Birchwood Surgery

Updated 16 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 4 March 2016. Improvements were required in relation to safe care and treatment. The practice sent in an action plan informing us about what they would do in relation to the following;

• The practice had not ensured that patient specific directives were in place for healthcare assistants to be able to administer certain types of vaccinations.

During the initial inspection we also found other areas where improvements were required:

• Ensure patients in the waiting rooms and throughout the premises are monitored, in case they become suddenly unwell.
• Review the arrangements for the segregation of clean and dirty areas for hand washing and waste disposal direct to sewage. The practice were limited in changing this as it would involve costly building work and had noted the shortcoming in their business plans and risk assessments.
• Ensure cold chain temperature recording is complete with actions and comments when temperatures exceed the recommended range.
• The practice had decided to treat patients alongside one another in a treatment room. There should be clear signage to inform patients that they can request improved privacy if they wish as conversations could be overheard. The practice should actively solicit patients’ views on the shared treatment area and act on them as necessary.
• Ensure all staff receive timely and adequate appraisals.

They told us the majority of these issues were addressed and provided us with statements and/or evidence to show they had taken the action to address the concerns.

We undertook a desk top review on 3 November 2016 to make a judgement about whether their actions had addressed the requirements.

The overall rating for the practice is good. You can read our previous report by selecting the ‘all reports' link on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2016

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

• Nursing staff had lead roles in chronic disease management, and patients at risk of hospital admission were identified as a priority.
• The practice participated in the Quality and Outcomes Framework (QOF - is a voluntary incentive scheme for GP practices in the UK. The scheme financially rewards practices for managing some of the most common long-term conditions e.g. diabetes and implementing preventative measures. The results are published annually). The practice used the information collected for the QOF and performance against national screening programmes to monitor outcomes for patients. In 2014/2015 the practice achieved 99.3% of the total number of points available, which was above the national average of 94.7% and the local average of 97.3%. The practice reported 11.1% exception reporting which was above CCG (10.4%) and national (9.2%) average.
• Longer appointments and home visits were available when needed.
• 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 nurses made phone calls to patients with certain long term conditions (for example those with chronic obstructive pulmonary disease) who had been discharged from hospital to assist them, with their needs and queries. This had led to a decrease in re-admissions for these patients.
• A hospital consultant diabetes clinic was held at the practice so that patients did not have to travel to the hospital for this service. This was also open for use for patients from other local practices.
• The practice offered a variety of long term conditions clinics and had dedicated administrative staff sent out questionnaires to patients with certain long term conditions in preparation for their attendance.

Updated 13 April 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 and young people who had a high number of A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.
• One of the nurses offered a nurse led gynaecology and family planning clinic as well as sexual health support in the community.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 87.7%, which was above the CCG and England averages.
• 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.

Updated 13 April 2016

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

• 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.
• There was a GP, nurse and emergency care practitioner available for doing home visits every day.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.
• The practice provided rheumatology clinics led by a nurse specialist.
• Two nurses were trained in wound care and a nurse led leg ulcer clinic was in place at the practice.

Updated 13 April 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 had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• 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.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years.

Updated 13 April 2016

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

• 91.5% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan, which was 2.4% above the CCG average and 3.2% above the national average. The exception reporting for this indicator was 24.4%, which was 1.1% below the CCG average but 11.8% above the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice hosted external services such as wellbeing clinics and counselling services to allow this treatment to be delivered to patients closer to their home and to eradicate the need to travel to the hospital for this. The practice provided facilities free of charge for these services.
• The practice had developed a mindfulness library from which patients could loan books if deemed useful by the GPs.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health 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 might have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice had 103 registered patients with dementia of which 72 had received an annual review since April 2015.
• 45 of 65 patients with mental health needs had a care review recorded since April 2015.

Updated 13 April 2016

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

• The practice held a register of patients living in vulnerable circumstances, including those with a learning disability.
• 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.
• Patients who were carers were proactively identified and signposted to local carers’ groups.
• GPs carried out home visits for patients with palliative care needs.
• 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.
• GPs visited local care homes at least once a week. Twice weekly if required.
• The practice carried out annual health checks for people with a learning disability and 58 out of 90 of these patients had received a review since April 2015.