Archived: Ley Hill Surgery

Updated 6 August 2015

Ley Hill Surgery is based in a two storey building that has undergone extension and has a registered patient list size of approximately 12000 patients.

The practice is a training practice for GP Registrars (fully qualified doctors who wish to become general practitioners) and a teaching practice for medical students in both foundation and final year of training.

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. Enhanced services require an enhanced level of service provision above what is normally required under the core GP contract.

The practice is open Mondays to Fridays 8am to 6:30pm and includes an extended hours service two days a week when the practice is open between 6:30pm and 8.15pm which would benefit working age patients. The practice has opted out of providing out-of-hours services to their own patients. This service is provided by ‘Badger’ the external out of hours service.

There are eight GPs working at the practice which includes one salaried GP and seven GP partners and also includes a number of male and female GPs. The practice employs four practice nurses and a health care assistant all of whom are female. There are also eight administrative staff, 13 reception staff an assistant practice manager and a practice manager. At the time of the inspection two of the partners were new to the practice and had not registered with the Care Quality Commission (CQC). We discussed this with the lead GP and the practice manager who assured us this would be completed.

We reviewed the most recent data available to us from Public Health England which showed that the practice is located in one of the least deprived areas in Birmingham. The practice has a higher than national average practice population aged 0 to 4 years and 65 years and over, and a slightly higher than national average practice population with caring responsibilities. The practice achieved 98.2 % of points for the Quality and Outcomes Framework (QOF) for the last financial year 2013-2014. This was above the average practice score nationally. The QOF is the annual reward and incentive programme which awards practices achievement points for managing some of the most common chronic diseases, for example asthma and diabetes.

Updated 6 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ley Hill Surgery on 18 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, and well-led services. We found the practice to be outstanding for providing responsive services. We also inspected the quality of care for six population groups these are, people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health. We rated the care provided to these population groups as good.

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

• There were systems in place to ensure patients received a safe service. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, reviewed and addressed. Risks to patients were assessed and well managed, with the exception of those relating to recruitment procedures which should be improved.

• There were effective arrangements in place to identify, review and monitor patients with long term conditions. Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. The practice demonstrated a caring and compassionate approach to end of life care and bereavement support.

• The practice was responsive to the needs of the practice population. The practice proactively engaged with patients in the local community and had initiated positive service improvements for its patients that were above its contractual obligations.

• There was strong and visible clinical leadership with defined roles and responsibilities and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice including:

• The practice demonstrated a caring and compassionate approach to end of life care and bereavement support. The practice had developed a ‘Bereavement Protocol’ this enabled the practice to take extra steps to communicate bereavements across departments, services and wider organisations and reduced the risk of inappropriate communications being sent avoiding unnecessary distress to family members and carers. The practice undertook reflection of the end of life care provided to patients and learning was shared with other practices. An audit was completed to ensure patients records clearly recorded their end of life wishes such as where the person would prefer to die.

• There was evidence that the practice was innovative and took a lead role in developing and improving primary care services for the local population. This included an innovative project to reduce unplanned hospital admissions in the elderly as part of the Clinical Commissioning Groups (CCG) ‘Aspiring to Clinical Excellence (ACE) Pioneers’ programme. The aim was to integrate general practice, community care with hospital care.

• The practice offered a range of in house services such as anti-coagulation services, physiotherapy and a cardiology outreach clinic. This enabled patients to be assessed and reviewed locally without the need to travel to the hospital. One patient commented on how effective this had been for their family member as the nearest hospital was some distance from their home.

• The practice had started a new system where the purpose of a medication was specified on the prescription to ensure patients were given all the relevant information they required.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Develop a system to ensure a clear audit trail for stock medicines in use.

• Ensure outstanding actions from completed infection prevention and control audits are acted on.

• Ensure robust recruitment procedures that demonstrate checks required by current legislation have been completed.

• Update the fire risk assessment and ensure risks associated with the general environment such as the control of substances hazardous to health (COSHH) are assessed and managed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 August 2015

The practice is rated good for the care of people 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. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health care professionals to deliver a multidisciplinary package of care. The practice undertook prevalence searches which enabled them to identify patients with long term conditions and those in high risk groups. This ensured they were added to the appropriate registers and could be easily identified and offered regular reviews of their health needs.

Updated 6 August 2015

The practice is rated good for the care of families, children and young people. There were systems in place 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours .There was evidence of joint working arrangements with the midwives and health visitors and systems in place for information sharing.

Updated 6 August 2015

The practice is rated good for the care of older people. The practice had a higher older practice population aged 65 years and over in comparison to the national average. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice worked in conjunction with the multidisciplinary team to identify and support older patients who were at high risk of hospital admissions.

Updated 6 August 2015

The practice is rated 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 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. T he practice was open extended hours to accommodate the needs of working age patients.

Updated 6 August 2015

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). Patients experiencing poor mental health had received an annual physical health check. It carried out advance care planning for patients with dementia. Staff worked closely with local community mental health teams to ensure patients with a mental health need were reviewed, and that appropriate risk assessments and care plans were in place. The practice hosted Birmingham Healthy Minds which was a mental health service to help facilitate access to psychological support, and there were weekly visits from a service that supported people who had alcohol dependency. Two of the GPs were Royal College of General Practitioners (RCGP) trained drug misuse prescribers and worked in conjunction with a drug support worker (in the practice).

The practice undertook a dementia coding exercise which identified 198 patients who were not on the dementia register. The notes of these patients were reviewed by doctors in the practice and resulted in action being taken to ensure patients needs were assessed appropriately. The practice sign posted patients experiencing poor mental health to various support groups and voluntary organisations.

Updated 6 August 2015

The practice is rated good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those with a learning disability and those with caring responsibilities. It had carried out annual health checks for people with a learning disability and offered longer appointments .The practice regularly worked with multidisciplinary teams in the case management of vulnerable patients. Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of contacting relevant agencies in normal working hours and out of hours.

The practice provided an enhanced service to avoid unplanned hospital admissions. This service focused on coordinated care for the most vulnerable patients and included emergency health care plans. The aim was to avoid admission to hospital by managing their health needs at home. An enhanced service is a service that is provided above the standard general medical services contract (GMS).