Haden Vale Medical Practice

Updated 7 July 2016

Haden Vale Medical Practice provides medical services to approximately 5600 patients in the local community of various ages. There are two GP partners (one male and one female) and two salaried GPs (one male and one female). The practice is based in the Cradley Heath area of the West Midlands.

The GPs are supported by a practice nurse who had started three weeks prior to our inspection visit. The practice had advertised to recruit a healthcare assistant (HCA) as the Clinical Commissioning Group (CCG) funded HCA had left in February 2016. The non-clinical team consists of a team of administrative and reception staff and a practice manager. The practice also had medical students from the local university.

Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contracted obligations to provide 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 open between 8am and 6.30pm Mondays to Fridays and extended hours appointment is offered from 6.30am to 8pm on Tuesdays. The practice has opted out of providing out-of-hours services to their own patients. This service is provided by ‘Primecare’ the external out of hours service provider.

We reviewed the most recent data available to us from Public Health England which showed that the practice is located in an area with a higher deprivation score compared to other practices nationally. Data showed that the practice has a lower than average practice population aged 50 years and over in comparison to other practices nationally. The practice also has a slightly higher than the national average number of patients aged between 0 to 15 and 25 to 50.

The practice achieved 85% points for the Quality and Outcomes Framework (QOF) for the financial year 2014-2015. This was below the local average of 93% and national average of 95%. The QOF is a voluntary 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 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Haden Vale Medical Practice on 28 April 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events. However, learning was not always shared with all staff members.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Most patients 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 staff and patients, which it acted on.

We saw one area of outstanding practice:

The practice employed an ‘elderly social care co-ordinator’ who organised coffee mornings every two weeks and trips away. We saw that a group of patients had gone away during Christmas and another residential event was planned for the summer. The elderly care co-ordinator also acted as an advocate to access other social services and visited patients in their homes. Some patients told us that the social events and coffee mornings helped them deal with bereavement and other issues they had experienced. They told us that the activities of the care co-ordinator had made a positive impact on their physical and mental wellbeing as they could access peers for support through the activities organised.

The areas where the provider should make improvement are:

• Ensure learning from all incidents, significant events and complaints are shared appropriately with staff to prevent re-occurrence

• Ensure emergency equipment is being checked regularly to confirm they are in working order.

• Ensure practice performance for diabetes and mental health related indicators are improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 July 2016

The practice is rated as requires improvement for the care of people with long-term conditions. The practice had recently employed a nurse and they had a lead role in chronic disease management such as diabetes and COPD. We saw that achievement for diabetes and COPD indicators were significantly lower compared to local and national averages. The GPs carried out reviews for diabetes and COPD before the nurse started. We were told that although reviews were being carried out they were not always recorded and were not as structured.

Longer appointments for conditions such as diabetes were available and home visits were available when needed. 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.

Updated 7 July 2016

The practice is rated as 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. The practice offered a full family planning service and offered coil and implants service. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw positive examples of joint working with midwives and health visitors.

Updated 7 July 2016

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 and had a range of enhanced services, for example 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 employed an elderly care co-ordinator who also visited patients in their homes and acted as an advocate to access other social services. They organised coffee mornings every two weeks for the elderly and their carers. Records we looked at showed that it was well attended with 20 or more people attending. The coffee morning was subsidised by the practice. The elderly care co-ordinator also organised other social events. For example, during Christmas a group of patients had gone to Devon for four days and this was organised by the care co-ordinator.

The practice had effective systems in place to identify and assess patients who were at high risk of admission to hospital. These patients were reviewed and care plans developed to reduce the need for them to go into hospital.

Updated 7 July 2016

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. For example, the practice operated extended hours service which was useful for parents with children and those who worked. 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 7 July 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multidisciplinary teams in the case management of people 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. Information was made available at the practice to sign post patients to various support groups and services. This was also available on the practice website. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Data we looked at showed that the practice achievement for mental health QOF indicator was significantly lower. We were told that the practice found it difficult to engage some patients and the practice did not have a nurse for a significant period which also contributed to this.

Updated 7 July 2016

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 including those with a learning disability. The practice offered longer appointments for patients with a learning disability.

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 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.