Enki Medical Practice

Updated 15 November 2017

Enki Medical Practice provides NHS services to the local community in Handsworth, Lozells and Aston, West Midlands. The practice is situated in a multipurpose modern built building shared with other health care providers. Enki Medical Practice is part of Modality Partnership, an organisation operating across 27 different locations in Sandwell, Birmingham, Walsall, Hull and Wokingham providing NHS services to more than 90,000 patients. The practice is accessible by public transport and has a large car park including nine disabled parking spaces.

The practice has an approximate patient population of 7540 and is part of the NHS Sandwell and West Birmingham 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.

Enki Medical Practice is registered with the Care Quality Commission to provide primary medical services to patients under a Personal Medical Services (PMS) contract with the Clinical Commissioning Group (CCG). PMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The practice also provides enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The practice is based in an area of high social and economic deprivation of mixed ethnicity groups, with over 15 different languages spoken. Based on data available from Public Health England, the levels of deprivation in the area served by the practice are ranked as one out of ten, with one being the most deprived and ten being the least deprived. Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial.

The practice serves a higher than average male patient population aged between 25 and 49, and has a below average practice population aged 60 and over.

The practice’s clinical staff consists of two partner GPs and four salaried GPs. There are male and female GPs available. There are two advanced nurse practitioners, two practice nurses and two fulltime healthcare assistants.

The practice’s non-clinical staff consists of one fulltime practice operations manager, one fulltime reception manager and six reception staff.

The practice also employs a pharmacist and a musculoskeletal specialist.

They are a training practice for trainee GPs.

The practice is open between 8am and 6.30pm on Monday, Tuesday, Wednesday and Friday and 8am to 8pm on Thursdays. Appointments are from 8.30am to 12.30pm, 2pm to 6pm on Monday, Tuesday, Wednesday and Friday and 8.30am to 12.30pm, 2pm to 7.45pm on Thursday. Appointments with the healthcare assistant are available 8am to 4pm daily and with the advanced nurse practitioner 8.30 to 6.30pm daily. The practice offers pre bookable face-to-face GP appointments on most Saturday and Sunday mornings 9.30am to 12.30pm.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by the external out of hours service provider. 

Updated 15 November 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Enki Medical Practice on 11 February 2016. The overall rating for the practice was requires improvement with requires improvement ratings in safe and well-led services. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Enki Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection carried out on 25 October 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 11 February 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection. Overall, the practice is now 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.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments 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 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 had tailored their services to meet the needs of its patient population.
• The practice had 140 substance misuse patients on their register, staff we spoke with were passionate about caring for this patient group.

The areas where the provider should make improvement are:

• Consider how patients are informed regarding the availability of weekend appointments.

• Ensure that lines of accountability are clear to ensure that policies are well governed and fully embedded at the practice.

• Consider formalising the clinical supervision arrangements for the nursing team.

• Continue to explore and work on ways to improve telephone access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management.

• Data from 2016 to 2017 showed 83% of patients with diabetes, on the register, had a blood sugar reading that showed their condition was being adequately controlled. This was similar to the CCG and national average of 79%.

• 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.

• The practice had dedicated teams to aid continuity of care including a named GP for these patients and 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Patients with a long term condition were also sign posted to smoking cessation, health trainers, alcohol and drug services and route 2 wellbeing services.

• The practice maintained a Palliative Care register, which helped identify the more seriously ill patients. All seriously ill patients were discussed amongst the clinicians on a regular basis including daily team meetings once the morning appointments had finished .

• The practice offered access to Cardiology, Rheumatology, Dermatology and Gynaecology services at the practice or at other local practices within the wider organisation.

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of families, children and young people.

• 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 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 worked with health visitors and school nurses to support this population group. For example, in the provision of child health surveillance clinics.

• The practice had good baby changing and breast feeding facilities.

• Unverified data from the practice showed the practice’s uptake for the cervical screening programme was 84%.

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of older people.

• All older patients had a named GP.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice worked with an outside support organisation to help patients with various issues such as improving mobility in and around the home.

• Where older patients had complex needs, including those at risk of falls, the practice discussed patients in multidisciplinary meetings.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

• The practice provided ECGs and 24 hour blood pressure monitoring at the practice, this meant patients did not need to go to the hospital for these services.

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now 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, extended opening hours on a Thursday and Saturday and Sunday appointments most weekends.

• The practice also offered telephone consultations for those patients unable to come into the practice for an appointment because of work commitments.

• Patients were able to book appointments in advance online with a clinician of their choice.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of people experiencing poor mental health (including people with dementia).

• Data for 2016 to 2017 showed 75% of patients diagnosed with dementia, had their care reviewed in a face to face meeting in the last 12 months.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• Data for 2016 to 2017 showed 90% of patients registered with the practice, who are diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate.

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

• Patients at risk of dementia were actively identified and offered assessments.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

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

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of people who circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability or mental health condition.

• End of life care was delivered in a coordinated way, which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments and annual reviews for its vulnerable patients.

• 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 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.

• The practice had 140 substance misuse patients on their register. They worked closely with three drug workers through a shared care agreement to provide services for these patients.

• The practice also registered patients who had previously been removed from other practices’ lists; this service was part of the practice’s Zero Tolerance service

• The practice was a Safe Place site for anyone who was in need of assistance. For example Dementia patients or patients suffering domestic violence.