a purpose built health centre and was suitable for children and babies and lifts were available.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children. The practice discussed any safeguarding concerns as part of two monthly multidisciplinary meetings with relevant health professionals.
• We saw positive examples of joint working with midwives and health visitors. The practice provided immunisation clinics for children and provided postnatal checks.
• Immunisation rates were low for all standard childhood immunisations. The practice was aware of this and was working to address this.
• Appointments were available outside of school hours.
• The practice’s uptake for the cervical screening programme (in the preceding five years) was 81%. This was comparable to the CCG average of 80% and the national average of 81%.

Updated 17 May 2017

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 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 had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice worked closely with multidisciplinary teams so patients’ conditions could be safely managed in the community. Patients could be referred to other local practices that were part of the same provider offering additional services such as Urology, Rheumatology as well as Ear Nose and Throat (ENT) services. This provided convenience for patients who did not have to travel to hospital for the service
• The practice was accessible to those with mobility difficulties.

Updated 17 May 2017

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. The practice had a significantly higher than national average working age patients registered at the practice. The practice had increased the number of online and telephone consultations as a result of feedback from patients. It also offered early morning appointments from 7am to 8am on Mondays.
• Patients could access appointments and services in a way and at a time that suited them. Appointments could be booked over the telephone, face to face and online.
• The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

• The practice offered a range of health promotion and screening that reflects the needs for this age group. This included NHS health checks.

Updated 17 May 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 percent of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was below the CCG average of 84% and the national average of 84%. We asked the practice to provide us with data from 2016-17 which showed that 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting. Although this demonstrated improvement, this was unverified and unpublished data.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. We looked at some mental health care plans and saw that some had input from external mental health teams.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 94%, compared to the CCG average of 91% and the national average of 89%.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. The GP told us that they initially followed this up with a telephone call.

Updated 17 May 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 homeless people, travellers and those with a learning disability.
• The practice was located near the city centre of Birmingham and staff were aware of and could demonstrate understanding of some of the barriers faced by vulnerable patients.
• Staff had attended external training to understand the barriers (to healthcare) faced by patients from vulnerable groups.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and held meetings with the district nurses and community teams.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice’s computer system alerted GPs if a patient was also a carer. There were 41 patients on the practices register for carers; this was 1% of the practice list. There was supportive information in place for carers to take away as well as information available through the practice website. The practice offered annual reviews and flu vaccinations for anyone who was a carer.