The Victoria Surgery

Updated 13 July 2017

The Victoria Surgery is located in the Tipton area of the West Midlands. The practice list size is approximately 2600 patients. We reviewed the most recent data available to us from Public Health England which showed that the practice population and age distribution was similar to the England average, with a slightly higher number of female patients aged between 40 and 45.

The clinical team includes three GP partners (two female and one male) and a part time practice nurse. The GP partners and the practice manager form the practice management team and are supported by a team of four receptionists, who all cover reception and administration duties.

The practice provides services under a General Medical Services (GMS) contract. 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 provides enhanced services (an enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients), for example avoiding unplanned admissions.

The practice is open from 8am to 6.30pm, Monday to Friday and from 9am to 12pm on Saturdays. The practice closes on Thursdays at 1pm and there is a formal arrangement in place with a nearby practice where patients can be seen.

Appointments run from 9am to 12:30pm and then again from 4pm to 6:30pm during week days, except for Thursdays when the practice closes at 1pm.

Between the hours of 8am to 9am and 12:30pm to 4pm, primary care cover is provided by an external provider. The practice is closed on Thursday afternoons and cover is provided by the same external provider.

Online prescribing and prescription requests are available and the practice had introduced Electronic Prescription Service (EPS) where patients could have their medicines at a designated chemist.

Updated 13 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Victoria Surgery on 20 January 2016. The overall rating for the practice was Good. However, for providing safe service the practice was rated as requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for The Victoria Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection on the 20 January 2016.

Overall the practice is rated as Good.

Our key findings were as follows:

• During our previous inspection we saw that the practice had a defibrillator and oxygen available on the premises. This equipment was only checked annually and we found that the oxygen mask and defibrillator pads were out of date. At this follow up inspection we saw monthly checks had been introduced for both the defibrillator and oxygen to ensure it was in good working order. There were masks and pads available and they were in date.

• When we inspected the practice in January 2016 we saw that some prescriptions had not been collected for nearly two months; two of these were for children, one of which was for the treatment of asthma. This did not ensure safeguards were in place to ensure that vulnerable patients always received medicines in a timely way. At this follow up inspection we saw the practices’ repeat prescription protocol had been reviewed and a monthly log had been introduced to account for all uncollected prescriptions.

• When we inspected the practice in January 2016 we saw most staff had received a Disclosure and Barring Service (BDS) check. However, one staff member was undergoing a DBS check. They carried out the role of a chaperone but the practice had not formally assessed risk whilst waiting to for the outcome of the DBS check. At this inspection we looked at all administration staff files and saw DBS checks were in place. DBS checks help to identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable

• During our previous inspection we saw all the emergency medicines were in date. However, they were they were not easily accessible to staff in the event of an emergency. At this follow up inspection we saw that the practice had carried out a risk assessment and had relocated the emergency medicines to accessible locations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 April 2016

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

The provider was rated as requires improvement for safe and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Chronic disease management was led by the GPs and patients at risk of hospital admission were identified as a priority.
• Nationally reported data showed that the outcomes for patients with long term conditions were consistently better that the CCG and National average.
• A six week diabetic education course was offered to support patients to manage their care.
• Longer appointments 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.

Updated 8 April 2016

The practice is rated as requires improvement for the care of families, children and young people.

The provider was rated as requires improvement for safe and caring. The concerns which led to these ratings apply to everyone using the practice, 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.
• Immunisation rates were relatively high for all standard childhood immunisations. Uptake of childhood immunisation rates was comparable to the CCG and national average.
• Nationally reported data showed that the outcomes for patients with Asthma were consistently better than the CCG and national average.
• Uptake of cervical screening was consistently better than the CCG and national average.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice was proactive in contacting patients that do not attend for childhood immunisations and cervical cytology.

Updated 8 April 2016

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

The provider was rated as requires improvement for safe and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Patient received personalised care from a named GP to support continuity of care.
• The practice was responsive to the needs of older people, and urgent appointments for those with enhanced needs.
• The premises were accessible to patients with mobility difficulties.
• Nationally reported data showed that the outcomes for patients with conditions commonly found in the older population were consistently better than CCG and national averages.
• The percentage of people aged 65 and over who received a seasonal flu vaccination was comparable to the National average.
• Shingles vaccinations were available for eligible patients.

Updated 8 April 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students).

The provider was rated as requires improvement for safe and caring. The concerns which led to these ratings apply to everyone using the practice, 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. For example extended opening hours and online booking for appointments
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 8 April 2016

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

The provider was rated as requires improvement for safe and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Performance for mental health related indicators was above the CCG and national average. For example 100% of patients with severe mental health conditions had a documented care plan in place that had been agreed with the individual, their family and/or carers as appropriate.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice provided a weekly counselling service

Updated 8 April 2016

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

The provider was rated as requires improvement for safe and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and carers enabling additional support to be provided
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.