Modality Hillcrest Surgery

Updated 30 October 2017

Modality Hillcrest Surgery is part of a wider group of GP practices registered with the Care Quality Commission under the service provider “The Modality Partnership”. The Modality Partnership is a single GP organisation that operates across 28 different locations in Sandwell, Birmingham, Walsall, Hull and Wokingham. The Modality Partnership comprised of 60 partners at the time of our inspection.

Modality Hillcrest surgery provides primary care services to approximately 6820 patients under a General Medical Services (GMS) contract. It provides services from the below sites:

• Main location – 9 Twickenham Road, Kingstanding, Birmingham, B44 0NN.

• Branch Site - 6 Dyas Road, Great Barr, Birmingham B44 8SF.

The level of deprivation within the practice population is below the national average with the practice population falling into the eighth most deprived decile.

The practice staffing consists of two male GP partners, plus five salaried GPs, a pharmacist, a physician associate, an advance nurse practitioner, three nurses and two healthcare assistants. The clinical team is supported by a practice manager and a team of reception and administrative staff.

The practice opens from: 8am to 8.30pm on Mondays; 7am to 6.30pm on a Tuesday and Friday; and 8am to 6.30pm on Wednesday and Thursday. Consulting times are generally from 8.30am to 12pm each morning and from 3pm to 6pm daily. Extended hours appointments are offered from 6.30pm to 8.30pm on a Monday evening and from 6.50am to 8am on Tuesday and Friday mornings.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Badger and is accessed via 111.

Updated 30 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Modality Hillcrest Surgery on 7 July 2017 and 16 August 2017. Overall, the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to safeguard patients from abuse and minimise risks to patient safety. Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• The practice used clinical audits to review patient care and improved services as a result.

• Results from the national GP patient survey showed most patients felt that they were treated with compassion, dignity and respect, and were involved in their care and decisions about their treatment.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services based on feedback from patients and from the patient participation group.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision, which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

The areas where the provider should make improvement are:

• Continue to review, monitor, and act upon patient experience data to drive service improvement. This includes the national GP survey results and satisfaction scores relating to access to services and interactions with GPs.

• Continue to promote patient education and the uptake for health screening programmes including the health checks for people with a learning disability, bowel and breast cancer screening.

• Ensure changes made to monitoring of patients on high risk medicines are embedded.

Janet Williamson

Deputy Chief Inspector of General Practice

Updated 30 October 2017

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

• Nationally reported data showed positive outcomes were achieved for long-term conditions that were assessed. For example, performance for diabetes related indicators was 99.5%, which was above the local average of 90.9% and the national average of 89.8%.

• The practice prioritised the identification of patients at risk of diabetes and self-management of diabetes through patient education.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• 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.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Longer appointments and home visits were available when needed.

Updated 30 October 2017

The practice is rated as good for the care of families, children and young people.

• A flexible appointment system ensured that children could be seen on the same day when this was indicated. This included the use of telephone triage to ensure those with urgent requirements were dealt with promptly and appointments were available outside of school hours.

• The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

• The practice held monthly safeguarding meetings with the health visitor and children on a protection plan or in need were regularly reviewed.

• The practice worked with midwives, health visitors, and school nurses to support this population group. For example, in the provision of antenatal, post-natal and child health surveillance clinics.

• Systems were in place to identify and follow up patients living in disadvantaged circumstances and those at risk of health deterioration. For example, children and young people who had a high number of accident and emergency (A&E) attendances.

• Immunisation rates were relatively high for all standard childhood immunisations. For example, published data showed uptake rates for the vaccines given to under two year olds ranged from 89.3% to 90.5%.

• Patients we spoke with on the day and feedback received from our comment cards stated young people were treated in an age-appropriate way and were recognised as individuals.

Updated 30 October 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• Nationally reported data showed that outcomes for conditions commonly found in older people were in line with or above the local and national averages.

• The care and treatment of older patients including those receiving end of life care, reflected current evidence-based practice.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• The practice was responsive to the needs of older patients, offered home visits and urgent appointments for those with enhanced needs.

• Where older patients had complex needs, the practice shared summary care records and / or care plans with local care services.

• Older patients were provided with health promotional advice and support to help maintain their health and independence for as long as possible.

Updated 30 October 2017

The practice is rated as good for the care of working age people.

• The needs of this population groups 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 was proactive in offering online services, which enabled patients to view their summary care record, book GP appointments and request repeat prescriptions.

• Patients had access to telephone consultations and extended hours for both GP and nursing staff appointments.

• Health promotion advice was offered and a full range of health screening that reflects the needs for this age group were offered. This included NHS health checks and flu vaccinations.

• Published data showed the uptake rates for breast and bowel screening were marginally below the local and national averages, despite a number of measures implemented to promote patient education. For example, breast cancer screening in the last three years was 64% when compared to the local average of 68.6% and national average of 72.5%.

Updated 30 October 2017

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients and considered the physical health needs of patients with poor mental health and dementia.

• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia.

• Patients at risk of dementia were identified, offered an assessment, and referred to support organisations including a local dementia café.

• The practice carried out advance care planning for patients living with dementia. Following our inspection, we received information that the practice had adopted the care plan developed by the Alzheimer’s society UK to ensure patient's individual needs were personalised.

• The practice had information available for patients experiencing poor mental health on how they could access various support groups and voluntary organisations.

• 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 practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Published data showed most patients with mental health and dementia had received a review of their health and had a care plan in place.

Updated 30 October 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The safeguarding lead GP regularly worked with other health and social care professionals in the case management of vulnerable patients.

• End of life care was delivered in a coordinated way and took into account the needs of people whose circumstances may make them vulnerable. Patients with palliative care needs were reviewed at a monthly multi-disciplinary team meeting and their care plans were updated and shared with relevant organisations to ensure continuity of care.

• Patients with a learning disability were offered annual health checks and longer appointments when required. The uptake rate for the health checks was 36% at the time of inspection.

• A total of 130 carers were registered with the practice and this equated to 2% of the patient list.

• The practice had information available for vulnerable patients and carers about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people, and adults whose circumstances may make them vulnerable. They 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.