Archived: Meadowside Family Health Centre

Updated 10 July 2017

Founded in 2015, GPS Healthcare was formed by merging six existing GP surgeries. GPS Healthcare has a location at Meadowside Family Health Centre and the other registered location in the group is Tanworth Lane Surgery. There are also four branch surgeries; Knowle Surgery, Park Surgery, Village Surgery and Yew Tree Medical Centre. The group of practice has a total of 40,700 patients are registered across the six sites. During this inspection we visited Meadowside Family Health Centre.

The practice has a General Medical Services contract (GMS) 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. The practice also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes.

The area served has low deprivation compared to England as a whole and based on data available from Public Health England; the levels of deprivation in the area served by GPS Healthcare ranked at nine out of ten, with ten being the least deprived.

The group of practices is served by a team of 137 staff. There are 18 GP partners (seven male, 11 female) working across the sites and 13 salaried GPs (four male, nine female). There are also two advanced nurse practitioners (female), 16 practice nurses (female) and six health care assistants (female). Each site has a site manager supported by administrative and reception staff.

The group of practices offers training and teaching facilities, which means GP trainees and are able to undertake part of their training at the practices. The practice also mentors trainee nurses.

Meadowside Family Health Centre is open between 8am and 6.30pm Monday to Friday, from 6pm the practice can only be accessed by telephone. Appointments are from 9am to 12.30pm and 1.30pm to 6pm on Monday to Friday. Emergency appointments are available daily. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. The out of hours service is provided by the Birmingham and District General Practitioner Emergency Room (Badger) Out of Hours service.

The practice is part of NHS Solihull Clinical Commissioning Group (CCG) which has 27 member practices. The CCG serve communities across the borough, covering a population of approximately 238,000 people. A CCG is an NHS Organisation that brings together local GPs and experienced health care professionals to take on commissioning responsibilities for local health services.

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Meadowside Family Health Centre, part of GPS Healthcare, Solihull on 18 May 2017. GPS Healthcare are a group of six practices in Solihull and includes two registered locations Meadowside Family Health Centre and Tanworth Lane Medical Centre and an additional four branches.

All of the practices share one practice list and have a central management team with shared policies, procedures and governance arrangements. We have produced two reports to reflect both locations registrations; however due to the structure of the provider organisation much of the detail included in the reports will be replicated.

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

• The practice had a clear vision which had safety, quality of care and staff involvement as its top priority. The strategy to deliver this vision had been produced with staff and stakeholders and was regularly reviewed and discussed with staff.
• A comprehensive understanding of the performance of the practice was maintained through the management board. Performance was managed centrally and managers could review achievement and compliance at each location and across the organisation. We saw evidence of quality improvement activity that had been implemented with case studies to demonstrate learning. The learning points were cascaded to staff and discussed at individual site and team meetings.
• The management team had a meeting structure in place which included a staff forum to ensure all staff had the opportunity to contribute to the practice vision and values.
• The provider had expanded the six practices with seven additional consultation rooms, through the local infrastructure investment scheme and from investment of the GP partners. This had enabled them to offer more services.
• The practice had an active patient participation group (PPG) and the provider also held a GPS Healthcare wide network PPG meeting was held on a regular basis. The practice implemented suggestions for improvements as a consequence of feedback from patients and from the PPG. For example the PPG were asked for suggestions and ideas on how to improve the patient information leaflet which was acted on. This included adding information on medicines waste and the leaflet being available in different formats to support vulnerable patients.
• A patient newsletter had been set up which was issued every three months. The newsletter promoted health awareness and updated patients on changes within the practices and the plans that had been implemented.
• 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, this included regular health awareness events.
• There was evidence of quality improvement including clinical audits. There had been 21 clinical audits undertaken in the last two years across all six sites and the learning shared with each practice. These were completed audits where the improvements made were implemented and monitored.
• The practice had set up a comprehensive health and safety system. This included a standard operating system that had been adapted at all sites and an annual event planner, so all sites were aware of when risk assessments, training and checks would be completed.

