Archived: Drs Brinksman, Conlon, Manley, Saunders, Hull & Martins

Updated 10 May 2016

• Drs Brinksman, Conlon, Manley, Saunders, Hull and Martins practice (also known as Ridgacre House Surgery) is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.
• The practice is registered with the Care Quality Commission to provide primary medical services. The practice has a personal medical service (PMS) contract with NHS England. Under this contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care.
• The practice (Ridgacre House Surgery) is located in a suburban area of Birmingham in premises that have been adapted for the purpose of providing primary medical services. There is also a branch surgery, Highfield House Surgery at 88 Highfield Lane, Birmingham B32 1QX which we visited during our inspection. The diabetic clinic is held at Highfield House Surgery on one session each week but otherwise it is not routinely used to see patients. Close to the main surgery there is a separate building known as the annex which is used for meetings and some administrative functions. The provider also has another location in Nechells, Birmingham which is separately registered with CQC.
• Based on data available from Public Health England, the levels of depravation in the area served by Ridgacre House Surgery are above the national average. The practice has a registered list size of approximately 9300 patients.
• Practice staff work flexibly across the provider’s two registered locations (Ridgacre House Surgery and the Nechells Practice), although clinical staff are mainly affiliated with one location they cross over if needed. Altogether the staff team consists of 13 partners, 8 nurses and 23 administrative staff. Clinical staff consisted of both male and female members.
• The practice is open from 8.30am Monday to Thursday and 7.30am on a Friday. It closes at 6.30pm on Tuesday, Thursday and Friday, 7.30pm on Wednesday and 8pm on Monday.
• The practice has not previously been inspected by CQC.

Updated 10 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Brinksman, Conlon, Manley, Saunders, Hull & Martins (Ridgacre House Surgery) on 8 March 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. The practice had developed an incident reporting system to encourage reporting. The system used was adopted by other practices and resulted in higher rates of reporting and increased openness.
• The practice used innovative and proactive methods to improve patient outcomes and had worked with other local providers to share best practice. A range of schemes developed by the practice to deliver service improvements have been implemented widely with support from the CCG. These include ambulance triage, GP referral triage and a medicines waste project.
• Feedback from patients about their care was positive.
• The practice had worked closely with other organisations in planning how services were delivered to ensure that they met patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. Feedback from the patients survey had highlighted difficulties in patients seeing the same GP. The employment of several associate partners is hoped to create greater stability in the workforce and improve patient satisfaction as patients get used to the associate partners.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The practice had business resilience in that they had multiple premises and staff that worked across sites. This meant it could adapt quickly to service disruption.
• Information about how to complain was available and easy to understand and complaints were thoroughly investigated and handled in a sensitive and timely manner.
• The practice had a clear vision which had quality and safety as its top priority. Strong governance arrangements with clear staff roles supported the running of the service and service improvement.

We saw areas of outstanding practice:

• The provider had developed a reporting tool for incidents and significant events which risk rated incidents. The tool had been adopted by other practices within the local clinical network and had been recognised by the CCG as improving reporting. Practice staff were proactive in reporting incidents. The practice had high levels of incident reporting (148 in the last 12 months). High reporting is viewed positively as it enables the practice to identify trends, reflect on incidents that occurred and learn from them. Weekly clinical governance meeting ensured incidents and significant events underwent regular review and were acted on. Learning was shared internally and with other providers.
• The provider was a key player in the CCG for driving innovation and developments for service improvement. Schemes developed by the provider that had been adopted by others included: Ambulance triage in which GPs gave advice and support to paramedics at the scene to reduce unnecessary referrals to A&E and provide more appropriate care. Early indicators show the number of patients that had attended A&E had reduced from 70% to 12% since September 2016 across participating practices. The provider had also undertaken a medicines waste project in which a savings of £1563 had been achieved in two months by targeting patients where over prescribing had been identified. This scheme was also being adopted by the CCG.
• The provider had operated an internal triage referral system for 10 years, during which time over 4000 referrals had been reviewed by colleagues to improve the accuracy of referrals across both of their sites. With CCG funding this system was being extended within the locality with a pilot due to start in April 2016. GPs with specialist interests and training were being identified to undertake referral triage within a set time frame to help improve the quality of referrals and help reduce pressure on secondary care.
• The provider worked with hospital services and the drug workers team to combine hepatitis C treatment for relevant patients with the treatment for substance misuse. By combining the treatments it was felt patients were more likely to comply. This approached successfully led to the eradication of hepatitis C in three patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 May 2016

The practice is rated as outstanding for the care of older people. The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

