Withymoor Surgery

Updated 11 May 2016

Withymoor surgery is a long established practice and is the branch practice for AW Surgeries, located in the Brierley Hill area of Dudley. There are two surgery locations that form the practice; these consist of the main practice at Albion House Surgery and a branch practice at Withymoor Surgery. There are approximately 17,810 patients of various ages registered and cared for across the practice and as the practice has one patient list, patients can be seen by staff at both surgery sites. 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.

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 clinical team includes nine GP partners, three salaried GPs, seven practice nurses and five health care assistants. There are also four trainee GPs at the practice and two apprentice health care assistants joining the team in April 2016. The GP partners and the business manager form the practice management team and they are supported by deputy practice manager and a team of 14 receptionists and 11 support staff who secretarial and administration roles. There are also a team of four employed cleaners who are supervised by a cleaning supervisor at the practice. All staff members work across both practice surgeries.

The practice is open for appointments between 8am and 6:30pm during weekdays; the practice is open later on Tuesdays and Wednesdays when extended hours are offered between 6:30pm and 8pm. There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 11 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at AW Surgeries, Withymoor Surgery on 24 March 2016. Overall the practice is rated as good.

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

• Risks to patients were assessed and well managed. Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

• The practice was proactive in identifying and managing significant events. All opportunities for learning from internal and external incidents were maximised.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment

• The practice had a regular programme of practice meetings and there was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice.

• Staff we spoke with said they felt valued, supported and that they felt involved in the practices plans. Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

• The practice offered a range of clinical services which included care for long term conditions such as diabetes, a range of health promotion and the GPs also offered minor surgery to registered patients and for patients who were locally referred from their own GP. An in-house dermatologist worked with the practice on a weekly basis to offer general dermatology services.

• The practice offered proactive care to meet the needs of its population. The practice was focusing on a proactive and preventative care method and we saw how staff had conducted a thorough analysis across long term condition registers in order to improve current systems and care for patients with comorbidities.

• The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active patient participation group which influenced practice development.

We saw some areas of outstanding practice:

• The practice had a dedicated children’s hour at 8:30am and 3:30pm for on call GPs to see children who for example, woke up unwell or were collected from school unwell. Staff explained that due to the popularity of this, appointments were increased to six morning appointments and six afternoon appointments for the GP on call to see children during this appointment window. Children under the age of five were also seen as a priority.

• Members of the management team held a number of outside posts; this was used to benefit the practice through shared learning and for leading on projects to benefit patients. For example, the practice were exploring ways of identifying vulnerable patients who may be in need of extra support, this included identifying any ex-military patients through a veterans health initiative. The veteran’s health initiative was developed by one of the practices GPs who had carried out research in to this area through their role as associate dean for the Black Country.
• An in-house dermatologist worked with the practice on a weekly basis to offer general dermatology services. Practice data demonstrated that 1754 appointments were offered to local patients and filled with the dermatologist during 2015, 308 of appointments were attended by patients of the practice. Use of this service avoided patients having to travel to other community clinics and secondary care services. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 May 2016

The practice is rated as good for the care of people with long-term conditions.

• The practice was a lead practice in the area for the local long term conditions framework, data from January 2016 highlighted that 5528 (31%) of the practices patients had a long term condition. The local long term conditions framework was developed and initiated by the local Clinical Commissioning Group (CCG) to replace the Quality and Outcomes Framework (QOF) in the future.

• The practice was focusing on a proactive and preventative care method and we saw how staff had conducted a thorough analysis across long term condition registers in order to improve current systems and care for patients with comorbidities.

• Performance for overall diabetes related indicators 100%, with an exception rate of 0%.
• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

Updated 11 May 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.

• Childhood immunisation rates for under two year olds ranged from 98% to 100% compared to the CCG averages which ranged from 40% to 100%.

• Immunisation rates for five year olds ranged from 95% to 98% compared to the CCG average of 93% to 98%.

• The practice had a dedicated children’s hour at 8:30am and 3:30pm for on call GPs to see children who for example, woke up unwell or were collected from school unwell. Staff explained that due to the popularity of this, appointments were increased to six morning appointments and six afternoon appointments for the GP on call to see children during this appointment window. Children under the age of five were also seen as a priority.
• The practice was also working with the local pharmacist to educate patients through the pharmacy first scheme; this was to help patients identify where they could seek advice from a pharmacist instead of attending an appointment with the GP for minor ailments.

Updated 11 May 2016

The practice is rated as outstanding for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people. Clinical staff carried out home visits for older patients and patients who would benefit from these.

• The practice had 1214 patients over the age of 75; this was 7% of the practices population. The practice continually monitored patients over the age of 75 with complex needs and who were most at risk of admission to hospital, these patients had advanced care plans in place.

• The practice also recognised the need to make regular contact with their patients over the age of 65 who were classed as healthy and were therefore working on making regular contact with these patients.
• There was a dedicated team in the practice who were responsible for co-ordinating care and continually monitoring the practice older population.

Updated 11 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

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

• The practice’s uptake for the cervical screening programme was 80%, compared to the national average of 81%.

• Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations with a GP at times to suit patients. The practice offered text messaging reminders for appointments to remind patients of their appointments in advance.
• The practice offered extended hours on Tuesdays and Wednesdays.

Updated 11 May 2016

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

• There were longer appointments available at flexible times for people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practices dementia register contained a total of 104 patients diagnosed with dementia. The practice had also identified that 88 of these patients had other conditions and were additionally included in the practices long term condition register.

• Data showed that diagnosis rates for patients identified with dementia were 100%, with an exception rate of 0%. Practice data highlighted that most of these patients had care plans in place and all of these patients were regularly reviewed. Clinical staff also visited all patients on the dementia register at home, in order to offer support and care at the preferred place of the patient.
• There were 141 patients on the practices mental health register. Most of these patients had care plans in place, these patients were regularly reviewed and further reviews were planned. Performance for mental health related indicators was 100%, with an exception rate of 0%.

Updated 11 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There were longer appointments available at flexible times for people with a learning disability, for carers and for patients experiencing poor mental health. Immunisations such as flu vaccines were also offered to vulnerable patients at home, who could not attend the surgery.

• There were 47 patients on the practices learning disability register, 64% of the practices patients with a learning disability had a care plan in place, these patients were also regularly reviewed. The practice was working on improving this and the team was working on alternative methods to ensure that these patients were also regularly reviewed.
• The practice had a palliative care register consisting of 173 patients in place and a register of frail patients containing 148 patients which included patients who were at risk of falls. 71% of the patients on the practices palliative care register had a care plan in place and all of them were receiving regular reviews. Most of the patients who were at risk of falls were regularly reviewed and we saw minutes of multi-disciplinary team meetings which supported this.