Ward End Medical Centre

Updated 22 August 2016

Ward End Medical 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.

Ward End Medical 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 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 is located in a purpose built health centre. Based on data available from Public Health England, deprivation in the area served is among the highest 10 per cent nationally. The practice has a registered list size of approximately 6,700 patients.

The practice is open 8.30am to 6.45pm on Monday, Tuesday Wednesday and Friday and 8.30am to 1pm on a Thursday. Appointment times vary between clinicians and on a daily basis but are usually between 8.30am and 12pm and between 3pm and 6pm with the exception of Thursday when it closes in the afternoon. The practice does not provide any extended opening hours. When the practice is closed during the day (8am and 8.30am Monday to Friday and 1pm and 6.30pm on a Thursday) and in the out of hours period (6.30pm to 8am) patients receive primary medical services through another provider, Birmingham and District General Practitioner Emergency Room Group (BADGER).

The practice has three GP partners (all male), one of which is in the process of registering with CQC and two long term locum GPs (both female). Other practice staff consist of a physician assistant, three practice nurses (one of which is a diabetic nurse specialist) and two healthcare assistants. There is also a team of administrative staff which include three practice administrators who share responsibilities for the daily running of the practice.

The practice was previously inspected by CQC in July 2015 and was found to be in breach , regulation 12 Safe Care and Treatment, regulation 17 Good Governance and Regulation 19 Safe Care and Treatment of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014.

Updated 22 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ward End Medical Practice on 15 July 2016. The practice had previously been inspected in July 2015 and was found to be in breach of regulations 12 (safe care and treatment), 17 (good governance) and 19 (fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice was rated as requires improvement for providing services that were safe and well led and was rated requires improvement overall.

Following the inspection the practice sent us an action plan detailing the action they were going to take to improve. We returned to the practice to consider whether improvements had been made in response to the breaches in regulations. We found the practice had made sufficient improvements and is now 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.
• Risks to patients were assessed and generally well managed. We saw improvements in relation to infection prevention and control, recruitment checks and medical emergencies.
• 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. However, feedback from patients found that not all felt involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand and supported leaning.
• Patients said they usually found it easy to make an appointment but some patients found getting through on the phone difficult. Patients were able to obtain urgent appointments on 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.

The areas where the provider should make improvement are:

• Ensure COSHH risk assessments include safety information for products used in the practice.
• Review and implement ways in which the identification of carers might be improved so that this group of patients can receive support.
• Review systems of obtaining and responding to patient feedback. Identify how this may be improved and utilised to support service improvement including, verbal complaints, comments made through NHS Choices, national patient survey and the patient participation group.
• Ensure the practice nurse has formal opportunities for clinical engagement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 August 2016

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

• Patients with long term conditions received annual reviews to check their health and medicines needs were being met. There were specific clinics for patients with diabetes and asthma.
• A diabetic nurse who was previously funded through the CCG had been employed by the practice to continue running their diabetic clinic when funding had ceased.
• Practice performance for diabetes related indicators overall was 100% which was higher than the CCG and national average of 89%. Exception reporting for diabetes was comparable to CCG and national averages.
• For the convenience of patients the practice provided in house services such as electrocardiogram (ECG), ambulatory blood pressure monitoring, spirometry and phlebotomy to support the diagnosis and management of patients with long term conditions.
• Longer appointments and home visits were available when needed.

Updated 22 August 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 did not attend for immunisations. Immunisation rates were relatively high for the majority of standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 82%, which was above the CCG average of 78% and comparable to the national average of 82%.
• Baby changing facilities were available.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided post natal and baby checks.
• The practice worked with health visitors, the partners told us there were difficulties holding formal meetings due to local pressures on the health visiting team but that they regularly spoke on the telephone.

Updated 22 August 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.
• The practice offered flu and shingles vaccinations to eligible patients in this age group. Data from the CCG for 2015 showed uptake of flu vaccinations was higher than other practices in the local clinical network.
• Practice staff worked as part of a multidisciplinary team to provide care and support to patients with end of life care needs.

Updated 22 August 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 considered by the practice.
• 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. For example, NHS health checks.
• Although the practice did not offer extended opening hours telephone consultations were available.
• The practice used text messages to remind patients of their appointments.
• Travel vaccinations were available on the NHS.

Updated 22 August 2016

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

• National reported data for 2014/15 showed 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average 82% and national average 84%. Exception reporting was comparable to CCG and national averages.
• National reported data for mental health outcomes (2014/15) was 96% which was comparable to the CCG average 92% and national average 93%. There were also lower levels of exception reporting than the CCG and national averages.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Information displayed in the waiting area signposted to various support groups for people with dementia and their families to meet together socially.
• The practice had recently started to provide support to patients who misused drugs and alcohol. Since June 2016 two drug worker clinics operated from the practice.

Updated 22 August 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 such as those with a learning disability, those who misused drugs and alcohol and those with caring responsibilities.
• Patients on the learning disability register were offered health reviews which were carried out at the practice or within the patient’s home. The practice told us that there were 39 patients on the learning disability register and during 2015/16 they had carried out health reviews on 85% of these patients. Protected time was given to the practice nurse to undertake the reviews.
• The practice had 43 patients registered as carers, those identified were signposted to locally available 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.
• Children in local temporary accommodation were encouraged to receive immunisations.