Archived: Lozells Medical Practice

Updated 22 October 2015

Lozells Medical Practice is located in the Finch Road Primary Care Centre and in the NHS Sandwell and West Birmingham Clinical Commissioning Group (CCG). The practice provides primary medical services to approximately 3,900 patients in the local community under a general medical services (GMS) contract. The practice is located in one of most deprived areas in the country. The population served is younger than the national average.

There were two GP partners, both male, only one partner was working at the practice during the inspection. In addition a female locum GP also works regularly at this practice. A practice manager, IT manager, practice nurse (female) and three administrative staff also work at the practice.

The practice opening times and surgery times are from 10am until 1pm Monday to Friday and from 4.30pm to 6.30pm on Wednesday and Friday. Extended opening hours are provided until 8pm on Mondays and Tuesdays until 7pm. The practice is closed on a Thursday afternoon. This information was available on the practice website.

The practice manager told us that when the practice was closed during the day and on a Thursday afternoon, general medical service were commissioned by the practice from Primcecare the out of hours provider. Primecare also provide out of hours cover when the surgery closed in the evening until 10am the following morning. A duty doctor is on call from 8am until 10am and from 1pm until 4.30pm Monday to Friday to answer calls forwarded to the practice from Primecare.

Updated 22 October 2015

Letter from the Chief Inspector of General Practice

We completed a comprehensive announced inspection at Lozells Medical Practice on 12 March 2015. Overall the practice is rated as requires improvement.

We found that the practice was good for providing an effective and caring service and required improvement for being safe and well-led. However, we found the practice to be inadequate for providing a responsive service. As a result, we found the practice required improvement in providing services for people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health.

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

• Patients were at risk of harm because systems and processes in place to keep them safe were not effective. For example appropriate steps had not been taken to ensure sufficient numbers of staff were on duty on each occasion, systems in place regarding emergency equipment were not robust and the practice had not undertaken infection control audits.
• Systems were in place to review the needs of those patients with complex health needs or those in vulnerable circumstances.
• Patients said that the GPs listened to what they had to say and treated them with compassion, dignity and respect. However the results from the last national patient survey showed that the practice was below CCG and national averages regarding the percentage of patients who felt that they were involved in their care and decisions about their treatment.
• Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that it was very difficult to get through the practice when phoning to make an appointment.
• Staff felt supported by management and the practice proactively sought feedback from staff and patients, which it acted on.
• There was an open culture within the practice and staff were actively encouraged to raise concerns and suggestions for improvement.
• The practice had limited formal governance arrangements, not all staff had access to policies and procedures.

However, there were areas where the provider must make improvements

Importantly, the practice must:

• Implement effective systems in the management of risks to patients and others against inappropriate or unsafe care. This must include robust management of recruitment of staff and environmental checks.

• Ensure audit processes are in place to assess the risk, prevent, detect and control the spread of infection.

• Implement systems to ensure that all complaints received are recorded and appropriate action is taken regarding investigation, corresponding with the complainant and review.

There were also areas where the practice should make improvements.

• Implement Incident/significant event reporting, recording and monitoring processes to ensure trends and lessons learnt are captured and shared internally, and where appropriate externally.

• Provide staff with information regarding the roles and responsibilities of a chaperone and ensure that the practice’s chaperone procedure is followed.

• Ensure staff training records are well maintained so that the practice can be assured the training relevant to staff roles have been completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 October 2015

The provider was rated as requires improvement for providing a safe and well led service and inadequate for providing a responsive service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice had identified patients and developed care plans for those with the most complex needs as part of the unplanned admissions enhanced service There were arrangements to ensure the continuity of care for those who needed end-of-life care. Patients with urgent health needs were able to access same day appointments. Emergency admissions for 19 ambulatory care sensitive conditions was in line with the national average. These are chronic conditions that can be appropriately managed in the primary care setting. When needed longer appointments and home visits were available. Patients in this population group had structured annual reviews to check their health and medication needs were being met.

