Archived: Leach Heath Medical Centre

Updated 29 March 2016

Leach Heath 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.

Leach Heath Medical Centre 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 the GMS 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 is located in a purpose built accommodation. Based on data available from Public Health England, deprivation in the area served is slightly higher than the national average. The practice has a registered list size of approximately 9000 patients. The practice told us that their list size had increased by approximately 1000 patients over the last three years due to the closure of a nearby practice and redevelopment in the area.

The practice is open between 8.30am and 6.00pm Monday to Friday. Consultation times are 8.40am to 11.30am and 3pm to 5.50pm daily. Extended opening hours are on Monday 6.30pm to 7.45pm and on a Thursday 7am to 8am and 6.30pm to 7.30pm. When the practice is closed during the out of hours period, between 6.30pm to 8am, primary medical services are provided by Primecare.

The practice currently has three GP partners (two female and one male), three salaried GPPs (two female and one male). Other practice staff consisted of a team of four practice nurses and two healthcare assistants (all female). There is a team of administrative staff which includes a practice manager and IT manager who support the daily running of the practice.

The practice became a teaching practice in May 2015 for medical students.

The practice has not previously been inspected by CQC.

Updated 29 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Leach Heath Medical Centre on 5 February 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 assessed and generally well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patient outcome data reported lower than local and national average scores for many conditions. However, the practice had experienced a sudden increase in practice size due to the closure of another practice and redevelopment in the area which had impacted on this.
• Feedback from patients about their care and treatment was very positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice was rated highly in relation to the quality of consultations and overall experience of the service in the latest National GP Patient Survey.
• Information about services and how to complain was available and easy to understand.
• The latest National GP Patient Survey rated access to appointments as comparable to others and in some cases above national and local averages. However, several patients raised with us difficulties getting through on the phone as their main frustration.
• 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.

We saw one area of outstanding practice:

• The practice was working with the Alzheimer’s Society in a new project funded by the CCG to provide additional support to patients diagnosed with dementia. The practice coordinated dementia reviews to coincide with the drop in sessions run by the charity. This enabled the patient to be linked to a support worker. The benefits to patients and their carers were around education, emotional support, coping strategies and respite. With agreement from the patient, information could be shared with their GP so that the GP was aware and could respond to any additional needs the patient and their family might have.

The areas where the provider should make improvement are:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Review fire evacuation arrangements for patients accessing treatment rooms on the first floor who may need assistance.
• Review systems for monitoring staff training to reduce the potential for gaps.
• Review policies and procedures to ensure they are practice specific.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 March 2016

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

• Nationally reported data on patient outcomes was generally lower than local and national averages for long term conditions. The practice had experience a sudden growth in the population list size which provided some explanation to these scores .
• Clinical staff held lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Patients were offered annual structured reviews of their condition to check their health and medicine needs were being met.
• National reported data for 2014/15 showed performance for diabetes related indicators was at 73% which was lower than both the CCG average and national average of 89%.
• Longer appointments and home visits were available for those who needed them.
• The practice worked with relevant health and care professionals to deliver a multidisciplinary package of care. We received positive feedback from the health professionals we spoke with.

Updated 29 March 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 who did not attend immunisations.
• Child immunisation rates were comparable to and in some cases higher than the CCG averages for standard childhood immunisations.
• The percentage of patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 72% which was comparable with the CCG average of 74% and national average of 75%.
• The premises were accessible for pushchairs, baby changing facilities were available and appointments outside school hours.
• Baby health and post natal health checks were also provided at the practice.
• The health visitor held clinics at the practice.

Updated 29 March 2016

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

• The practice had experience a sudden growth in the population list size which provided some explanation to the lower than average nationally reported outcome scores.
• Nationally reported data for 2014/15 showed performance against CCG and national averages were slightly lower for patient outcomes for conditions found in older people. For example, diabetes, stroke and chronic obstructive pulmonary disease.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was below the CCG and national averages
• The practice held weekly meetings to discuss all unplanned admissions and offered reviews to those patients to reassess their care needs.
• The practice held regular multi-disciplinary team meetings with district nurses, palliative care nurses and case managers to meet the needs of those at the end of life.
• Home visits were offered to those whose health prevented them from attending the surgery.
• Flu vaccinations and health reviews were also carried out at home by a practice nurse for those who were housebound.
• The practice was accessible to those with mobility difficulties.

Updated 29 March 2016

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 offered services that were accessible and flexible and offered continuity of care to this group of patients.
• The practice offered online services for booking appointments and ordering repeat prescriptions for patient convenience.
• Extended early morning appointments and evening appointments were available for those whose working or other commitments meant it was difficult to attend during the day.
• Travel vaccinations and advice was available at the practice.
• A range of health promotion and screening was on offer to meet the needs of this patient group including NHS health checks, family planning and access to smoking cessation and health trainers to support healthier lifestyles.

Updated 29 March 2016

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

• National reported data from 2014/15 showed that 93% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months. This was above the CCG average of 82% and national average of 84%.
• National reported data from 2014/15 showed performance against mental health related indicators was at 87% which was below the CCG average of 92% and the national average of 93%.
• As part of a CCG led scheme, the Alzheimer’s Society provided drop in services which coincided with dementia reviews. This enabled patients to gain assistance from a support worker who could give practical support and advice to patients with dementia and their families.
• Patients with poor mental health were offered annual reviews and those with long term conditions were assessed to identify the need for emotional support.

Updated 29 March 2016

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

• The practice held registers of patients living in vulnerable circumstances including those with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice offered longer appointments for patients who needed them including patients with a learning disability. Patients with a learning disability were offered annual health reviews with the practice nurse.
• Patients with no fixed abode would be seen if they needed support.
• Onsite support was available for patients with drug addictions.
• The practice recognised the need for support for all patients at risk of domestic violence, men, women and children.
• 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.
• Support was available for those identified as carers. A carers pack which provided information about support was available to them. The practice also held carers support coffee mornings.