Archived: OHP-Falcon Medical Centre

Updated 20 December 2017

OHP-Falcon Medical Centre is a member of the provider organisation Our Health Partnership, a partnership of approximately 40 practices and 340,000 patients across the West Midlands area. Our Health partnership aims to support the member practices in meeting the changing demands of primary care. The practice also sits within 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.

The practice is currently managed on a day to day basis by OHP-Ley Hill Surgery. Ley Hill Surgery originally provided care taking arrangements when the previous provider of Falcon Medical Centre left. Under the previous provider the practice had been rated as inadequate by CQC. This report was published in April 2016. Ley Hill Surgery formally took over responsibility for Falcon Medical Centre in January 2017 and now shares the same practice code as Ley Hill Surgery in which nationally reported data such as the quality and outcomes framework (QOF) are jointly reported.

The practice is also currently undergoing a merger with five other practices within the Sutton Coldfield area to form one practice (The Sutton Coldfield Group Practice) consisting of approximately 52,000 patients.

OHP-Falcon Medical Centre is located in purpose built premises. Falcon Medical Centre is located in a deprived area within the predominantly affluent Sutton Coldfield area of the West Midlands. It is the only area within Sutton Coldfield that is within the 20% most deprived areas nationally. The practice has a registered list size of approximately 2100 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.

Most of the practice staff including all clinical staff are shared across Falcon Medical Centre and Ley Hill Surgery. Currently practice staffing consists of five GPs (three male and two female) who in total provide one whole time equivalent GP for the practice (10 sessions). Two of the GPs cover 60% of all the sessions at the practice. Nursing cover is provided by five nurses (including two nurse prescribers) and a health care assistant. There is a practice manager (who covers both practice sites) and a team of three administrative/reception staff.

The practice is open Monday to Friday between 8.15am and 12.15pm and between 4pm to 6pm except on a Wednesday afternoon when the practice is closed. When the practice is closed between 8am to 8.15am, 12.15pm and 4pm and 6pm to 6.30pm cover is provided by another provider ‘Primecare’. During the out of hours period (6.30pm to 8am) cover is provided by ‘Birmingham and District General Practitioner Emergency Room (BADGER) group’. Extended opening hours are available on two evenings each week at the OHP- Ley Hill Surgery, patients at Falcon Medical Practice are able to use this service.

Updated 20 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at OHP-Falcon Medical Centre on 16 October 2017. Ley Hill Surgery took on caretaking arrangements for Falcon Medical Centre from October 2016 until January 2017 and was awarded the General Medical Services (GMS) contract in January 2017. Ley Hill Surgery became the registered provider with CQC in June 2017. In September 2017 both practices became registered with CQC under the provider organisation Our Health Partnership.

We first inspected the practice under the previous provider registration in January 2016, the practice was rated inadequate and placed into special measures.

We then carried out this inspection under the new provider registration on the 16 October 2017. Overall the practice is now rated as good.

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

• When Ley Hill Surgery first took over Falcon Medical Centre they were faced with a number of significant challenges which included the quality of patient records and care, repeat prescribing and the premises which they have successfully sought to address.
• We saw evidence of strong leadership at Falcon Medical Centre. Staff had identified the needs of the practice population and had sought to ensure the service reflected those needs to improve outcomes for patients. Links were also being established within the local community to help address health inequalities.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. These had led to various audits to ensure patients were receiving care in line with evidence based guidance.
• The practice had established clearly defined systems to minimise risks to patient safety. Improvements in areas such as the premises, infection control, patient records, prescribing and follow up of patients with long term conditions were seen.
• The practice was proactive in working with other health and social care professionals to safeguard some of the practices most vulnerable patients. A successful scheme to support patients at risk of unplanned admissions and to support early discharge was adopted by the practice. Community Matrons employed by a group of local practices facilitated safe support within the patient’s home.
• Results from the national GP patient survey (published in July 2017) found patient satisfaction scores were lower than local and national averages in many areas. This was in contrast with feedback we received as part of the inspection which showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. The data related to a period prior to the current registration. In response to the survey the practice had carried out a comparative in-house survey which showed consistently positive scores in relation to consultations and access.
• Information about services and how to complain was available. Only one formal written complaint had been received in the last 12 months.
• Patients we spoke with said they found it easy to make an appointment with urgent appointments available the same day.
• Staff identified a charity that maintained a list of vulnerable patients in the area and established links so that the charity could share with them any concerns in the future about patients who might need support.

