University Medical Practice

Updated 12 April 2017

The practice is part of the NHS Birmingham Cross City clinical commissioning group (CCG). We visited the following location as part of inspection: University Medical Centre, 5 Pritchatts Road, Edgbaston, Birmingham, B15 2QU.

The University Medical Practice provides care and treatment to 20,180 patients of all ages, based on a General Medical Services (GMS) contract. The practice has a large student population, (almost 90% of patients are university students), but also provides care and treatment of patients who are not students. Approximately 50% of patients were aged between 18 and 25 years of age and, 89% were below 45 years of age. Sixteen per cent of patients were from China. The practice had a high patient list turnover, over 20% a year. The practice had no patients registered with them that lived in nursing homes and only two patients that lived in a residential home.

The area in which the practice is situated is in the sixth least deprived decile. Figures show that 89.9% of the practice’s patients are in paid work or full-time education compared with the England average of 62.5%. The percentage of patients with a long-standing health condition is higher than the national average, 59.6% compared to 53.2%. There are fewer patients with caring responsibilities than the England average, 5.3% compared to 17.8%.

The practice occupies purpose built premises that are located on the edge of the university campus in Edgbaston. There are 20 consulting rooms, a minor operations suite and two meeting rooms. All treatment and consultation rooms are located on the ground floor. The practice has eight GP partners (five male, three female), a GPR (trainee doctor, female), a foundation year two trainee doctor (female), two nurse practitioners and two practice nurses (female), a practice manager (male), and a team of 11 administrative and reception staff. Three of the GP partners acted as University Medical Officers, in addition to their roles and responsibilities at the practice. The practice was a training practice and had recently begun offering training placements to army foundation doctors.

The practice is open Monday to Thursday, between 8:30am and 6pm, and on Fridays between 8:45am and 5:30pm. When the practice is closed patients can access out-of-hours care via Prime Care, and the NHS 111 service.

Approximate GP appointment times are: Monday: 8:30am to 12:40pm and 2:40pm to 5:20pm; Tuesday: 8:30am to 1pm and 1:50pm to 5:20pm; Wednesday: 8:30am to 12:10pm and 2:20pm to 5:20pm; Thursday: 9am to 1pm and 1:50pm to 5:20pm; Friday: 8:30am to 11:40pm and 1:50pm to 5pm. A limited number of daily lunch time appointments are also available.

Updated 12 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the University Medical Practice on 17 January 2017. 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 the practice had an effective system for reporting and recording significant events, and learning from them.

• Risks to patients and staff were assessed and well managed. Effective governance arrangements were in place.

• All staff were actively engaged in monitoring and improving quality and patient outcomes.

• Staff assessed patients’ needs and delivered care and treatment in line with current evidence based guidance. They had the skills, knowledge and experience to deliver effective care and treatment.

• Staff had been very proactive in identifying and meeting the needs of their atypical patient population. They were highly committed to delivering services that recognised individual needs, promoted equality and provided flexibility, choice and continuity of care.

• Data from the NHS National GP Patient Survey of the practice, published in July 2016, showed patients rated the practice higher than others for almost all aspects of care.

• Data from the NHS National GP Patient Survey also showed that the practice had performed better than the local CCG and national averages in relation to telephone access and appointment availability.

• Information about services and how to complain was available and easy to understand.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Staff were very committed to supporting patients to live healthier lives through a targeted and proactive approach to health promotion.

• A culture had been created which encouraged and sustained learning and improvement at all levels.

• The provider had a clear vision and strategy for the development of the practice and they were committed to providing their patients with good quality, safe care. There was strong clinical leadership and clear and effective governance structures were in place.

However, there were also areas where the provider should make improvements. The provider should:

• All staff should complete information governance and health and safety training.

• Review the complaint response letter template to make sure it complies with recognised guidance and contractual obligations for GPs in England.

• Continue to improve the uptake of cervical screening for females aged between 25 and 64 years of age and maintain an accurate and up-to-date patient population list.

• Develop a system by working with the local clinical commissioning group to mark the records of parents or guardians of at-risk children to alert clinical staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 April 2017

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

• The QOF data, for 2015/16, showed the practice had performed above, or broadly in line with, most of the local CCG and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• Patients with long-term conditions were offered regular reviews, to check their health needs were being met and they were receiving the right medication. Longer appointments and home visits were available when needed.

• All twelve housebound patients had a named GP, and had received a comprehensive annual review during the previous 12 months.

Updated 12 April 2017

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

• There were systems in place to protect children who were at risk and living in disadvantaged circumstances. For example, appointments were available outside of school hours. Children who were ill had access to same day care via the daily duty surgeries. Patients were able to access fortnightly, midwife-led ante-natal clinics. Clinicians carried out telephone reviews with new mothers. They also carried out ‘new baby’ checks, which included relevant immunisations. The family of any child failing to attend a paediatric clinic were contacted by the practice nurse, to find out why and what could be done to ensure attendance.

