The Care Quality Commission
  • Doctor
  • GP practice

Cavendish Medical Practice

Overall: Good read more about inspection ratings

Summerfield Primary Health Care Centre, 134 Heath Street, Birmingham, B18 7AL (0121) 203 2050

Provided and run by:
Cavendish Medical Practice

Important: This service was previously registered at a different address - see old profile

All Inspections

28 November 2023

During an inspection looking at part of the service

We carried out an announced focused assessment of the responsive key question at Cavendish Medical Practice at on 28 November 2023. The rating for the responsive key question is Requires Improvement. As the other domains were not reviewed during this assessment, the rating of good will be carried forward from the previous inspection and the overall rating of the service will remain Good.

Safe - Good

Effective - Good

Caring - Good

Responsive – Requires Improvement

Well-led – Good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Cavendish Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection.

We carried out this inspection to undertake a targeted assessment of the key question of responsive.

We recognise the work that GP practices have been engaged in to continue to provide safe, quality care to the people they serve. We know colleagues are doing this while demand for general practice remains exceptionally high, with more appointments being provided than ever. In this challenging context, access to general practice remains a concern for people. Our strategy makes a commitment to deliver regulation driven by people’s needs and experiences of care. These assessments of the responsive key question include looking at what practices are doing innovatively to improve patient access to primary care and sharing this information to drive improvement.

How we carried out the inspection

This inspection was carried out remotely.

This included:

  • Conducting staff interviews using video conferencing.
  • Requesting evidence from the provider.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • The practice understood the needs of its local population and tailored services to meet those needs.
  • The practice continuously audited and adjusted services based on patient demand to support patients to access appropriate care.
  • The practice worked effectively with local partners to improve access to services for the wider patient population.
  • During the assessment process, the provider highlighted the efforts they are making or are planning to make to improve the responsiveness of the service for their patient population. The effect of these efforts are not yet reflected in patient feedback. Patient feedback was that they could not always access care and treatment in a timely way.

Whilst we found no breaches of regulations, the provider should:

  • Continue with efforts to improve patient satisfaction in relation to access.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

10 September 2019

During a routine inspection

We carried out an announced comprehensive inspection of Cavendish Medical Practice on 10 September 2019.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

  • The practice had clear systems, practices and processes to keep people safe and safeguarded from abuse.
  • Patients’ needs were assessed and care and treatment was delivered in line with current legislation and evidence-based guidance.
  • We saw evidence of effective quality improvement activities undertaken in the practice to improve care and services for patients.
  • Staff worked together and with other organisations to deliver effective care and treatment.
  • There were clear responsibilities, roles and systems of accountability to support good governance.
  • Staff treated patients with kindness, respect and compassion. Feedback from patients was positive about the way staff treated people.
  • The practice organised and delivered services to meet patients’ needs. The practice ensured that information was available in various formats and languages to meet the needs of their patient population, this included information made available in other languages to encourage cancer screening and uptake of childhood immunisations.
  • Published data highlighted that the practices childhood immunisation uptake rates for 2018/19 and cancer screening rates for 2017/18 were below target. Unpublished and unverified data from the practice showed improvement in these areas and evidence gathered during the inspection gave assurance of ongoing efforts to improve these areas.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Continue with efforts to improve uptake of childhood immunisations and cancer screening.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care