The outstanding feature at this practice was the leadership and this was demonstrated through:

• The practice had identified that talks from local charities was an opportunity to support patients and their families and had linked with local charities and services to do this. For example: Four events had taken place over 12 months and were advertised in the practices, on the website and in the practice newsletter. The four events included, a dementia friends event, a living well after a cancer diagnosis by MacMillan and Cancer Research UK, Age UK and Solihull Carers to offer support to all carers over the age of 13 years. The practice had an average of 10 patients and their families attend each event. The practice had set up a ‘Healthcare Hub’ in conjunction with the local library, to offer access to health advice and health awareness to the local population.
• The practice undertook the General Practice Improvement Programme, sponsored by NHS England. This was a program focused on the organisational efficiency that can be developed by making use of ‘lean’ process mapping. By identifying and removing differences between sites, the practice had developed a protocol for dealing with emergency situations. This included having exactly the same emergency grab bag (with identical contents, in specified pockets) in each location. The practice had an innovative use of technology with each department having a ‘Whats App’ program on their telephone to liaise with each other in the case of an emergency and to organise cover in the case of staff sickness.

There was an area of practice where the provider should make improvements:

• Continue exploring and establishing effective methods to identify carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 July 2017

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. For example, the latest published QOF results showed 90% of patients with chronic obstructive pulmonary disease (COPD) had received a review in the past 12 months, this was in line with the local average of 89% and the national average of 90%.
• The nursing team held regular meetings to discuss chronic long term conditions and we saw evidence of a recent respiratory meeting which highlighted good practice and areas to review for improvement. This included an agreement by the nursing staff that all patients with COPD had a 30 minute appointment slot where possible due to the complexity of their condition.
• 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. 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.
• The provider ran a leg ulcer service across the six sites for GPS Healthcare registered patients and also the local community.
• The practice held anti-coagulation clinics every week to monitor patients on Warfarin.
• The provider supported DiCE clinics on a regular basis for patients with diabetes. Diabetes in Community Extension (DiCE) clinics are community based clinics held by specialist nurses and consultants to support patients with complex diabetes.

Updated 10 July 2017

• 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’s uptake for the cervical screening programme was 78% which was comparable to the national average of 81%.
• We saw examples of joint working with midwives and the community midwife ran antenatal clinics two mornings a week.

Updated 10 July 2017

• 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 appointments for those with enhanced needs. This included flu and shingles vaccinations for patients who were unable to attend the surgery.
• The practice had been a pilot site for the Care Navigator Service, in conjunction with Age UK Solihull. The Care Navigator Service offered support to older people to find solutions to issues they may face and assists them to navigate and access relevant services that could meet their needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• Data provided by the practice showed 291 patients on the palliative care register across the six sites and we saw evidence to support that patients were discussed at six weekly meetings and their care needs were co-ordinated with community teams.

Updated 10 July 2017

• The needs of the working age population had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. Patients were able to access any of the six practices across Solihull from 8am to 6.30pm. This was facilitated by the use one clinical system allowing access to patient records. Telephone consultations were available at the request of patients.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. This included stop smoking clinics across GPS Healthcare for patients and the local community.
• The practice’s uptake for the cervical screening programme was 78% which was comparable to the national average of 81%.
• Data provided by the practice showed 85% of patients who were currently registered as smokers had received support to quit smoking.
• The practice made use of texting to remind patients of their appointment and an electronic prescribing service.

Updated 10 July 2017

• There were 386 patients on the dementia register. The latest published QOF data for 2015/16 showed 81% of patients had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations, this included health awareness events to support patients and their families. For example, the practice had held a dementia friends evening which was accessible by all patients from the six surgeries. All staff had received dementia awareness training and were now dementia friends.
• The provider had piloted a new community dementia diagnosis pathway to support the Memory Assessment Service and the Alzheimer’s Society. The pilot was created to support patients and their carers through the processes of screening and diagnosis giving patients and their carers access to clinical dementia experts, as well as a package of support. 
• The practice supported a local dementia care home and offered weekly ward rounds and domiciliary visits. Feedback from the home reflected the support and care offered by the staff and GPs to the patients.
• Data provided by the practice showed 322 patients on the mental health register. The latest published QOF data for 2015/16 showed 89% of patients had a comprehensive, agreed care plan documented in their medical record in the last 12 months, which was comparable to the national average of 89%.
• Patients who needed mental health support were referred to the Improving Access to Psychological Therapies (IAPT) services. IAPT held a clinic at Meadowside practice each week and clinics were also available at other sites within GPS Healthcare every day 

Updated 10 July 2017

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Data provided by the practice showed 208 patients on the learning disability register and 85% had received an annual review.
• The practice held a register of 389 carers, which represented 0.9% of the whole practice list. There was a carers information board which detailed support available, this also included information for young carers. Carers were invited for flu vaccinations and the practice had supported a carers event in conjunction with Solihull carers to offer support and advice to carers from the age of 13 years old.
• All staff had received training on carers and MacMillan cancer support.
• End of life care patients received a priority service. All sites worked to the Gold Standard Framework and the practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff we spoke with 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.