Archived: The Hill General Practice & Urgent Care Centre

Updated 12 April 2017

The Hill General Practice and Urgent Care Centre is located within Sparkhill Primary Care Centre in the Sparkhill district of Birmingham. It has approximately 5000 patients registered and is operated by Care UK Clinical Services Ltd under a General Medical Services (GMS) contract with NHS England until 31 March 2017. It is planned that a new provider will take over the practice from that date and that services will continue as usual. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice has a lead GP (male), 8 sessional GPs (six male and two female), four practice nurses, two employed health care assistants and two additional health care assistants who are ‘bank’ staff. They are supported by a clinical director, a service manager and administrative and reception staff.

The practice is open from 8am to 8pm during every day of the week. Appointments are provided throughout these times, with those from 6.30pm to 8pm and at the weekends being provided as part of an extended hours service. Additionally, the practice provides an urgent care facility throughout these hours. This is a practice nurse led walk-in facility which is open to patients registered with any GP practice and those not registered anywhere. An average of 70-85 patients use this facility daily.

When the practice is closed, patients can access out of hours care provided by the Badger Group through NHS 111. The practice has a recorded message on its telephone system to advise patients. This information is also available on the practice’s website.

Home visits are available for patients who are unable to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book new appointments without having to telephone the practice. Telephone appointments are available for patients who are unable to reach the practice during normal working hours.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. There is a high prevalence of diabetes within the local community, along with a high level of deprivation and large numbers of patients who do not speak English as a first language.

Updated 12 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Hill General Practice and Urgent Care Centre on 20 December 2016. Overall the practice is rated as requires improvement.

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

• There were clearly defined processes and procedures to ensure patients were safe and an effective system was in place for reporting and recording significant events.
• The practice had a clear vision which had quality and safety as its top priority. This was regularly reviewed and discussed with staff.
• Patients said they were treated with dignity, respect and compassion. Patients were involved with decisions about their care and treatment.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care delivered in line with current guidelines. Staff had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Appropriate procedures were followed for patients who used the urgent care facility, for example, to ask them for written details of medicines they were taking, allergies they might have and to obtain consent to share information with the GP practice they were registered with.
• Urgent same day appointments for patients registered with the practice were available when needed. Patients we spoke with and those who completed comment cards before our inspection said they were always able to obtain same day appointments.
• Information about how to complain was available and easy to understand.
• Patients said GPs gave them enough time and treated them with dignity and respect.

We saw the following areas of outstanding practice:

• The practice proactively identified patients who were carers, particularly ‘hidden’ carers who cared for family members. There were approximately 500 patients who were registered as carers (11% of the patient list). The practice subsequently provided them with support, for example, a monthly carer’s forum and coffee morning. Carers were signposted to appropriate local organisations and community groups for support, for example for advice and assistance with benefits. Dedicated appointments were also available to allow carers flexibility to bring in patients after working hours.

However there were areas of practice where the provider should make improvements:

• Continue to identify and monitor areas for improvement to improve patient satisfaction.

• Encourage patients to take part in the national programmes for cervical, bowel and breast cancer screening.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 12 April 2017

The practice is rated requires improvement for the care of people with long-term conditions.

• The practice had a register of patients with long term conditions to enable their health to be effectively monitored and managed.

• An experienced member of the administration team had the task of contacting patients on the long term conditions registers to invite them for reviews.

• Longer appointments and home visits were available when needed. Appointments lasted up to 30 minutes when required.

• Patients were provided with information leaflets during consultations and directed to use patient information websites.

• Patients had a named GP and a review every 12 months to monitor their condition and ensure they received correct medicines. This also included carers if the patient had one. The frequency of the review depended on the severity of the patient’s condition.

• All patients who had been prescribed eight or more medicines had had a medicines review within the last 12 months.

• The practice achieved a 100% influenza vaccination record for diabetes patients during 2015/16. This was above the CCG average of 97% and the national average of 94%.

Updated 12 April 2017

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

• A total of 60% of eligible patients had received cervical screening in the last 12 months. This was below the CCG average of 83% and the national average of 82%. The practice told us they encountered reluctance within some cultures to have the test carried out.

• Appropriate staff were trained to deal with Female Genital Mutilation (FGM) and appropriate procedures were in place.

• There were appointments outside of school hours and the practice building was suitable for children and babies.

• Outcomes for areas such as child vaccinations were in line with the national average.

• We saw positive examples of joint working with midwives and the local health visitor. Antenatal and postnatal appointments were available at the practice every week.

• A monthly multi-disciplinary team meeting was held which included the midwife and health visitor. The child protection register and non-attendance for immunisations and checks were reviewed at this meeting.

• A full range of family planning and sexual health services were available.

Updated 12 April 2017

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

• The practice was part of the Risk Identification and Care Planning enhanced service which identified care co-ordinators and developed care plans for the most vulnerable 2% of the practice patients. These patients had an alert placed on their patient records to ensure clinical staff were aware.

• The practice worked closely with the Clinical Commissioning Group (CCG) Proactive Care Team to provide integrated care for patients within the community.

• Dedicated appointments were available to allow carers flexibility to bring in patients after working hours.

• Older patients were given personalised care which reflected their needs.

• Over the last 12 months all patients aged 75 and over had been invited for a health check. This included blood tests, fracture assessment, frailty assessment, and checks for depression and dementia. From those checks, the practice identified patients who needed further investigation and referred them appropriately.

• Home visits were offered to patients who could not reach the practice.

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

Updated 12 April 2017

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

• The practice ensured it provided services to meet the needs of the working age population. Appointments and a walk in service were available from 8am until 8pm for seven days every week.

• The practice sent appointment reminders by text, with the facility to cancel an appointment no longer required by return text.

• On-line access was available for booking appointments and ordering repeat prescriptions.

• Telephone consultations were available for patients who were unable to reach the practice during the day.

• Regular reviews of the appointment system were held to ensure patients could access the service when they needed to. This had recently resulted in additional telephone appointments being made available.

• A full range of services appropriate to this age group was offered, including travel vaccinations and smoking cessation.

Updated 12 April 2017

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

• 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 Clinical Commissioning Group (CCG) average of 88% and the national average of 84%.
• The practice had a register of patients with poor mental health to enable their health to be effectively monitored and managed.
• The practice worked with multi-disciplinary teams to provide appropriate care for patients with poor mental health. This included patients with dementia.
• Patients were signposted to appropriate local and national support groups.
• Staff demonstrated a good working knowledge of how to support patients with mental health needs and dementia.

Updated 12 April 2017

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

• The practice proactively identified patients who were carers and subsequently provided them with high levels of support.There were approximately 500 patients who were registered as carers (11% of the patient list). The practice held a monthly carers forum and coffee morning. Dedicated appointments were also available to allow carers flexibility to bring in patients after working hours.

• The practice had a register of patients who were vulnerable to enable their health to be effectively monitored and managed. This included patients with a learning disability.

• The practice supported vulnerable patients to access various support groups and voluntary organisations.

• Longer appointments were available for patients with a learning disability.

• The practice worked with other health care professionals to provide care to vulnerable patients, for example, the district nursing team and community matron. Vulnerable and complex patients were discussed at the monthly multi-disciplinary team meeting.

• Staff could recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities to share appropriate information, record safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.