Brace Street Health Centre

Updated 24 July 2017

Dr R Kumar & Dr J P Singh's Surgery is one of three GP practices located in Brace Street Health Centre. Brace Street Health Centre is purpose built for providing primary medical services, it also hosts various community services.

The practice is part of the NHS Walsall 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.

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.

The practice registered list size is approximately 2,900 patients. Based on data available from Public Health England, the practice is located within the 20% most deprived areas nationally. The practice population is younger than the national average for example, 26% of the practice population is under 18 years compared to the CCG average of 23% and the national average of 21%. While 12% of the practice population is over 65 years compared to the CCG and national average of 17%. The practice population is also ethnically diverse covering a range of nationalities from Asia, Eastern Europe, Africa and the UK.

The practice registered with CQC in February 2016 as a partnership when the former salaried GP joined as a part-time partner. Practice staff consist of two GPs (both male), one practice nurse (female), a practice manager and a team of administrative / reception staff.

The practice is open:

Monday 9am to 1pm and 4pm to 7pm (extended opening)

Tuesday 9am to 1pm and 4pm to 6.30pm

Wednesday 9am to 1pm

Thursday 9am to 7pm (extended opening)

Friday 9am to 1pm and 4pm to 6.30pm

When the practice is closed during core hours calls are handled by WALDOC. In the out of hours period between 6.30pm and 8am on weekdays and all weekends and bank holidays the service is provided by another out of hours provider which is reached through the NHS 111 telephone service.

Updated 24 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brace Street Health Centre - Dr R Kumar & Dr J P Singh's Surgery on 14 June 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.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. These included safeguarding, infection prevention and control and medicines management.
• 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.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Complaints were responded to in a timely way.
• Patients we spoke with said they found it easy to make an appointment and there was continuity of care. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

We saw one area of outstanding practice:

• Despite high levels of deprivation and an ethnically diverse population in which there is cultural reticence to participate in cervical screening the practice had achieved a high uptake for cervical screening (knowledge and engaged with the local community at a personal level to promote uptake. This has been achieved through persistent calling of eligible patients, where possible in their own language to discuss the importance of cervical screening and secure appointments.

The areas where the provider should make improvement are:

• Review business continuity plan to ensure it contains contact details for all staff so that they may easily be contacted in an emergency.
• Continue to review and take action to improve the uptake of national screening programmes for breast and bowel cancer.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 July 2017

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

• Clinical staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Nationally reported outcome data for patients with diabetes was above the CCG and national average overall (100% compared with the CCG average of 93% and national average of 90%). The practice also had lower exception reporting for diabetes indicators at 5% compared to the CCG average of 9% and national average of 12%).
• The practice followed up on patients with long-term conditions discharged from hospital to ensure their needs were being met.
• 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 practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice provided in-house spirometry (for the diagnosis and monitoring of respiratory conditions), electrocardiographs (ECGs) and phlebotomy (blood taking) for the convenience of patients.

Updated 24 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 attended accident and emergency (A&E) attendances or did not attend for their appointments and those attended hospital.
• Immunisation rates were relatively high for all standard childhood immunisations.
• We saw children and young people were treated in an age-appropriate way and were recognised as individuals. The practice made patients under 16 years aware that they were entitled to confidential advice.
• Appointments were available outside of school hours. Staff told us that they tried to bring in children for their long term condition reviews (such as Asthma reviews) doing school holidays.
• The premises were suitable for children and babies. There were facilities within the health centre for baby changing and breast feeding.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics. The health centre was shared with the health visiting team and antenatal clinics with the midwife operated weekly from the practice.

Updated 24 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 urgent same day appointments for those with enhanced needs.
• The practice participated in multidisciplinary team meetings with communitystaff to discuss those with complex care and palliative care needs.
• The practice followed up patients recently discharged from hospital including those who had unplanned admissions.
• Patients over 75 years were invited for an annual health review, 52 had been completed in the last 12 months.
• The premises was accessible to those with mobility difficulties and a hearing loop was available if needed.
• The practice offered flu, pneumonia and shingles vaccinations for eligible patients. These were given as home visits for patients whose health needs resulted in difficulty attending the practice.

Updated 24 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, the practice was open until 7pm on a Monday and Thursday for extended opening.
• The practice offered telephone consultations as appropriate.
• The practice was proactive in offering online services for making appointments and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
• Uptake of cervical screening was above CCG and national averages despite the high levels of deprivation and cultural reticence within the practice population. The practice had achieved high uptake rates through persistent calling to promote the service and where possible in the patients first language.
• The practice had held an event with guest speakers to promote national screening programmes for breast and bowel cancer. However, uptake remained lower than CCG and national averages.
• The practice offered travel advice and vaccinations.
• Health checks were offered to patients aged 40 to 74 years, 81 had been undertaken in the last 12 months.
• The meningitis vaccination was available for students between 18-25 years.

Updated 24 July 2017

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

• The practice carried out dementia screening to support the earlier diagnosis and treatment.
• Nationally available data for 2015/16 showed 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG and national average of 84%. Exception reporting was comparable to the CCG and national averages at 9% compared to the CCG and national average of 7%.
• National reported data for 2015/16 showed 94% 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 92% and national average 89%. There was no exception reporting.
• Patients were able to access support from the mental health nurse and counselling services located in the health centre on a weekly basis.
• Depot injections for medicines used in the management of poor mental health were carried out at the practice for patient convenience.

Updated 24 July 2017

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

• The practice held register of patients living in vulnerable circumstances including those with a learning disability, with palliative care needs and carers.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients 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.
• We received CQC comment cards which described caring and compassionate care to vulnerable patients.
• The practice supported patients to access the service. This included the provision of interpreter services and hearing loop. For patients with no fixed abode the practice policy was to use the practice address.