Great Barr Medical Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

At the last inspection we rated the practice as requires improvement as patient feedback was negative about accessing the service. At this assessment we found that patient feedback continued to be negative with further reductions in patient satisfaction. Staff reported a shortage of GP appointments were available and this was impacting on patients being able to access the service in a timely manner.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback through the GP patient survey showed 54% felt the healthcare professional recognised or understood any mental health needs during their last general practice appointment, this was lower than local and national averages. The survey also showed 81% of patients questioned said they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment, this was slightly lower than local and national averages.

The practice told us that they regularly involved patients in planning and making shared decisions about their care and treatment that meets their needs. On reviewing staff training we found some staff had not received training updates in equality and diversity, deprivation of liberty and mental capacity. The practice had commenced the family and friends test, however we found no evidence to demonstrate the outcome of the national patient survey had been reviewed and used this to make improvements.

We were unable to gain assurances that staff and leaders worked within the primary care network (PCN) and other agencies to ensure that people’s care and treatment was delivered in a way that met their needs and were responsive. For example, the practice was supported by a paramedic to support clinical care and availability, however feedback from staff in clinical roles showed a continuous lack of support from the leadership team. Minutes of meetings shared showed no evidence that multi disciplinary meetings were being held with the community services to discuss and manage the needs of patients with complex medical issues. The practice held registers of patients living in vulnerable circumstances including those with a learning disability, mental health or safeguarding concern.

We were provided with evidence to demonstrate that clinical meetings had been held on 2 occasions since the return of the GP partners to the practice, however we found no evidence that processes had been implemented to ensure that community teams were included in discussions. Safeguarding meetings were held at the practice, however the minutes provided showed no evidence of discussions with health visitors when safeguarding concerns had been highlighted.

The practice website was accessible to patients. The website included useful information on health awareness and promotion. Information and resources were available for patients to support them to understand how to access services. For example, there were arrangements in place for people who need translation services or who may be digitally excluded.

There were systems in place to support patients who faced communication barriers to access treatment and patient records were held in line with guidance and requirements. We found the practice complied with the Accessible Information Standard and that information about people that collected and shared was in line with data protection legislation requirements. Due to the lack of effective processes, we found patients had not received accurate and up to date information following pathology results and delays in referrals and the actioning of tasks.

Feedback from the GP national patient survey results demonstrated that 70% of patients say the healthcare professional they saw or spoke to was good at listening to them during their last general practice appointment and 69% say the healthcare professional they saw or spoke to was good at treating them with care and concern during their last general practice appointment. These results were lower than local and national averages.

We found there was a system for recording complaints, however there was no evidence to demonstrate that they were regularly reviewed and discussed in practice meetings to share learning. The practice had received 65 complaints in the last 12 months and on reviewing a sample of complaints we evidence that some appropriate action was taken. The practice told us they had started to collate feedback via the Friends and Family test to make improvements to the service. The practice leadership team told us that they were trying to organise a patient participation group, however we found no evidence that this had been started to encourage patients to attend and gather their feedback.

The practice had a complaints policy in place, however we found the systems to monitor complaints and use patient comments to improve the quality of care was not embedded to ensure improvements were demonstrated. There had been 1 practice meeting for the whole team since the partners returned in February 2024 and the partners were not present. We found no evidence from minutes of the meeting that significant events and complaints were discussed. Information about how to complain was available and patients could make a complaint in person, or via the practice website.

The practice had developed services to respond to the needs of their population to improve access. This included a duty doctor, paramedic and pharmacy support. However, we found on the day of inspection staff told us there was a shortage of GP appointments. The practice had received feedback through complaints and the GP patient survey and following the inspection we received an action plan for the 2023 GP national patient survey which showed the outcomes of the survey would be discussed at a practice meeting in May 2024. The 2023 National GP Patient Survey data was below local and national averages. We found that patient feedback regarding access to care and treatment was significantly lower than national averages for how easy it was to get through to someone at their GP practice on the phone. For example: 13% found it easy to get through on the phone. Patients could access appointments by phone, online and by visiting the practice. The practice used a sign-posting triage system where reception staff would ask the patient for enough information to make a decision regarding which clinician was appropriate for them to see, however staff reported that on occasions patients were allocated to the wrong type of clinician which caused delays patients being seen in a timely manner. Patients were given the option of a face to face or telephone appointment. Patients who requested an emergency appointment were allocated to the duty doctor for triage. The practice website provided information for patients regarding how to book an appointment.

