Rushall Medical Centre

Updated 13 April 2017

The practice is based at 107 Lichfield road, Rushall, Walsall, WS4 1HB. There is a branch site located in Pelsall which has one GP available and this increased to two GPs during busier periods. Patients can request to be seen at either site. The practice is situated in a residential area and car parking was available to the front and rear of the premises. The practice was well served by local buses. Rushall Medical Centre is a modern, purpose built building.

The practice staff includes four GP partners (three female and one male) and three salaried GPs (all female), three locums GPs (two female and one male), a registrar GP (male), a clinical pharmacist one nurse practitioners and five practice nurses (female), three of which were nurse prescribers, two practice managers and five healthcare assistants and 15 reception/administrative staff. The practice was a training practice.

The practice was open from 7.30am to 6.30pm Monday to Friday and until 7pm on Thursdays. Appointments were from 8am to 6.30pm daily. Outside of these hours, cover was provided by the out of hours GP service which operated from 7pm midnight, seven days a week and the NHS 111 service.

Rushall Medical centre is one of a number of GPs covered by Walsall Clinical Commissioning Group (CCG). It has a practice list of around 14081 .The practice’s patient population has an above average number of adults aged from 75 to 79 years.

The practice provides the following regulated activities from Rushall Medical Centre, 107 Lichfield road, Rushall, Walsall, WS4 1HB:

• Treatment of disease, disorder or injury;
• Surgical procedures;
• Maternity and midwifery services;
• Family planning;
• Diagnostic and screening procedures

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rushall Medical Centre on 8 November 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 both internally and externally.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.

• 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice were proactive in identifying areas for further improvement or development and utilised quality monitoring and benchmarking to drive improvement.

We saw one area of outstanding practice:

• We saw that all incidents and complaints were RAG rated (Red, Amber, Green) in order to monitor the level of risk. A log of all incidents was maintained, and we saw that 17 had been recorded since January 2016. All incidents and complaints were categorised, for example, clinical, medication, administration and communication. The practice carried out a thorough analysis of the significant events in order to identify trends and areas for further learning. The practice told us that all incidents relating to medicines were reported to the Clinical Commissioning Group (CCG) in order to share the learning. The Practice were proactive in identifying areas for further improvement.

• Processes were in place for handling repeat prescriptions which included the review of high risk medicines. High risk medicines and antidepressants were not included in the repeat prescription policy and process. These were available on acute prescription and were only issued following a telephone or face to face consultation with a clinician.

The areas where the provider should make improvement are:

• Increase the number of identified carers. The practice had identified 0.72% patients as carers which was less than 1% of the practice list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 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.

• There were alerts for long term conditions on patient records.

• At 85%, the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was comparable to the CCG and national averages of 77% and 77%.

• Longer appointments and home visits were available when needed. The practice actively reviewed patients with long term conditions to enable reviews and consultations to be completed during one appointment.

• 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 had implemented an alert on patient records for patients on a specific anticoagulation medicine. Clinicians were prompted to ensure that specific blood tests had been completed prior to issuing prescriptions. This system was audited monthly and the practice were able to confirm that all 150 patients on this medication had been appropriately monitored.

• Patients with chronic obstructive pulmonary disease (COPD) and in receipt of a rescue pack (steroids and antibiotic) were coded in the patient record system. If a patient had experiences exacerbation and requested a replacement pack the code triggered a telephone consultation by the COPD lead nurse to ascertain if further intervention was required. The practice confirmed that 100% of these patients had received either a face to face or telephone consultation.

• The practice had an in house anticoagulation service. 270 Patients regularly used this service. Alerts were placed on patient records to ensure appropriate monitoring took place.

Updated 13 April 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 relatively high for all standard childhood immunisations.

• 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.

• At 81%, the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was comparable to the CCG and national averages of 81% and 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Children and babies were prioritised for same day appointments.

• We saw positive examples of joint working with midwives and health visitors.

• The practice offered an open access family planning clinic with walk in appointments at both sites. Patients requiring contraceptive implants were always accommodated in line with their menstrual cycle regardless if clinics were full.

Updated 13 April 2017

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

• The practice had a higher percentage of patients aged over 75 than the CCG and national average and 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 told us that they held a register of approximately 200 patients who routinely required home visits.

• An alert on patient records highlighted elderly patients who were particularly vulnerable.

• The Integrated Care Team (ICT) which included a GP from the practice case managed elderly patients at risk of admissions through weekly meetings and review of care plans.

• The practice had implemented an alert on patient records for patients who were at high risk of falls. Clinicians were prompted to complete a falls risk assessment tool which followed NICE guidance. The practice told us that 107 patients had this alert placed on their medical record.

• The practice supported local care and nursing homes with approximately 100 registered patients. Doctors at the practice attended each care home weekly to provide a ward round, with daily visits as requested. We were told that the clinical pharmacist would visit the homes to review patient’s medication following a discharge from hospital when necessary. Where medication had been prescribed outside of the practice the pharmacist would provide the care home with directives to ensure safe dispensing.

• 73% of patients over 65 had received their flu vaccine.

Updated 13 April 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 as well as a full range of health promotion and screening that reflects the needs for this age group.

• Repeat prescriptions could be requested electronically. The practice told us that 80% of repeat prescriptions were issued via the electronic prescription service (EPS) directly to the pharmacy of the patient’s choice.

• Same day appointments were available.

• The practice was open from 7.30am Monday to Friday to accommodate working people.

• Telephone consultations were available where patients could speak to a clinician of choice.

• Online appointment booking and prescription requests was available.

Updated 13 April 2017

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

• 92% 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 (01/04/2014 to 31/03/2015). This was comparable to the CCG average of 91% and the national average of 88%.

• Patients with severe mental health conditions were offered weekly appointments with a named GP and were also referred to the community psychiatrist nurse who held clinics at the practice on a monthly basis.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice were practice in offering dementia screening for appropriate patients attending the flu clinics. The practice told us that 44% of eligible patients had received screening for dementia.

• The practice carried out advance care planning for patients with dementia.

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

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• The practice told us that they held a register of patients with poor mental health; where appropriate they ensured crisis planning was in place and carers details recorded.

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

Updated 13 April 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. There was also an alert on the patient records where a patient was identified as vulnerable.

• The practice provided care and treatment to approximately 40 patients with a learning disability living in a local residential home. Doctors from the practice visited the home weekly to review patients care needs. The practice also offered longer appointments for patients with a learning disability.

• Prescriptions for high risk medicines and antidepressants were only issued with either a telephone or face to face consultation, ensuring appropriate monitoring had been completed.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. A community psychiatric nurse was based on site and was working with the practice to reduce the number of DNAs of patients in this population group.

• 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.