Greenfield Medical Practice

Updated 14 July 2017

Greenfield Medical Practice is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

Greenfield Medical Practice is located in a converted house adapted to provide primary health services. Clinical services are provided on the ground floor of the premises which have recently been refurbished. There is no dedicated parking facilities although parking along the street is permitted during surgery opening hours.

The practice registered list size is approximately 2800 patients.

Services to patients are provided under a General Medical Services (GMS) contract with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care and is a nationally agreed contract. The practice also provides some enhanced services such as childhood vaccinations.

Based on data available from Public Health England, the practice is located within the 10% most deprived areas nationally. The population served is predominantly of Asian origin with Pashto being the main language spoken among approximately 30% to 40% of the practice population. The practice population is younger than the national average for example, 35% of the practice population is under 18 years compared to the CCG average of 24% and national average of 21%. While 4% of the practice population is over 65 years compared to the CCG average of 15% and national average of 17%.

The principal GP registered with CQC in 2014 as a new provider. Practice staff consist of the principal GP (male) a long term locum GP (female), a practice nurse (female), a pharmacist independent prescriber (female) and a health care assistant. There is a practice and business manager and a team of administrative / reception staff.

The practice is open 8am to 6.30pm daily with the exception of Wednesday afternoon when it closes at 1.30pm. Morning appointments are available between 8.30am to 11.30am Monday to Friday and afternoon appointments between 4.30pm to 6.30pm on a Monday, Thursday and Friday and between 5pm and 6.30pm on a Tuesday. Extended opening is offered on a Tuesday evening until 7pm and Thursday evening until 7.30pm. When the practice is closed patients receive primary medical services from another out-of-hours provider (BADGER) which is contacted via the NHS 111 telephone service.

Updated 14 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greenfield Medical Practice on 18 May 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 in place for reporting and recording significant events. There was evidence of learning for incidents to improve the service delivered.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff 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.
• The practice actively participated in improvement activity to deliver improved outcomes for patients.
• Results from the national GP patient survey were lower than CCG and national averages. This was in contrast to feedback received through CCG comment cards and patient participation group members who highlighted many positive changes to the service since the provider had taken over and told us that they were treated with compassion, dignity and respect.
• The practice had taken action to improve access which included additional telephone lines and reception staff, the employment of a female doctor and pharmacist independent prescriber. There had also be improvements for supporting patients with long term conditions and refurbishment of the premises had led to improved disabled access. Urgent appointments were available the same day.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs. There had been recent refurbishment to the premises.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• There was a strong focus on continuous learning and improvement. For example, the practice had been involved in a pilot that had improved outcomes for patients with diabetes.

We saw one area of outstanding practice:

• The practice had made significant improvements in clinical performance and to the outcomes of patients with diabetes. The practice had a high prevalence of diabetes at 13% of the practice population (5% higher than the CCG and 6% higher than the national average) and a difficult population in terms of diabetes management. The practice had made significant improvements through the use of clinical audits and had participated in a pilot scheme for the integration of diabetes care across primary and secondary care. As the part of the pilot the HbA1c (a measure of diabetes control) was collected pre and post intervention and improvements made by the practice resulted in all patients being successfully discharged from secondary care.

The areas where the provider should make improvement are:

• Ensure equipment cleaning schedules are kept up to date to ensure cleaning has been completed.
• Continue to review and take action to improve the uptake of national cancer screening programmes for breast and bowel cancer.
• Consider and implement ways in which carers could be supported.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 July 2017