In-house services for patients with diabetes, including insulin initiation was available, this included input from a consultant and nurse specialist. Separate meetings were held with this multi-disciplinary team regarding these patients. Spirometry services were also provided including diagnosis and screening. The practice were high achievers regarding the quality and outcomes framework (QOF) and were above the clinical commissioning group (CCG) average. For those people with the most complex needs the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 22 October 2015

The provider was rated as requires improvement for providing a safe and well led service and inadequate for providing a responsive service. The concerns which led to these ratings apply to everyone using the practice, including this population group. Immunisation rates were high for all standard childhood immunisations and systems in place ensured that non-attenders were contacted. Appointments were available outside of school hours and the premises was suitable for children and babies. We were provided with good examples of joint working with midwives, district nurses and health visitors.

All staff had received training in safeguarding children so that they had the knowledge and understanding to act if they were concerned a child may be at risk of harm. Safeguarding procedures were in place for identifying and responding to concerns about children who were at risk of harm and systems were in place for identifying at risk patients, both children and adults. For example patients at risk of domestic violence or children on the child protection register.

Women were offered cervical screening and there were systems in place to contact patients who did not attend their appointment.

Updated 22 October 2015

The provider was rated as requires improvement for providing a safe and well led service and inadequate for providing a responsive service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice offered personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example the unplanned admissions enhanced service, (a scheme to avoid unplanned hospital admissions by focusing and coordinating care for the most vulnerable patients), atrial fibrillation screening for over 65 year olds, and facilitating timely diagnosis and support for people with dementia. Patients in this population group aged 75 years and over had a named GP. Those patients identified as the most at risk of an unplanned hospital admission had been given a separate direct dial telephone number which enabled them easier access to obtain an appointment. Care plans were in place and regularly reviewed and rapid access appointments were available. The practice was responsive to the needs of older people, including offering home visits and longer appointments. Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people.

Updated 22 October 2015

The provider was rated as requires improvement for providing a safe and well led service and inadequate for providing a responsive service. The concerns which led to these ratings apply to everyone using the practice, including this population group. 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 flexible and offer continuity of care. The GPs at this practice were sexual health in practice (SHIP) trained. The SHIP scheme includes specific training regarding sexually transmitted infections, HIV, contraception, unintended pregnancy, young people ’ s access and sexual health promotion. The practice offered extended opening hours for appointments until 8pm on a Monday and 7pm on a Tuesday, and online appointment booking and ordering of repeat prescriptions had recently been introduced which currently had a low uptake. Health promotion advice was offered and accessible health promotion material was available in the waiting area. Women were offered cervical screening and there were systems in place to contact patients who did not attend their appointment.

Updated 22 October 2015

The provider was rated as requires improvement for providing a safe and well led service and inadequate for providing a responsive service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations including Healthy Minds. A counsellor is available at the practice on a weekly basis. The practice website contains links to services such as the Alzheimer ’ s society, health talk online and the mental health foundation. Information was available to patients from these organisations. The practice had a system in place to follow up on patients who had attended accident and emergency where there may have been mental health needs.

Performance data available for patients in relation to outcomes for patients with dementia were above the CCG average. Performance data available for in relation to outcomes for patients with mental health conditions including schizophrenia, bipolar affective disorder and other psychoses were also above the CCG average. Depression screening is undertaken and direct referral to the community mental health team as necessary.

Dementia screening is undertaken for appropriate at-risk patients, for example those with peripheral arterial disease or a history of CVA.

Updated 22 October 2015

The provider was rated as requires improvement for providing a safe and well led service and inadequate for providing a responsive service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice held a register of patients living in vulnerable circumstances including those with learning disabilities and this showed that annual health checks had been completed and 100% of these patients had received a follow-up. The practice offered longer appointments for people with learning disabilities and for those patients whose first language was not English. Flags were put on computer systems to alert staff if a patient had a learning disability, for those whose first language was not English or patients who had drug or alcohol problems. This enabled staff to allow additional time or make appropriate arrangements, such as interpreters, when making appointments for these patients.

The practice provided an enhanced service to avoid unplanned hospital admissions. This service focused on coordinated care for the most vulnerable patients and included emergency health care plans. The aim was to avoid admission to hospital by managing their health needs at home. An enhanced service is a service that is provided above the standard general medical service contract (GMS).

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector organisations such as Healthy Minds. Staff knew how to recognise signs of abuse in vulnerable adults and children.