LPS - Weatheroak Medical Practice

Updated 14 September 2017

LPS Weatheroak Medical Practice is located in Sparkhill, Birmingham, and serves patients in the B11 and B12 postcode areas of Birmingham. The practice is part of the NHS Birmingham South and Central Clinical Commissioning Group (CCG). The practice is situated in a converted residential house which is owned by the provider. The building is set over two floors with patient services provided on the ground floor. The main entrance to the practice has a ramp to support patient access.

The total practice patient population is 2,620. The practice provides GP services in an area considered as one of the more deprived within its locality. The practice has a predominantly Asian registered patient list (68%) as well as 3% mixed, 6% black, and 5% other non-white ethnic groups. The average life expectancy at the practice for males is 77 years and females 81 years, which are lower than the national life expectancy averages of 79 and 83 respectively.

The practice is open Monday to Friday from 8.30am to 6.30pm (excluding bank holidays). The practice closes between 1pm and 3pm each day. The exception is Thursdays when the practice is open from 8.30am to 1pm only. When the practice is closed telephone lines are switched to divert urgent and emergency calls to the GP out of hours service, which is provided by Badger Medical Services.

The practice provides same day appointments and pre-bookable appointments for one day in advance. Urgent appointments are also available for patients that need them.

The clinical staff team consists of full time GP lead partner (male), a part-time female salaried partner, a part-time practice nurse, and a full-time health care assistant. The clinical team is supported by a practice manager, a receptionist, a receptionist/medical secretary, two management support staff, and a cleaner.

The practice has a General Medical Services (GMS) contract with NHS England. This is a contract for the practice to deliver General Medical Services to the local community or communities. The practice provides a number of services, for example long-term condition management including asthma, diabetes and high blood pressure. The practice offers NHS health checks and smoking cessation advice and support.

We previously carried out an announced comprehensive inspection at LPS Weatheroak Medical Practice on 17 October and 1 November 2016. The practice was rated inadequate for providing safe services, for providing effective services, for providing caring services, for providing responsive services, and for being well-led. The overall rating for the practice was inadequate.

Updated 14 September 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at LPS Weatheroak Medical Practice on 17 October and 1 November 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the inspection carried out on 17 October and 1 November 2016 was published on 25 January 2017, and can be found by selecting the ‘all reports’ link for LPS Weatheroak Medical Practice on our website at www.cqc.org.uk.

On 5 July 2017 we carried out an announced, follow-up comprehensive inspection to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 October and 1 November 2016. This report covers our findings in relation to those requirements.

We found the practice had carried out detailed analysis of the previous inspection findings, and had then sought support from and involved stakeholders including the Clinical Commissioning Group (CCG) and Patient Participation Group (PPG). The practice had then made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements themselves. There was evidence of a cultural and leadership change within the practice, and we saw a positive approach to performance and improvement throughout.

Our key findings were as follows:

• People were protected by a strong, comprehensive safety system and a focus on openness, transparency and learning when things went wrong.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Arrangements for managing medicines kept patients safe.

• Staff were aware of current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment, including regular training updates.

• Patient outcomes were above local and national averages.

• The practice had appropriate arrangements to identify patients who were carers to enable them to receive care, treatment and support that meets their needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Patients’ satisfaction with how they could access care and treatment was in line with or above local and national averages.

• Information about services and how to complain was available in a range of languages. Improvements were made to the quality of care as a result of complaints, concerns and patient feedback.

• There was effective oversight, planning and responses to practice performance.

• 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.

The practice is now rated as good for providing safe services, for providing effective services, for providing caring services, for providing responsive services, and for being well-led. The overall rating for the practice is now good.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 September 2017

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

• The practice held registers of those patients with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. We saw that nursing staff utilised, reviewed and kept up to date care plans for patients with long term conditions.

• Performance for diabetes related indicators was higher overall than CCG and national averages. For example, 94% of patients with diabetes had a blood pressure reading at or under the recommended level, compared with CCG and national averages of 77% and 78% respectively. The practice’s exception reporting rate for this indicator for 2016/17 was less than 1%, compared with the CCG and national averages of 9%.

• The practice engaged in diabetes prevention and early intervention work.

• Longer appointments and home visits were available when needed.

• All patients with long-term conditions had a named GP clinical lead.

• Structured annual reviews were provided to check health and medicine needs were being met.

• 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 health care assistant had a role of care co-ordinator, and was available to patients with long-term conditions to provide additional support and guidance.

Updated 14 September 2017

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

• Children and young people were seen on the same day if they needed an appointment.

• There were systems to identify and follow up children who were at risk, for example, children and young people who had a high number of Accident and Emergency (A and E) attendances.

• Immunisation rates were high for all standard childhood immunisations.

• Children and young people were treated in an age-appropriate way and were recognised as individuals. We saw evidence to confirm this including care planning.

• The practice provided sexual health advice for young people and contraceptives were available.

• Performance for cervical screening indicators was in line with CCG and national averages. For example the percentage of women aged 25-64 receiving a cervical screening test in the last five years was 82%, compared with CCG average of 80% and the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice provided combined parent and baby clinics carrying out post-natal and early child development checks.

• We saw positive examples of engagement and joint working with midwives and health visitors.

Updated 14 September 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice offered longer appointments for older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent same-day appointments when needed.

• The practice provided enhanced services for older people under a Local Improvement Scheme. This included risk profiling, care planning and over 75s health checks.

• Practice staff worked closely with other health care professionals to deliver care to older people, for example community nursing staff.

• The practice held regular multidisciplinary team meetings to discuss the needs of older patients.

• The practice directed older people to appropriate support services.

Updated 14 September 2017

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice offered extended hours appointments one day a week up to 8pm, and two days a week up to 7pm.

• 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.

Updated 14 September 2017

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

• Performance for mental health related indicators was higher overall than CCG and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan recorded in the preceding 12 months was 100% (all patients), compared with CCG and national averages of 93% and 89% respectively. The practice’s exception reporting rate for this indicator for 2016/17 was zero (no patients), compared with the CCG average of 8% and the national average of 13%.

• Patients experiencing poor mental health (including those with dementia) were placed on a register, had a care plan in place and were invited to see a GP for a comprehensive review at least once a year.

• Longer appointments were available for those patients with mental health needs or dementia.

• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, for example Birmingham Healthy Minds and a local counselling service.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 September 2017

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

• The practice held registers of patients living in vulnerable circumstances.

• We saw evidence that circumstances were considered in care planning and treatment for vulnerable patients and the practice regularly worked with other health care professionals to deliver care and treatment.

• The practice had a dedicated list of patients registered as having a learning disability and had offered health checks for all of these patients. 10 out of 13 patients had received a health check in the last 12 months. The practice used information to support care planning and offered longer appointments for patients with a learning disability.

• The practice provided help and support for patients who were carers.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff were trained and knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.

• Staff had received training in domestic violence and female genital mutilation (FGM).