Bosworth Medical Centre

Updated 11 December 2019

Bosworth Medical Practice is situated in a purpose built Primary Care Centre, known as Chelmsley Wood Primary Care Centre in the Chelmsley Wood area of Birmingham. The practice is based in an area with socio-economic deprivation, with a high demand for GP appointments and low patient activations and resilience. Public Health England data ranks the levels of deprivation in the area as one out of 10, with 10 being the least and one being the most deprived. Approximately 9,183 patients are registered with the practice.

The service is registered to provide the regulated activities of Diagnostic and screening procedures, Maternity and midwifery services, Family planning, Surgical procedures and the Treatment of disease, disorder or injury.

The practice is led by a team of four GP partners, two of which are Registered Managers. There are also two salaried GPs. The GP team consists of male and female GPs. The clinical team includes two advanced nurse practitioners (one male and one female), three practice nurses (females) and a healthcare assistant (female). In addition the practice employs a paramedic practitioner, a clinical pharmacist and a diabetes nurse specialist (all female) as part of their clinical team.

The practice team includes a practice manager and a team of staff who cover PA, reception management, IT, admin and reception duties.

The practice is a training practice and provides training and teaching opportunities to trainee GPs and medical students. The practice also provides opportunities for physician associate students from Birmingham University.

The practice is open between 8.30am and 6.30pm on all weekdays apart from Wednesdays when the practice is open later for extended hours, these operate until 8pm. There is also a duty doctor on call each day from 8.30am for urgent needs. In addition, patients can pre-book appointments through the practices primary care network (PCN): North Collaborative, available at the practice on weekday evenings and on weekends. When the practice is closed patients are automatically diverted to the GP out of hours service provided by the Badger Out of Hours Group. Patients can also access advice through the NHS 111 service.

Updated 11 December 2019

We carried out an announced focussed inspection of Bosworth Medical Practice on 16 October 2019. We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

This inspection focused on the following key questions: Effective, Caring, Responsive and Well-led. This included how the practice provided effective and responsive care across the six population groups. The six population groups are:

• Older people
• People with long-term conditions
• Families, children and young people
• Working age people (including those recently retired and students)
• People whose circumstances may make them vulnerable
• People experiencing poor mental health (including people with dementia)

Because of the assurance received from our review of information we carried forward the Good ratings for the key question of Safe.

You can read the reports from our last inspections by selecting the ‘all reports’ link for Bosworth Medical Practice on our website at www.cqc.org.uk.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

Following this inspection we have rated this practice as good for providing caring and well-led services and good for providing effective care to all the population groups with the exception of working age people which was rated as requires improvement for effective care.

We rated the service as requires improvement for providing responsive services to all the population groups. The practice is rated as good overall.

We found that:

• The practice was based in a deprived area with socio-economic deprivation. Evidence and feedback gathered during our inspection highlighted a theme whereby despite efforts, the practice faced challenges in engaging their population in health reviews and general practice processes across areas including engagement in the childhood immunisation schedule, cervical screening and systems for booking appointments.
• Overall, Quality and Outcomes Framework (QOF) exception rates showed improvement yet remained above average in some areas. When we looked at a sample of cases that had been exception reported , we saw they had been done so appropriately.
• Uptake rates for primary immunisations were above World Health Organisation (WHO) targets for 2018/19 however targets specifically for booster vaccinations were below target. Unverified and unpublished data provided by the practice showed the practice were meeting targets for booster uptake for the year so far.
• Public Health England (PHE) data showed that the practices cervical screening uptake rates for 2017/18 were below target. Unpublished and unverified data from the practices patient record system supported efforts made to improve uptake.
• The results from the national GP patient survey with regards to questions about access, listening, care and concern as well as overall experience were below local and national average. Results from the practices more recent in-house survey were more positive.
• Feedback about actual care and treatment was positive and staff expressed that in some areas they felt the results stemmed from patients expectations regarding access. Overall, we noted that the practice was working through these challenges by making efforts to change the culture of the practice and were working through patient education around general practice processes.
• Overall appointments offered in the practice were above the national average and patients had seven-day access to appointments through the practices primary care network (PCN).
• We noted efforts to improve patient satisfaction with regards to access, including implementing a new telephone system, recruiting more clinical staff to offer more appointments, adaptations to the appointment system and increasing appointments for online booking. Whilst we saw efforts undertaken to improve access there was no evidence provided to determine if these efforts had improved patient experience in this area, at the time of our inspection.
• There was clinical mentorship in place for clinical staff including nurses, the practice paramedic and pharmacist. There was formal supervision in place which included regular reviews of prescribing practice for prescribers including a process of peer review and consultation audits.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Continue with efforts to improve uptake of childhood immunisations in specific areas and cervical cancer screening.
• Continue to capture and identify carers in order to offer them support where needed.
• Continue with efforts to improve patient satisfaction where feedback highlights areas for improvement and analyse changes implemented to demonstrate impact and to identify areas for further changes.
• Continue to engage patients in reviews and further reduce exception reporting rates.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Updated 19 April 2018

Updated 19 April 2018

Updated 19 April 2018

Updated 19 April 2018

Updated 19 April 2018

Updated 19 April 2018