Archived: Tile Cross Surgery

Updated 5 September 2016

Tile Cross Surgery is based in Tile Cross area of the West Midlands. There are two surgery locations that form the practice; these consist of the main practice at Church Road and the branch practice at Tile Cross Surgery. There are approximately 11460 patients of various ages registered and cared for across the practice and as the practice has one patient list, patients can be seen by staff at both surgery sites. Systems and processes are shared across both sites. During the inspection we visited both locations. As the locations have separate CQC registrations we have produced two reports. However where systems and data reflect both practices the reports will contain the same information.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes. The practice runs an anti-coagulation clinic for the practice patients.

There are two GP partners (one male, one female) and two female salaried GPs. The practice has undergone significant upheaval in the last nine months with the resignation of four GP partners, a practice nurse and the retirement of another practice nurse. The practice has employed a new salaried GP and two practice nurses recently. The nursing team currently consists of three nurses and two health care assistants. Another practice nurse is due to start in June 2016. The non-clinical team consists of a practice manager, assistant practice manager, administrative and reception staff. The clinical staff worked across both sites.

The area served has higher deprivation compared to England as a whole and ranked at three out of ten, with ten being the least deprived.

The practice is open 8am to 6.30pm Monday and Wednesday, 8am to 1pm Tuesday, Thursday and Friday. When Tile Cross surgery is closed, patients can access appointments at the Church Road site. Extended hours appointments are available 7.30am to 8am Monday to Friday. Emergency appointments are available daily. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. The out of hours service is provided by Badger Out of Hours Service and NHS 111 service and information about this is available on the practice website.

The practice is part of NHS Solihull Clinical Commissioning Group (CCG) which has 38 member practices. The CCG serve communities across the borough, covering a population of approximately 238,000 people. A CCG is an NHS Organisation that brings together local GPs and experienced health care professionals to take on commissioning responsibilities for local health services.

Updated 5 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tile Cross Surgery on 5 May 2016. Overall the practice is rated as requires improvement. There are two surgery locations that form the practice; these consist of the main practice at Church Road and the branch practice at Tile Cross Surgery. Systems and processes are shared across both sites. During the inspection we visited both locations. As the locations have separate CQC registrations we have produced two reports. However where systems and data reflect both practices the reports will contain the same information.

Our key findings across all the areas we inspected were as follows:

• The practice had defined and embedded systems in place to keep people safeguarded from abuse. There was a system in place for reporting and recording significant events and staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses.
• We observed the premises to be clean and tidy, but the building was situated in a residential area which posed difficulties for parking and access.
• The practice had reviewed its fire evacuation procedures with the local fire officer to ensure that robust systems were in place.
• Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment and results were circulated and discussed in the practice.
• 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. Some staff had not received regular appraisals.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was limited information on display about local services and no details of carers groups or support organisations were available.
• Information about how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Due to resignation of four GP Partners, the practice had employed locums to ensure that appointments were available daily.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.
• Governance and risk management arrangements were in place, but were not operating effectively and therefore the provider did not have appropriate oversight of risk. For example no risk assessments had been completed in the absence of disclosure and barring checks (DBS) for members of the reception team who occasionally chaperoned.
• Areas of poor performance in relation to QOF and screening had been considered with action plans in place to mitigate this.
•  Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. We saw evidence that quarterly multidisciplinary team meetings took place.

The areas where the provider must make improvements are:

The provider did not have effective systems to enable them to identify, assess and mitigate risks by;

• Seeking and acting on feedback received to demonstrate improvements to services.

• Keeping records to demonstrate that staff were up to date with the immunisations recommended for staff who are working in general practice, such as Hepatitis B, mumps and rubella (MMR) vaccines.

• Ensuring all staff are risk assessed in the absence of a Disclosure and Barring Service (DBS) check when carrying out chaperoning duties.

Patients were not protected against the risks associated with receiving unsafe care or treatment in that;

• Patient Specific Directions were not in place for patients who received vaccinations by the Health Care Assistant.