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

• Nationally reported patient outcome (QOF) data showed the practice performed well for the management of long term conditions. There was a system to recall patients for a structured annual reviews to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care needs were updated.
• The practice was among the lowest in the CCG for emergency admissions for long term conditions.
• The practice had a high prevalence of diabetes (13% of the population, 5% higher than the CCG and 6% higher than the national average. Nationally reported outcome data for patients with diabetes was comparable to the CCG and national average overall (88% compared with the CCG average of 91% and national average of 90%). The practice also had lower exception reporting for diabetes indicators at 8% compared to the CCG average of 11% and national average of 12%).
• The practice had worked as part of a pilot scheme to manage patients with diabetes working collaboratively with a secondary Care Diabetes Specialist Consultant and Diabetes Specialist Nurse. The practice had successfully improved outcomes for these patients and all were now being managed in the primary care setting.
• The practice ran group education sessions for patients with diabetes.
• Work had been undertaken to improve the accuracy of the diabetes register which had increased from 177 in 2012/13 to 253 in 2016/17.
• Clinical audits demonstrated significant improvement in the use of medicines used in diabetes against national guidance.
• The practice provided in-house spirometry and ambulatory blood pressure monitoring (ABPM) for the convenience of patients.
• Uptake of flu vaccinations for patients at risk was higher than the CCG average.

Updated 14 July 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, a weekly ante-natal clinic ran was held at the practice.
• Urgent appointments are available for young children who are seen on the same day and outside of school hours.
• The practice provided baby changing facilities and a private room for breast feeding. A notice was displayed advising patients of a breast feeding friendly service.

Updated 14 July 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.
• 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 same day appointments for those with enhanced needs. Patients were also available to request longer appointments if needed.
• The practice identified older patients who may need palliative care as they were approaching the end of life. The practice worked with other health professionals to support the needs of this group of patients.
• The practice followed up on older patients discharged from hospital and ensured that their care needs were being met.
• Patients over the age of 75 years were offered a health check. The uptake of the over 75 years health check was 83%.
• Patients over 65 years were offered flu and pneumococcal. The practice uptake was 81% for flu vaccine which was the fourth highest in the CCG and 64% for the pneumococcal Vaccine.

Updated 14 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours on two evenings each week (Tuesdays and Thursdays).
• The principal GP would see patients before their first appointment at 8am and carry out home visits at weekends if needed. Members of the patient participation group were aware of this.
• The practice made use of texting to remind patients of their appointments and to get feedback on the service.
• The practice was proactive in offering online services as well as a range of health promotion and screening that reflects the needs for this age group. However, despite efforts there was a low uptake of national cancer screening programme, in particular breast and bowel cancer. These had been identified as one of the priority areas for the practice.
• Data available from the practice showed 92 out of 145 patients invited for a NHS health check in the last 12 months had received one.

Updated 14 July 2017

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

• Nationally available data for 2016/16 showed 85% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national average of 84%. Exception reporting was higher than CCG and national averages at 19% but this related to only three patients.
• National reported data for 2015/16 showed 97% of patients with poor mental health had a comprehensive, agreed care plan documented, in the preceding 12 months which was comparable to the CCG average 88% and national average 89%. There was no exception reporting.
• The practice had highlighted mental health as an area they wished to improve on. Practice staff advised us that they needed to challenge attitudes towards mental health within the community and encourage patients to seek help where needed. They were working with other practices in the local commissioning network to try and bring in support from the Mental Health Trust to improve mental health provision in primary care.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice displayed information available for patients experiencing poor mental health about how they could access support.
• Same day and longer appointments were available for patients with poor mental health or dementia as needed.
• The practice worked in collaboration with the local Mental Health Team/Community Psychiatric Nurse (CPN) to support patients.

Updated 14 July 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 such as those with a learning disability.
• Patients with a learning disability were given a learning disability passport which contained important information about them and their likes and dislikes which they took with them as they moved between different services.
• Patients with a learning disability were invited for annual health checks using a nationally recognised tool. Of the 39 patients on the learning disability register 33 patients (87%) have received a health check and had care plans in place.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. The practice worked with the palliative care team to support patients at end of life.
• The practice offered longer appointments for patients who needed them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.
• The practice had a significant proportion of patients whose first language was not English. Translation services were available, many of the staff were multilingual and one member of the clinical team could speak Pashto which was spoken by approximately 30-40% of the practice population.