Archived: Reservoir Road Surgery

Updated 25 October 2017

Reservoir Road Surgery is located in Erdington, Birmingham. The practice is situated in Stockland Green Primary Care Centre which is a multipurpose modern built building shared with other health care providers, providing NHS services to the local community.

Based on data available from Public Health England, the levels of deprivation in the area served by Reservoir Road Surgery are below the national average, ranked at one out of 10, with 10 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 patient population aged between zero to nine and 25 to 39. Patients aged between 60 to 85 plus is below local and national average. Based on data available from Public Health England, the Ethnicity estimate is 6% Mixed, 16% Asian and 14% Black.

The patient list is 12,250 of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery 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.

On-site parking is available with designated parking for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair and push chairs.

The practice staffing comprises of three GP partners (all male), five salaried GPs, a nurse practitioner, four practice nurses and two health care assistants. Management and reception team consists of one practice manager, a deputy and an assistant manager who are supported by a head receptionist and a team of administrators, secretaries and receptionists. The practice is also an approved training practice providing training to medical students. There was one male GP registrar (GPs on a registration course).

The practice is open between 8.30am and 6.30pm Mondays, Wednesdays, Thursdays and Fridays. Tuesday opening times are between 8.30am and 8pm. The practice is also open on Saturdays between 8.30am and 11.45am.

Morning GP consulting hours are from 9am to 11.30am and evening consulting hours are from 4pm to 5.45pm Mondays to Fridays. Extended consulting hours are provided on Tuesdays from 6.30pm to 7.40pm and Saturdays from 9am to 11am. The practice has opted out of providing cover to patients in their out of hours period. During this time, services are provided by Birmingham and District General Practitioner Emergency Rooms (BADGER) medical services.

The practice was previously inspected by CQC on the 15 June 2016 where we rated the practice overall as requires improvement. As a result of our findings we served Reservoir Road Surgery with requirement notices which required the practice to provide a report saying what actions they were going to take to meet the legal requirements. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Updated 25 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Reservoir Road Surgery on 15 June 2016. The overall rating for the practice was requires improvement. This was because arrangements for preventing the spread of infection, systems for monitoring and improving the quality of service including patient outcomes required improvement. Governance arrangements including systems for assessing and monitoring risks also required improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Reservoir Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 5 September 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 during our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall, the practice is rated as good.

Our key findings were as follows:

• A system was in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns and report incidents. However, records we viewed during our inspection showed limited evidence of communication with complainants and shared learning following safety incidents.

• The practice had clearly defined and embedded systems to minimise risks to patient safety. For example, effective systems were in place for receiving and acting on national alerts from the Medical and Healthcare products Regulatory Agency (MHRA).

• Staff were aware of current evidence based guidance. Staff received training in most areas to provide them with the skills and knowledge to deliver effective care and treatment.
• Data from the 2015/16 Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.

• The practice carried out a number of quality improvement activities to monitor performance such as clinical audits. These demonstrated areas of improvement in the delivery of the service

• Results from the July 2017 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. We saw examples where improvements were made to the quality of care as a result of complaints and concerns. However, staff were not able to demonstrate that all complaints were followed up with an acknowledgment or finalisation letter.
• Feedback from patients received through the completed Care Quality Commission comment cards and from members of the Patient Participation Group showed that patients 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.
• The practice had a clear vision and strategy which had been produced with the involvement of practice staff and was regularly reviewed and discussed during meetings.
• The practice had visible clinical and managerial leadership and governance arrangements. However, oversight of some governance arrangements such as management of complaints, significant events and monitoring of training needs was not effective.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that persons employed in the provision of a regulated activity receive appropriate training and professional development as necessary to enable them to effectively carry out the duties they were employed to perform.

In addition the provider should:

• Ensure effective recording of learning outcomes to ensure opportunities to learn from incidents are maximised.

• Ensure systems and processes are established and operated effectively.

• Continue to encourage patients to attend national screening programmes such as breast cancer screening.

• Continue exploring and establishing effective methods to identify carers in order to provide further support where needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 October 2017

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients diagnosed with diabetes who had a blood pressure reading within recommended range in the last 12 months (2015/16) was 55%, compared to CCG average of 76% and national average of 78%. Unverified data provided by the practice for 2016/17showed performance had improved to 88%.

• 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.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• The practice offered in house spirometry and managed all respiratory conditions. Discharge reviews were carried out following a respiratory admission.

• All these patients had a named GP 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.

• The practice offered weekly diabetes clinics and a specialist diabetic nurse visited the practice monthly to review insulin initiation. Patients had access to ears, nose and throat clinics as well as minor ops procedures at the practice.

Updated 25 October 2017

• 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 comparable to local and national averages for all standard childhood immunisations.

• Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

• Staff actively promoted the Pharmacy First Minor Ailment scheme to help improve access to health services to patients.

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

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of antenatal, post-natal and child health surveillance clinics.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 25 October 2017

• Staff we spoke with 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. Members of the nursing team carried out frailty and falls assessments as well as dementia reviews.

• The practice was responsive to the needs of older patients; for example, staff visited local nursing/residential homes, offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. Clinicians involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• The practice provided health promotion advice and literature which sign-posted patients to local community groups and charities such as Age UK.

Updated 25 October 2017

• 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. For example, online appointment booking as well as online repeat prescription requests.

• The practice encouraged the use of Electronic Transfer of Prescriptions.

• The practice offered the meningitis vaccine for 18 year olds and students going to university.

• Patients were signposted to external service for smoking cessation, mental health issues, alcohol advice/support and healthy eating.

• The practice’s uptake for the cervical screening programme was below local and national averages. For example, the practice had achieved 67%, compared to CCG average of 79% and the national average of 81%. However, 2016/17 unverified data showed the practice were now comparable to the local CCG average with a 76% uptake rate.

• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.

Updated 25 October 2017

• The practice carried out advance care planning for patients living with dementia. Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia.

• 86% of patients diagnosed with dementia had their care reviewed in the preceding 12 months, compared to CCG and national average of 84%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. Clear referral pathways to community psychiatric nurses had been established.

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

• The percentage of patients diagnosed with a mental health related disorder who had a care plan in place had increased since our last inspection. For example, 2015/16 data showed 28% had an agreed care plan documented in the record, in the preceding 12 months. 2016/17 unverified data provided by the practice showed performance had increased to 81%, compared to CCG average of 88% and national average of 89%.

• 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 identified and offered an assessment.

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

• The practice had a system for following up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 25 October 2017

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• 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 for patients with a learning disability.

• 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 a number of 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 held a carers list. Carers had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Data provided by the practice showed the practice had identified 134 patients as carers (approximately 1% of the practice list).