The areas where the provider should make improvement are:

• Ensure staff who chaperone are aware of and comply with recommended chaperoning guidelines when observing treatments and examinations.

• Have information available for patients on support groups and services available in the local area.

• Review current processes for ensuring patients with a learning disability receive annual health checks.

• Ensure that staff are informed and involved in the overall vision of the practice.

• Complete appraisals for all staff including development plans.

• Monitor quality and outcome framework (QOF) indicators to ensure patient reviews are up to date and completed.

• Continue to review the registers for patients with long term conditions and mental health needs to ensure appropriate reviews are in place.

• Consider how to proactively identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 September 2016

The practice is rated as requires improvement for providing safe, effective and, responsive and inadequate for well led services; this affects all six population groups.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The latest QOF results showed performance for chronic pulmonary obstructive disease (COPD) indicator was 69.7%, which was lower than the national average of 96%. The practice attributed the lower QOF scores to low exception reporting.

• Longer appointments and home visits were available when needed and housebound received reviews and vaccinations at home. For example, blood tests for warfarin monitoring were carried out by the Health Care Assistant.
• Patients with a long term conditions 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.
• We saw minutes of meetings to support that joint working took place and that patients with long term conditions and complex needs were discussed as part of the practices multi-disciplinary team meetings (MDT) meetings.
• The practice ran an In house diabetes clinic with the support of a hospital consultant at both Tile Cross and Church Road.

Updated 5 September 2016

The practice is rated as requires improvement for providing safe, effective and, responsive and inadequate for well led services; this affects all six population groups.

• The practice’s uptake for the cervical screening programme was 74% which was lower than the national average of 82%.
• The practice held nurse-led baby immunisation clinics and vaccination targets, but results were lower than the national averages.
• Urgent appointments were available for children and were also available outside of school hours.
• The premises were suitable for children and babies. We saw positive examples of joint working with midwives and health visitors and the midwife held an ante natal clinic once a week at the practice.

Updated 5 September 2016

The practice is rated as requires improvement for providing safe, effective and responsive and inadequate for well led services; this affects all six population groups.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• Patients 75 and over were being notified of their named GP and the practice carried out twice weekly ward rounds at the local nursing home.
• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. There were 1% of patients on the unplanned admissions list and we saw evidence that every new patient received a care plan. Patients who were discharged from hospital were reviewed within 24 hours of being discharged from hospital to establish the reason for admission. Patients were reviewed and care plans were updated.
• The practice worked closely with multi-disciplinary teams so patients conditions could be safely managed in the community.

Updated 5 September 2016

The practice is rated as requires improvement for providing safe, effective and, responsive and inadequate for well led services; this affects all six population groups.

• 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 reflected the needs for this age group.

• A full range of health promotion and screening that reflected the needs for this age group was also available. It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.

• The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• Early morning appointments were available for patients who could not attend during normal surgery hours.

Updated 5 September 2016

The practice is rated as requires improvement for providing safe, effective and, responsive and inadequate for well led services; this affects all six population groups.

• The practice had 103 patients on the dementia register and 76.9% had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 and offered same day appointments.
• The practice held a register of patients experiencing poor mental health; a low number had received a regular review. We saw that there were 91 patients on the mental health register and 76.5% had had care plans agreed.

Updated 5 September 2016

The practice is rated as requires improvement for providing safe, effective and, responsive and inadequate for well led services; this affects all six population groups.

• The practice offered longer appointments for patients who required them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. We saw that there were 46 patients on the learning disability register and ten patients had received an annual health checks. The practice attributed the low number of health checks to staff shortages and patients not attending their appointments despite reminders being sent. .
• 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.
• The practice held a register of carers and had 171 carers registered, which represented 1.49% of the practice list. On further investigation we found that the GPs were unsure of the correct coding to use to identify carers on the clinical system.
• Patients were unaware of what support and organisations were available due to lack of information being available in the waiting room and reception areas.