• Patients with long term conditions received regular reviews of their conditions to check their health and medicines needs were being met.
• The provider had recently undertaken an audit to review and address issues relating to overprescribing and medicine hoarding. The CCG planned to adopt the scheme as part of their 2016/17 targets. The outcome of the audit was showing improved outcomes for patients.
• The practice operated a number of clinics specifically for patients with long term conditions including diabetes, asthma, heart disease and hypertension.
• The practice also undertook screening for atrial fibrillation (heart condition) for patients over 65 years and had to date screened 1018 patients out of 1341 eligible to support early diagnosis and treatment.
• The practice was above average for patient uptake of national screening programmes such as bowel and breast cancer.
• Nursing staff had lead roles in chronic disease management and received training and support for this.
• Performance for diabetes related indicators overall was at 89% which was the same as both the CCG average and national average.
• Longer appointments and home visits were available for those who needed them.
• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 May 2016

The practice is rated as outstanding for the care of families, children and young people. The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

• 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 or had failed to attend immunisations. The practice worked closely with the health visiting team to support children at risk.
• Immunisation rates for standard childhood immunisations were comparable to the CCG and national averages.
• The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 77% which was slightly higher than the CCG average of 74% and national average of 75%.
• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. For example information displayed which emphasised the rights of children and young people to privacy and being able to speak in confidence.
• The practice was accessible for pushchairs, had baby changing facilities and advertised a breast feeding friendly service.Appointments were available outside of school hours.
• The practice’s uptake for the cervical screening programme was 72%, which was comparable to the CCG average of 69% and the national average of 74%.

Updated 10 May 2016

The practice is rated as outstanding for the care of older people. The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

• All patients over 75 years had a named GP and those who had been identified as having complex care needs.
• There was a GP lead for the care of older people and for managing patients who were identified as having complex care needs and at risk of admission to hospital.
• Ambulance triage was in place in which GPs gave advice and support to paramedics at the scene to reduce unnecessary referrals to A&E and provide more appropriate care. Early indicators showed that the number of patients that had attended A&E through this scheme had reduced from 70% to 12% since September 2016 across participating practices.
• The practice held regular multi-disciplinary team meetings with district nurses, palliative care nurses and case managers to review the care of those who were most vulnerable including those with end of life care needs.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• The premises were accessible to patients with mobility difficulties.

Updated 10 May 2016

The practice is rated as outstanding for the care of working-age people (including those recently retired and students). The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

• 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 offered online services as well as a range of health promotion and screening that reflects the needs of this age group. This included NHS health checks, access to health trainers, travel vaccinations, sexual health and family planning services.
• For the convenience of patients the practice offered extended opening hours on a Monday and Wednesday evening and on a Friday morning.
• A self check in reduced the need for patients to queue at reception.

Updated 10 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

• National reported data from 2014/15 showed that 72% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months. This was below the CCG average of 82% and national average of 84%. The practice told us that they had been actively working to improve the support for dementia patients and current data showed the practice performing now at 82%.
• Specific dementia clinics were being delivered and the practice had also begun to work in partnership with the Alzheimer’s Society to review and support patients with dementia and their families.
• National reported data from 2014/15 showed performance against mental health related indicators was 91% which was comparable to the CCG average of 92% and the national average of 93%.
• The practice provided in house counselling services for patients who would benefit from it.

Updated 10 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The provider was rated as outstanding overall. The issues identified as outstanding affected all patients including this population group.

• The practice held register of patients living in vulnerable circumstances including those with a learning disability or misused drugs and alcohol.
• The practice ran drug misuse clinics which was open to patients within the locality. Two of the GPs had a special interest in substance misuse and five held the RCGP certificate in alcohol and substance misuse Part 2 who worked with drug workers to support these patients. In conjunction with this service the practice ran a hepatitis C clinic to improve compliance with treatment. There were currently 62 patients actively receiving drug and alcohol support at the practice.
• Longer appointments were available for those who needed them.
• The practice told us that they would register patients with no fixed abode but did not currently have any patients.
• There were 124 patients registered as carers at the practice. A carers pack which provided information about support available was provided to those identified as carers.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• Staff knew how to recognise signs of abuse in vulnerable adults and children and were well supported. The safeguarding lead for the provider organisation also had lead roles in this area within the CCG and was an educator for other practices for domestic violence.
• The practice had a register for patients with a learning disability, these patients had been sent a patient passport so that their needs, likes and dislikes could be recorded and understood when using services. We saw that patients had been invited for reviews with uptake this year of 61%. The lead GP for safeguarding had recently visited a residential home in which a number of patients registered with a learning disability lived to carry out their annual health reviews. Practice staff told us that all patients on the register had been invited for a review.
• Those with specific needs were identified so that reception staff were aware and could support the patient as appropriate when they arranged an appointment.