• The practice offered contraceptive and sexual health advice, and information was available about how patients could access specialist sexual health services.

• The practice had a comprehensive screening programme. Nationally reported information showed they had performed in line with the national averages, in relation to breast and bowel cancer screening, but less well regarding cervical screening rates. The uptake of cervical screening for females aged between 25 and 64, attending during the target period, was much lower at 49.8%, than the national average of 81.4%. Clinical staff had a good understanding of the reasons behind their lower cervical screening rates, and had put an improvement plan in place to address this.

• The practice offered a full range of immunisations for children. Publicly available information showed they had performed less well in delivering childhood immunisations to under two year olds, when compared to the target set by NHS England. The practice’s immunisation rates, for the four immunisations given to children under the age of two, were 86.1%. These were below the 90% standard target set by NHS England. There was a small number of children registered with the practice and this can have a disproportionate impact on the immunisation rates. Also, the practice’s immunisation rates were affected by the challenges they faced delivering vaccinations to the children of overseas students.

Updated 12 April 2017

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

• Nationally reported Quality and Outcomes Framework (QOF) data, for 2015/16, showed the practice had performed above, or broadly in line with, most of the local clinical commissioning group (CCG) and national averages, in relation to providing care and treatment for the clinical conditions commonly associated with this population group.

• The practice was able to provide a more personal, comprehensive service to their older patients, as they had much small numbers registered with them than other practices. For example, the majority of patients aged over 75 had been included on a register used by the practice to help avoid unplanned admissions into hospital. Also, care plans had been put in place to help meet the needs of these patients.

• Staff worked in partnership with other health care professionals to ensure that older patients received the care and treatment they needed.

Updated 12 April 2017

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

• The majority of patients registered with the practice were students. The practice provided a range of services which reflected this. For example, each autumn staff engaged with the University and Students’ Guild to help raise awareness of Meningitis and, staff promoted the MenACWY vaccination to all new students registering with the practice. The practice also provided a full range of health promotion and screening that reflected the needs of patients who were not students.

• Staff worked closely with staff from the university to help mitigate the effect of issues affecting the academic progress of students.

• Signposting directed students to appropriate specialised services. Students had access to long-acting, reversible and emergency contraceptive services, as well as testing for sexually transmitted diseases.

• Patients were able to book appointments and request prescriptions online, and the practice provided two Saturday morning influenza vaccination clinics during the winter, for working patients and their families.

• Clinical staff actively used the e-referral service, which helped students to access secondary care treatment nearer to their own home.

• The QOF data, for 2015/16, showed the practice had performed either above, or broadly in line with, most of the local CCG and England averages, in providing recommended care and treatment to this group of patients.

• Information on the practice’s website, and on display in their patient waiting areas, informed patients how to access the out-of-hours service.

Updated 12 April 2017

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

• Performance for three of the mental health related indicators was similar to both the local CCG and national averages, but performance for the other three indicators was below both of these averages. For example, the percentage of women aged between 25 and 65, with the specified mental health conditions, whose notes included a record that a cervical screening test had been performed during the preceding five years, was higher than the England average (100% compared to 89%). However, the data also showed that the percentage of patients with the specified mental health conditions, who had had a comprehensive, agreed care plan documented in their medical record, during the period from 1 April 2015 to 31 March 2016, was lower than the England average (80.8% compared to 88.8%).

• The practice collaborated with other services and organisations to help provide students experiencing poor mental health with access to a range of appropriate interventions. For example, the practice worked closely with the university’s Counselling and Health and Wellbeing (CHWB) service, to help ensure patients were able to obtain specialist advice and support. Staff piloted the mental health digital peer support service ‘Big White Wall’ which is a digital mental health and well-being support service, which enables patients to access safe, anonymous and professionally moderated support. The practice had actively worked with the new local mental health service provider, ‘Forward Thinking Birmingham’ (FTB), to help provide patients, aged 18 to 25 years of age, with accessible and responsive mental healthcare.

• The practice had a system in place which helped ensure that patients with mental health problems who had attended accident and emergency department were followed up by the duty doctor, to see whether any additional support was needed.

Updated 12 April 2017

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. For example, staff maintained a register of patients with learning disabilities, which they used to ensure they received an annual healthcare review.

• Staff understood their responsibilities regarding information sharing and the documentation of safeguarding concerns, and they regularly worked with multi-disciplinary teams to help protect vulnerable patients. Staff were aware of how to contact relevant agencies in normal working hours and out-of-hours, to help ensure patients were safe.

• Arrangements had been made which helped patients who were homeless to register using a temporary address, such as that of a day care centre.

• Appropriate arrangements had been made to meet the needs of patients who were also carers.