Drs Oram, Walton, Hynes & Dutton

Updated 8 March 2018

Drs Oram, Walton, Hynes and Dutton is located in Horseley Heath, Tipton in the centre of a busy residential area. The large health centre is owned and managed by the partners. There is easy access to the building and facilities are provided for patients with a disability. There is no onsite car park serving except for on the main road. There are approximately 11,400 patients of various ages registered and cared for across the practices and as the practice has one patient list, patients can be seen by staff at both surgery sites. The second practice is Tandon Medical Centre, Kent Street, Dudley. Systems and processes are shared across both sites. During the inspection we visited both locations. As the locations have separate CQC registrations we have produced two reports. However where systems and data reflect both practices the reports will contain the same information.

The practice team consists of eight GPs, three of the GPs are partners (two male and one female) and five salaried GPs, (three female and male). One of the salaried GP is currently on maternity leave. The practice team also includes two nurse practitioners and three practice nurses (all female) and one health care assistant (HCA). There is a practice manager, an assistant practice manager and a team of administrative staff.

This practice has been accredited as a GP training practice since 1996. It has qualified doctors attached to it who are training to specialise in general practice. It has provided placements for medical students since 2008. Currently there are two GP Registrars attached to the practice (both male).

The practice holds a Personal Medical Services (PMS) contract with NHS England. The practice is part of Sandwell and West Birmingham Clinical Commissioning Group (CCG).

The practice is open between 8am and 7pm Mondays to Fridays. Appointments are available from 8.30am to 12pm and 3.30pm to 7pm on Mondays, 9am to 12pm and 3.30pm to 7pm on Tuesdays to Thursdays. On Fridays appointments are available from 8.15am to 12pm and 3.30pm to 7pm. In addition there are pre-bookable appointments that could be booked up to three weeks in advance and urgent appointments are available for people that needed them.

Patients requiring a GP outside of normal working hours are covered by a rota of GPs from the practice. Between 7pm and 8am patients are advised to call the 111 service. The majority of patients are of white British ethnicity with a number of East European and people from the Indian subcontinent. There are a proportionately high number of elderly patients and high prevalence of patients with a chronic disease. Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten, with level one representing the highest level of deprivation.

Updated 8 March 2018

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Drs Oram, Walton, Hynes & Dutton on 4 October 2016. The overall rating for the practice was Good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Drs Oram, Walton, Hynes & Dutton on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 February 2018 to confirm that 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 4 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had updated its emergency drugs policy which now specifically stated that a medicine which may be required following coil fitting was to be stocked. We saw the practice had stock of emergency medicines appropriate to the practice.

• The practice had reviewed its policy for processing blood test results. The policy stated that all incoming test results were to be processed within 48 hours. The practice had carried out regular audits to ensure they were adhering to this standard.

• The practice had re-designed its minor surgery consent form which included advice leaflets for specific procedures advising patients of the process and the risks. Records we looked at showed that comprehensive assessment of patients pre-operatively and consent was in place on the three cases sampled. There was comprehensive clinical records and appropriate referral of samples for analysis.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 March 2017

The practice is rated as 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. This included diabetes, asthma and chronic obstructive pulmonary disease (COPD). A diabetes specialist nurse and a hospital consultant held a bimonthly diabetes clinic at the practice.

• Performance for diabetes related indicators was better than the national average for example the percentage of patients on the diabetes register with a record of foot examination and risk classification within the period April 2014 to March 2015 was 91% compared to the CCG average of 87% and national average of 88% .

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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 employed a health care assistant (HCA) who liaised with other health care professionals and care was delivered in patient’s homes for those who could not attend the surgery, for example those with mobility problems.

Updated 30 March 2017

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 high for all standard childhood immunisations with the practice achieving up to 97.5% uptake in 2014/15 across all age groups. Practice nurses undertook weekly childhood immunisation clinics at each location.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• 78% of women aged between 25-64 had received a cervical screening test. This was similar to the CCG average of 80% and a national average of 82%.

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

• This population group had been specifically targeted by creating and uploading a 24/7 advice clip onto the practice website entitled “When should I worry” providing parents with advice about how to identify symptoms of serious illness.

• We saw positive examples of joint working with midwives, health visitors and school nurses such as monthly antenatal sessions provided by the midwife for delivering prenatal care and advice.

• The practice provided family planning clinics including the insertion of coils.

• The practice worked closely with the ‘emotional wellbeing team’ which promotedemotional health for women during and after child birth. The practice had been involved in developing the service locally.

Updated 30 March 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice population included 7% of patients over the age of 75 years.They invited these patients for annual health checks and all had a named GP.

• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated

Multidisciplinary meetings were held twice each month and included discussions about patients who were at high risk of falls. 

Updated 30 March 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 was proactive in offering online services such as appointment booking and ordering of prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.

• Extended hours were provided between 6.30-7pm Monday to Fridays which would benefit patients who were working. Morning and evening telephone consultations were available daily.

• The practice actively worked with ‘my-time active’ this service provided health trainers to both practices to undertake the NHS health check for patients.aged 40-74 years.

• There was early morning in-house phlebotomy (the taking of blood) service provided by the HCA.

• Patients could choose which practice they were seen at for their physiotherapy appointment.

• To manage demand, when capacity was full at one site, staff were currently looking at cross site appointments. Patients who were able to travel could then see their own GP at the other site which would enhance continuity of care.

Updated 30 March 2017

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

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  95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months, which was higher than the national average of 86%.

• 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months, which was higher than the national average of 90%.

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• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• One of the GPs had a special interest in mental health, had been the CCG lead for mental health in the past and taught on the Diploma in Primary Care Mental Health one day per week. He was the lead GP in setting up the local ESTEEM team to whom the locality referred patients with complex mental health needs. A variety of services were offered such as cognitive behavioural therapy (CBT), computerised CBT, hypnosis CD’s, art therapy, group and one to one counselling.As part of this service the practice had attached in-house counsellors .Patients could be seen in their own community for all of these services rather than engaging with hospital services.

• The practice served a 140 bed nursing home including a unit for the elderly mentally illpredominantly looking after patients suffering from dementia.One of the GPs provided two full ward rounds per week to this nursing home including 26 intermediate care beds for patients on step down care.The case management register covered a high percentage of these patients to enable review of unplanned admissions and A&E attendance.These ward rounds included quarterly medication reviews.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia andcarried out advance care planning for patients with dementia

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

Updated 30 March 2017

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 homeless people, travellers and 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. Discussions about vulnerable adults and children were a standing item agenda in the monthly practice meetings.

• A ‘route2wellbing’ (care navigation resource) was available on the practice website..