Leaders demonstrated they were aware of the challenges to patient access, however we were unable to gain assurances that they had acted to improve access. We received a copy of an action plan created response to the 2023 National GP Patient Survey results, however the plan had limited suggestions and focused on discussing the findings at a staff meeting at the end of May 2024. We spoke with members of staff in leadership and management roles. They told us that there was consistently a shortage of GP appointments with limited access in the afternoon. Clinical staff in various roles said they were under constant pressure to provide appointments and on numerous occasions, patients were allocated to them, but they were unable to provide care as the patients needs were complex and outside of their competencies. Staff reported this had been discussed with the leadership team, but no action had been taken to ensure patients received an appointment with the appropriate clinician. Staff shortages in the nursing team was impacting on the delivery of services and we found the remaining clinical staff were working through their breaks to ensure patients were provided with appointments. Staff reported that leaders were aware of the difficulties the nursing team were facing, however no support was being provided to support them.

Patients could book appointments by telephone, online, and in person by visiting the practice. Appointments were available face to face, by telephone, or as a home visit. Appointments with a GP were available throughout the week, however staff reported that GPs were not always available during the afternoon. Extended access some days from 6.30pm and 8.30pm. When the practice was closed patients were able to contact 111. The practice offered appointments from a variety of additional clinical staff for example nurses, paramedic and pharmacist. The practice had arrangements in place for prioritising patients. Staff were trained to book appointments with members of the practice clinical team or signpost patients to other appropriate services and were supported by a duty doctor, but feedback showed that due to GP appointment shortages, patients were being booked with the practice clinical team that were inappropriate.

The practice had not responded to all feedback by people who used the service within the last 12 months. People could leave feedback via NHS UK, the practice website and since February 2024, the practice had implemented the Friends and Family test (FFT). The practice had received 7 reviews in the past 12 months on NHS UK, however the practice had responded to 1 comment. We spoke with the leadership team on the day of inspection, but were unable to gain assurances that actions were being taken to improve patient satisfaction. Leaders told us that the practice were addressing workforce challenges including wider clinical support through the recruitment of more clinical staff. On the day of inspection we found changes had been made by the leaders to the clinical team with the reduction of GPs availability. The practice had employed 2 new pharmacists to support the clinical team. However, staff reported patients could not make routine appointments for medicine reviews. The leadership team told us they were in the process of setting up a Patient Participation Group (PPG), however no evidence was provided of what had been implemented to encourage patients to join the group. At the time of inspection we found no evidence to demonstrate that the 2023 GP national patient survey had been discussed with staff to discuss ideas and what improvements could be made to improve patient outcomes.

The provider complied with legal equality and human rights requirements, including avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes, including meeting the Accessible Information Standard. We saw examples where the practice had met the needs of vulnerable patient groups and removed barriers for improved patient experience. For example, the practice premises had a hearing loop in place and access to interpreters was available. People with learning disabilities and poor mental health experienced additional care through annual reviews.

Leaders understood the requirements of legislation when considering consent and decision making and had access to policies to support them. We found no evidence to demonstrate that the practice held multidisciplinary meetings with other agencies to share and discuss information relating to patient care and treatment, for example, those on the practice palliative care register.

There were systems in place for staff to keep up with training, but on reviewing staff training we found there was no systems in place to monitor staff training and when updates were required. We found some clinical staff had not kept up to date in training relating to the Mental Capacity Act, Deprivation of Liberty and safeguarding. There were registers held for those patients who were vulnerable who were on the palliative care register or at the end of their life. We found that clinicians understood the requirements of legislation and guidance when considering consent and decision making and saw that consent was documented.