The areas where the provider should make improvement are:

• To provide greater support for patients on the learning disability register.
• To identify systems for recording fire drills and any actions arising from them.
• To review information relating to access on the practice website and amend as appropriate.
• To improve patient involvement in supporting service improvement.
• To improve the number of identified carers so that they may be supported.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 December 2017

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

• 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.
• Patient’s outcomes as measured through the Quality Outcomes Framework (QOF) were in in line with CCG and national averages. Data for 2016/17 showed the practice had achieved a QOF score of 97%.
• Since the practice transferred to a new provider QOF scores for diabetes indicators so far for 2017/18 had reached 81%.
• Quality of patient records and coding at the practice had been a major concern when the practice was taken over. Clinical staff had been working to improve the quality of patient records in order to improve the accuracy of information and ensure patients with long term conditions were identified and received appropriate follow up.

Updated 20 December 2017

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

• From documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk. The practice met with the health visitor on a monthly basis.
• Practice staff told us that they had high numbers of non-attendances of children at hospital and would routinely follow these up.
• Immunisation rates were relatively high for standard childhood immunisations with the exception of Meningitis C.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. Practice staff told us that patients under 16 would be seen even if appointments were no longer available.
• Appointments were available outside of school hours with a GP and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group and we saw examples of those. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice was currently liaising with the local secondary school to support with education on sexual health and childhood obesity.

Updated 20 December 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. In conjunction with other practices within the Sutton Coldfield Group Practice, two community matrons had been employed to focus on admissions and discharges in the over 70 year olds. This had led to reductions in admissions, hospital bed days and reduced costs with appropriate support given to patients to keep them safe at home.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Practice staff were currently undertaking the gold standard framework accreditation training to help improve end of life care needs for earlier identification of patients.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. Patients could access an Age Concern Wellbeing Co-ordinator to provide social and other support where needed.
• The practice had built links and received positive feedback from a local care home in which they provided support to patients.
• The practice was proactively working to improve the standard of end of life care through accredited training.

Updated 20 December 2017

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

• The needs of working age people had been identified and the practice was working to develop services that were accessible, flexible and offered continuity of care for this group of patients. Although the practice did not directly offer extended opening hours patients were able to access extended hours appointments in the evenings at Ley Hill Surgery.
• Due to recent change in the practice IT system online services for booking appointments and repeat prescriptions had only recently become available.
• Uptake of national cancer screening programmes was in line with local averages but slightly below national averages.
• The practice offered an electronic prescription service which enabled prescriptions to be sent electronically from the GP practice to a patients chosen pharmacy for patient convenience.
• The practice had improved and expanded the provision of sexual health and contraceptive services to this group of patients.

Updated 20 December 2017

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

• Unpublished QOF data from the practice for the current year (2017/18) so far showed 68% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months.
• Unpublished QOF data from the practice for the current year (2017/18) so far showed the practice had achieved 69% of the total points available for indicators relating to mental health.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs and had undertaken audits to check evidence based guidelines were being followed.
• The practice had carried out home visits to patients with poor mental health whose condition made it difficult for them to visit the practice.
• The practice had organised for a mental health link worker from the charity MIND to run regular clinics at the practice. They were able to refer or signpost patients to appropriate services such as counselling or benefits advice. Over the last ten months they had been able to support approximately 40 patients.
• The practice had a GP who was a trained Substance Misuse prescriber and had successfully applied to provide this service at Falcon Medical Centre.

Updated 20 December 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 and with caring responsibilities.
• The practice had established links with a local charity providing support to local people such as food and other supplies so that they could help with any medical concerns.
• We saw numerous examples of cases where information of concern from other agencies had been actively followed up by the practice to help keep vulnerable patients safe.
• Only one patient on the learning disability register had received an annual health review in the last 12 months. The practice was aware this was something they needed to do and had been focussing on other priorities such as the completeness of patient records in order to accurately identify patients.
• There were 19 patients identified on the practice’s carers register (0.9% of the practice list). Information was available to signpost these patients to various support available, they were also prioritised for flu vaccinations and health checks.
• 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 in normal working hours and out of hours.