Holland Park Surgery

Updated 24 August 2016

Holland Park Surgery is located in Walsall West Midlands; situated in a multipurpose modern built NHS building, providing NHS services to the local community. Based on data available from Public Health England, the levels of deprivation (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by Holland Park Surgery are comparable to the national average, ranked at four out of 10, with 10 being the least deprived. The practice serves a higher than average younger population and those aged under 65.

The patient list is 3929 of various ages registered and cared for at the practice. Holland Park Surgery is built up of a group of GPs who work in a partnership called Umbrella Medical. The group of GPs were appointed to run the practice in November 2006. Service delivery is supported by six GP partners, a clinical and administration team. Services to patients are provided under an Alternative Primary Medical Services (APMS) contract with the Clinical Commissioning Group (CCG). APMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The surgery is registered with the Care Quality Commission (CQC) to deliver Diagnostic and screening procedures, Family planning, Maternity and midwifery services, surgical procedures, Treatment of disease, disorder or injury.

The practice is situated on the ground floor of a multipurpose building shared with other healthcare providers and the local library. There is parking for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staff comprises of one male and three female GPs with specialists interests in pharmacology, palliative care, men’s and women’s health. The nursing team is built up of one advanced nurse practitioner, two practice nurses, one health care assistant and two apprentice health care assistants. Service delivery is supported by a practice team which consists of one practice manager, one locality manager, two administrators, a clinical summariser, a secretary and three receptionists.

The practice is a teaching practice for the University of Birmingham Medical School facilitating GP Registrar’s (GPs in training) to gain experience, knowledge and higher qualifications in general practice and family medicines. The practice is also a Nursing Training Practice for the University of Wolverhampton taking first to fourth year nursing students.

The practice is open between 7:30am to 6:30pm Monday, Wednesday and Friday, 8:00am to 6:30pm Tuesdays and 7:30am to 1pm Thursdays.

GP consulting hours are from 7:30am to 6:30pm Monday, Wednesday and Friday, 8:00am to 6:30pm Tuesdays and 7:30am to 1pm Thursdays. Appointments were from 8:30am to 11:30am and 3:40pm to 6pm Mondays, Tuesdays, Wednesdays and Fridays; Thursday appointments were from 8:30am to 11:30am and the practice closed at 1pm. The practice has opted out of providing cover to patients in their out of hours period. During this time services are provided by Primecare. The practice also has a contract with Waldoc who provides cover from 1pm to 6:30pm on Thursdays.

The practice has not previously been inspected by CQC.

Updated 24 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holland Park Surgery on 11 May 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Throughout our inspection there was a strong theme of positive feedback from staff and patients. Patients said they were treated with compassion, dignity and respect and they felt involved in their care and decisions about their treatment.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice had a well-established shared care service which they managed in conjunction with community outreach workers. This allowed the practice to effectively manage physical and psychological problems that may coexist with illicit substance misuse.

• Feedback from patients about their care was consistently positive.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and the patient participation group. For example to bring more services closer to patients homes the practice listened to feedback and therefore implemented a Anticoagulation clinic (a blood test which tells clinicians how long Warfarin a blood thinning medication is delaying the blood from clotting) and carried out ultrasound and advanced dressings including compression dressings.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and assessed how they were being managed and responded to, improvements were made as a result.
• The practice was proactive in identifying and managing significant events. For example all significant events were thoroughly investigated and opportunities for learning from internal and external incidents were maximised.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership with robust governance arrangements in place. There was a regular programme of practice meetings and the overarching governance framework supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice.

The practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. There were clear systemic processes in place and a strong learning culture with development opportunities for all staff. The practice was well organised and made full use of their resources to respond to changing population needs. We saw several areas of outstanding practice for example:

• The practice attended the yearly canal event in order to promote services available to those who would not normally access health care services. As a result the practice identified a number of people who were not registered with the practice. The practice now registers and supports ‘Liveaboards’ (people living aboard canal boats).

• The practice holds a yearly Awareness Day which they invite professionals such as the hospice Palliative Care Consultant, local Macmillan Nurse, Pathways4Life (a dementia support worker service for hard to reach groups), life coaches and diabetes UK to raise community awareness of the range of services available. Topics discussed on the day such as end of life care created much interest amongst patients and their carers.

• The practice had a strong culture of continued professional development and was keen to encourage younger people to take up a career in general practice. For example the practice helped young professionals gain employment and training in a health and social care environment by employing two clinical healthcare support apprentices.

• Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example the Patient Participation Group PPG was involved in the registrars and student nurses induction plan, for example they provided talks on topics such as an overview of services from the eyes of patients.

