Archived: The Vesey Practice

Updated 22 November 2016

The Vesey Practice 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 essential services to patients who are ill and includes chronic disease management and end of life care.

The practice is located in a suburban area of Birmingham with a list size of approximately 9200 patients. The premises are purpose built for providing primary medical services and shared with another practice. The premises are owned by NHS property services.

Based on data available from Public Health England, the practice has lower levels of deprivation than the national average. It is within the top 30% of the most affluent areas nationally. The population has a higher proportion of patients over the age of 45 years and a lower proportion of patients under 40 years compared to the national average.

Practice staff consist of seven partners (four male and three female) who work a total of 42 GP sessions per week. There are four nurses (including one nurse prescriber), one health care assistant, a phlebotomist, a practice manager and a team of administrative staff. Support had been obtained from a recently retired practice manager who had formerly worked at a neighbouring practice due to the absence of the practice manager.

The Vesey Practice is open from 8am to 6.30pm Monday to Friday. Appointment times are between 8.30am to 10.30pm and 3.30pm to 5.30pm. When the practice is closed services are provided by an out of hours provider (BADGER). In addition the practice opens for extended hours between 6.30pm to 8.30pm on a Monday evening (for appointments with a GP or nurse) and one morning each week from 7.30am (the day varies depending on the GP on duty).

The practice is a teaching practice for final year medical students.

The practice has not previously been inspected by CQC.

Updated 22 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Vesey Practice on 27 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.
• In most cases risks to patients were assessed and well managed although there were some issues with the premises.
• 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.
• The practice worked effectively in collaboration with other services to help meet patients needs.
• Information about services and how to complain was available and easy to understand.
• Patients generally found it easy to make an appointment although found getting through on the telephone sometimes difficult. The practice had taken action to try and improve this. 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 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 an area of outstanding practice:

• The practice was proactive in providing support to patients who had been through cancer treatment. Patients were offered an end of treatment review with a trained nurse. The practice had offered 17 patients the opportunity of a review and eight patients had received one between February and August 2016. One of the GP partners was a Macmillan GP aimed at improving cancer care. They had supported in the development of practice nurse cancer courses.

The areas where the provider should make improvement are:

• Liaise with NHS property services to resolve issues relating to the cleaners room and fire equipment servicing.
• Review newly implemented systems for managing prescription safety to ensure they are working as intended.
• Review systems in place to ensure important information is shared with all staff in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 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 held a range of clinics for patients with long term conditions including diabetes, asthma and coronary heart disease.
• Performance for diabetes related indicators was 98% which was higher than the CCG average and national average of 89%. (Exception reporting for diabetes related indicators was 12% which was slightly higher than the CCG average of 10% and national average 11%).
• Patents received structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Patients on the heart failure register received six monthly reviews.
• The practice was able to provide inhouse a range of diagnostic and monitoring services to support patients with long term conditions. For example, phlebotomy, spirometry and ambulatory blood pressure monitoring.
• One of the partners was a Macmillan GP with an interest and desire to improve cancer care in the UK. According to the Macmillan website there are approximately 200 Macmillan GPs nationwide. The practice nurse carried out enhanced end of treatment reviews for patients who had completed their cancer treatment.

Updated 22 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.
• Patient confidentiality in patients under 16 years was promoted.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 78% and the national average of 82%. The practice had low exception reporting rates.
• Appointments were available outside of school hours and the premises were suitable for children and babies. Same day appointments were also available for under two year olds.
• The practice was accessible to those with pushchairs. Baby changing facilities were available and staff told us a private room would be made available for mothers wishing to breastfeed.
• The midwife held antenatal clinics from the premises.

Updated 22 November 2016

• The practice 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 offered home visits for patients whose clinical needs made it difficult to attend the practice. They would also accept repeat prescription ordering via telephone for patients who were housebound.
• The premises were accessible to patients with mobility difficulties and facilities included ramp and automatic door access, disabled toilet facilities and parking.
• The practice had worked collaboratively with other practices locally to provide innovative and proactive services to meet the needs of this population group, improve outcomes and reduce unplanned admissions to hospital. The practice was participating in an unplanned admission scheme with five other local practices. Three case managers have been employed between the practices to facilitate early discharge with appropriate support. Data available has shown a positive impact on bed days and deaths in hospital. The scheme covers a wider population than the local enhanced scheme for unplanned admissions by including all patients over 70 years.
• The practice was involved in a collaborative scheme between September 2015 and September 2016. The elderly care support nurse project was designed to identify and support previously unrecognised need. The elderly care support nurse reviewed patients over 75 years to identify, assess and help address any unmet care and support needs. Over 300 patients from across the participating practices have benefited to date receiving care and support from a range of services including the NHS, local authority, third sector and voluntary organisations.

Updated 22 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.
• The practice offered extended opening hours on a Monday evening and one morning each week for the convenience of patient that worked. Telephone appointments were also available.
• 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. For example NHS health checks
• Travel vaccinations were available.
• Family planning services including fitting of intrauterine devices and contraceptive implants.
• The practice provided enhanced sexual health services for registered and non-registered patients with the practice.
• Practice nurses were trained in providing emergency contraception.
• Practice staff told us that they had an open door policy for returning local students.

Updated 22 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, which was  below the CCG average 82% and national average 84%.
• National reported data for 2014/15 showed 96% of patients with poor mental health had comprehensive, agreed care plan documented, in the preceding 12 months which was above to the CCG average 89% and national average 88%.
• Patients with anxiety and depression were able to access services such as improving access to psychological therapies (IAPT) support. These sessions were held on a weekly basis at the premises.
• Some reception staff trained as dementia friends.
• There were displays dedicated to support for patients with mental health and dementia in the waiting area.

Updated 22 November 2016

• The practice held registers of patients living in vulnerable circumstances and with caring responsibilities. For example, those with a learning disability.
• Patients with a learning disability were offered an annual review.
• The practice offered longer appointments for patients who needed them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Carers were offered health checks and information packs signposting them to support available.
• Patients with alcohol related hospital attendances were followed up by clinical staff.
• The practice was developing a frailty register to identify those patients in need of additional support.
• 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.
• Practice told us they would register patients with no fixed abode with the practice address. They also had patients in temporary accommodation which they were able to register as temporary residents.