Archived: Dr Borg-Bartolo and Partners

Updated 15 November 2016

Dr Borg-Bartolo and partners’ practice (also known as Millennium Medical Centre) 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 general medical service (GMS) contract with NHS England. Under this contract the practice is required to provide general primary care services to patients who are ill and includes chronic disease management and end of life care.

The practice is located in an urban area of Birmingham with a list size of approximately 9,200 patients. The premises are purpose built for providing primary medical services. Some community services including district nursing and health visiting services operate from the premises .

Based on data available from Public Health England, the practice is located in one of the most deprived areas in the country and is within the 10% most deprived. The practice population is slightly younger than the national average with a higher proportion of patients under 24 years and a lower proportion of patients aged between 50 years and 75 years.

Practice staff consist of six partners (four male and two female) and one salaried GP, the practice currently has one practice nurse and a second has recently been recruited to replace a nurse who has recently retired. The practice also has two health care assistants, a practice manager and a team of administrative staff.

The practice is open between 8.15am to 1pm and between 2pm to 6.15pm Monday to Friday. Appointment times are usually 8.30am to 11.50am, 2.30pm to 4.30pm and 4pm to 5.50pm daily. In addition the practice provides extended opening for appointments on a Saturday morning between 8.15am and 12 noon. Between 1pm and 2pm the practice has arrangements with another provider (Southdoc) to cover calls. When the practice is closed during the out of hours period services are provided by an out of hours provider (BADGER).

The practice has recently become a training practice for qualified doctors training to become GPs.

Dr Borg-Barolo and partners’ practice was previously inspected in 2013.

Updated 15 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Borg-Bartolo and Partners (also known as Millennium Medical Centre) on 16 September 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.
• Risks to patients were in most cases 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. Any learning was shared however, the practice did not routinely make use of verbal complaints to identify trends and potential for service improvement.
• Patients did not always find it easy to get through to the practice to make an appointment, however we saw that the practice had made improvements in this area and urgent appointments were 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 areas where the provider should make improvement are:

• Identify a lead responsible for infection control to ensure it is given sufficient attention within the practice.
• Ensure actions following risk assessments are clearly identified and addressed.
• Review fire evacuation arrangements for patients accessing treatment rooms on the first floor who may need assistance.
• Review systems for monitoring staff training to ensure essential training is kept up to date.
• Identify systems for recording informal verbal complaints in order to identify trends and potential service improvements.
• Continue to monitor and ensure improvement to patient survey results including access to appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 November 2016

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice had made improvements in the number of emergency admissions.
• Practice performance for diabetes related indicators overall was 97% which was higher than the CCG and national average of 89%. Exception reporting for diabetes related indicators was comparable to CCG and national averages.
• 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 offered a range of services in-house to support the diagnosis and monitoring of patients with long term conditions including spirometry, electrocardiographs, phlebotomy and ambulatory and home blood pressure monitoring.
• The practice had undertaken screening for atrial fibrillation and dementia to support earlier diagnosis and treatment.

Updated 15 November 2016

• 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.
• The practice’s uptake for the cervical screening programme (2014/15) was 83%, which was above the CCG average of 78% and comparable to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Including space for pushchairs, baby changing facilities and promotion of breast feeding.
• We saw positive examples of joint working with midwives, health visitors and school nurses. Baby check clinics alongside health visitor clinic. Health visitors worked from the same building which supported communication.

Updated 15 November 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population. All patients had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice supported patients in three care homes and had a lead GP for this.
• Nationally reported data showed that the practice performed well in relation to patient outcomes for conditions commonly found in older people.
• The practice routinely discussed any unplanned admissions including those from care homes to ensure their care needs were being appropriately met.
• The practice regularly met as part of a multi-disciplinary team with other health professionals to discuss the care of those with complex and end of life care needs.
• The practice was accessible to those with mobility difficulties.

Updated 15 November 2016

• 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.
• Saturday morning appointments and telephone appointments were available for the convenience of those who worked or with other commitments during normal opening hours.
• The practice was proactive in offering online services. Information was readily available to support patients in using the online systems for booking appointments and prescriptions.
• The practice offered a range of health promotion and screening that reflected the needs for this age group.

Updated 15 November 2016

• Nationally reported data for 2014/15 showed 72% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was slightly below the CCG average of 82% and national average of 84% but with lower exception reporting 4% compared to the CCG and national average of 8%.
• The practice had introduced dementia clinics that ran alongside the Alzheimer’s Society service who provided social and other support to patients and their families. To date 20 patients and their families were being supported through this scheme.
• Nationally reported data for 2014/15 showed 95% of patients on the practice’s mental health register that had a comprehensive, agreed care plan documented, from the preceding 12 months was 93% compared to the CCG average of 89% and national average of 88%. However, exception reporting was also higher at 17% (compared to CCG 11% and national 13%). Practice data for 2016/17 showed the practice was already achieving 82% at the time of inspection for this outcome.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health.
• The community psychiatric nurse ran clinics and undertook patient reviews from the premises.
• Patient information was readily available signposting patients with poor mental health to support services such as counselling.
• The practice was working with the Alzheimer’s Society. Patients with a diagnosis of dementia and their carers were referred to support workers from the Alzhiemer’s Society who could provide social and practical support to patients and their carers.

Updated 15 November 2016

• The practice held register of patients living in vulnerable circumstances and caring responsibilities. For example, those with a learning disability. The practice had a higher prevalence of learning disabilities than the CCG overall which had been validated by the learning disability services.
• The practice offered patients with a learning disability health checks and patient passports to ensure their preferences and needs were taken into account when moving between services. There was a lead GP responsible for patients with a learning disability.
• Longer appointments for patients who needed them.
• An alert system was used to identify patients at risk or with special requirements that needed additional support.
• 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 support groups and voluntary organisations. The Citizens Advice Bureau ran services once a week from the premises.
• The practice had registered patients with no fixed abode and issued food bank vouchers where needed.
• 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.
• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 141 patients as carers (approximately 1.5% of the practice list).
• The practice actively followed up patients with alcohol related hospital admissions.