However there were areas of practice where the provider should make improvements. For example:

• The practice should continue to increase the uptake of health checks for patients aged 40 to 70 and over 75s.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 August 2016

The practice is rated as outstanding 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. We saw that the practice held bi-monthly unplanned admissions meetings, these were well minuted and there was clear evidence of actions taken to reduce further hospital admissions.

• Performance for diabetes related indicators was similar to the national average. For example 83% had a specific blood glucose reading of 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) compared to the CCG and national average of 78%.

• The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) was 98%, compared to CCG average of 97% and national average of 94%.

• Longer appointments and home visits 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.

• Clinical staff were encouraging patients to engage with the Expert Patients Programme (a self-management programme for people living with long-term conditions, which supports them by increasing their confidence, improving their quality of life and helping them manage their condition more effectively).

• The practice provides a room for the community physiotherapist who runs a weekly clinic at the surgery. 

Updated 24 August 2016

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

• 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.

• Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

• The practice held nurse-led baby immunisation clinics and vaccination targets were in line with the national averages.

• The practice’s uptake for the cervical screening programme was 80%, which was above to the CCG average of 73% and the national average of 74%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

• Appointments were available outside of school hours and we observed the premises to be suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses. For example the practice held bi-monthly multidisciplinary sharing and safeguarding meetings.

Updated 24 August 2016

The practice is rated as outstanding 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, for example they offered support to registered patients who resided in the local care home, home visits and urgent appointments was available for those with enhanced needs.

• The practice is located in a multipurpose shared building and we saw that they proactively engaged with other health care professionals. For example we saw evidence of excellent working relationships with district nurses and community matron. The practice used the Integrated Care Team for conditions that can be safely managed in the community such as cellulitis and Deep Vein Thrombosis.

• The practice pharmacist carried out medication checks and held regular meetings with the GPs to discuss patient’s needs.

• Data provided by the practice showed that 68% of patients aged 75 plus have had their health checks. The practice were pro-actively trying to increase this number, for example we were told that the practice used two apprentice healthcare assistants to help increase the uptake of over 75s health checks. Patients were also invited for checks opportunistically.

• The practice holds annual awareness days, each year they would have a specific theme. For example end of life care which was attended by the hospice Palliative Care Consultant and the local Macmillan Nurse. We were told the event created much interest amongst patients and their carers and did much to raise awareness of end of life issues in the local community. This was confirmed by some of the patients we spoke to on the day who stated that the practice held very good awareness events.

• We were told that the practice upcoming awareness day would be attended by a range of services such as Diabetes UK, Walsall Health Trainers and Lifestyle Services, Pathways4Life and St Giles Hospice.

Updated 24 August 2016

The practice is rated as outstanding 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. There were three online appointments per GP session available daily.

• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years. Although the uptake was low, for example 20% had their routine health check; we saw that the practice used apprentice health care assistants to help increase the uptake and they were also opportunistically directing patients to apprentice health care assistants

• We saw that the practice were proactive in offering a full range of health promotion and screening.  The practice had a Facebook and Twitter page to provide updates on their services, the practice provided data which showed that their Facebook page had 100 likes with the largest page reach being 124 people.  We saw that the practice actively engage with the local community, especially those who might otherwise have little contact with health services.

Updated 24 August 2016

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

• 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the national average. Data provided by the practice showed that there were 50 patients on the practices register for dementia, five declined a care plan, of the remaining 45 patients 73% had care plans in place.

• Performance for mental health related indicators was above the national average. For example 92% compared to the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example the practice worked closely and signposted patients to Pathway4life, we also saw that the practice signposted patients to the monthly dementia café.

• 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. We saw that patients were also being discussed during the practice bi-monthly unplanned admissions meeting.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• Community Psychiatric Nurse ran sessions at the practice to support patients who were experiencing mental health issues.

Updated 24 August 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability (LD). The practice provided data which showed that 85% of patients with a LD have had a care plan and medication review in the last 12 months, 96% had a face to face review in the last 12 months.

• The practice attended the yearly Brownhills Canalside Festival to provide general health advice, blood pressure checks and information to those who would not normally access health care services. As a result the practice identified a number of people who were not registered with the practice. The practice now registers and supports ‘Liveaboards’ (people living aboard canal boats).

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example they provide shared care service in partnership with the local addiction service for patients with opiate dependency allowing them to obtain their medication at the surgery. The practice found that this reduces stigma and allowed the practice to manage any physical and psychological problems that may coexist with illicit substance misuse.

• 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.

• The practice provided in house bereavement counselling via their longstanding attached Community Psychiatric Nurse. We were told that the practice always sent a condolences card to relatives of patients who have passed away.