Mossley Fields Surgery

Updated 24 March 2017

The practice is located at 3 Fisher Road, Walsall, West Midlands, WS3 2TA. The practice is part of a partnership which operates as Umbrella Medical and consists of a total of four practices operating in the Walsall area. Mossley Fields Surgery serves a patient population of around 4,100 patients and is a member of NHS Walsall Clinical Commissioning Group.

The practice is situated in a purpose built premises which opened in 2015 and is located over two floors. The premises is accessible for those with a physical disability as floor surfaces are level, entrance doors are automatic and there are wide corridors and rooms allowing access for patients using wheelchairs. Consulting and treatment rooms are all located on the ground floor with the upper floor used for administration, meeting and educational purposes. There is parking available on the site for patients.

The practice population age profile shows that it is above the CCG and national average for patients under 18 years old (28% compared to the CCG average of 23% and national average of 21%) The practice is below the CCG and national average for patients aged over 65 years old (12% compared to CCG and national average of 17%). The average life expectancy for the practice population is 76 years for males and 81 years for females (CCG average for males is 77 years and females 82 years and the national average is 79 years for males and 83 years for female). Data published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The practice population is mainly of White British ethnicity.

The practice provides services under the terms of the General Medical Services (GMS) contract, this is a nationally agreed contract commissioned by NHS England. In addition the practice offers a range of enhanced local services which included:

• Childhood vaccination and immunisation

• Influenza and Pneumococcal immunisation

• Extended hours access

• Out of area in hours care provision

• Alcohol support – identification and brief intervention

• Learning disability support

• Minor surgery

The practice works closely with a team of community health professionals that includes health visitors, midwives, members of the district nursing team and health trainers.

Umbrella Medical is composed of seven GP partners. Mossley Fields Surgery is staffed by two GP partners (one male, one female), one salaried GP (male) and two clinical pharmacists (both male). In addition there are two practice nurses (one with an extended role) and one health care assistant apprentice (both female). Clinical staff are supported by a practice manager, a locality manager, a reception supervisor and a team of administration and reception staff as well as a business administration apprentice. The practice is a teaching and training practice and supports GP Trainees (qualified doctors training to be GPs) Year 1 undergraduate medical students and student nurses. At the time of inspection there were two GP Trainees (both female) training at Mossley Fields Surgery.

The practice appointments include:

• On the day appointments

• Pre-bookable appointments

• Telephone triage/consultations where patients could speak to a GP or nurse to ask advice and if identified obtain an appointment

• Home visits

Appointments can be made in person, via the telephone or online.

The practice is open between 7.30am to 6.30pm Mondays, Tuesdays, Wednesdays and Fridays and from 8.00am to 6.30pm on a Thursday. Appointments are available from 7.30am to 11.50am and from 1.30pm to 5.50pm Mondays, Tuesdays, Wednesdays and Fridays, and from 8.00am to 11.50am and from 1.30pm to 5.50pm on Thursdays.

Out of hours care delivered by an external provider can be accessed via the practice telephone number or patients can contact NHS111.

The practice has not been previously inspected by the CQC.

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mossley Fields Surgery on 9 January 2017. Overall the practice is rated as outstanding.

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

• The practice had an open and blame-free culture with regard to the identification and notification of any significant events and incidents. A thorough analysis of significant events was carried out and these were discussed at monthly practice and educational meetings.

• The practice used innovative and proactive methods to improve patient outcomes and proactively worked with other local providers. For example, the practice organised a health and wellbeing awareness raising event for patients which was attended by a range of local support organisations such as carers’ and dementia groups. In addition staff had worked in collaboration with the local fire and rescue service to promote “Safe and Well” checks. These checks aimed to assess fire risks in patients’ homes and to provide health and wellbeing information to the elderly and vulnerable.

• There was a comprehensive programme of audits, and a good understanding of performance and continuous improvement was evident. Findings and associated learning from audits were disseminated to staff.

• Feedback from patients about their care was consistently positive and above local and national averages. Patients we spoke with said that they were treated with compassion, dignity and respect and felt involved in decisions about their care and treatment.

• The practice provided shared care services and clinics which would normally be delivered in secondary care settings such as hospitals. This allowed patients to receive care closer to their homes and reduced the burden on secondary care services.

• The practice implemented suggestions for improvements and had made changes to the way it delivered services as a consequence of feedback from patients and from the patient reference group (PRG).
• The practice had a vision which had quality and safety as a priority and there was a clear strategic approach to deliver this vision.
• The practice had a culture of teaching and training which was promoted. This ensured patient care was provided by staff who were knowledgeable and skilled.

We saw areas of outstanding practice at the surgery which included the delivery of a high number of responsive local health and wellbeing services and initiatives:

• The practice was responsive to the needs of vulnerable groups and delivered interventions or redesigned operating procedures to actively meet these needs. This included the delivery of shared care services, interaction with traveller families to promote child immunisations and vaccinations and the delivery of services to homeless people.

• The practice recognised the importance of health promotion to raise community health and delivered a range of activities to support this work. This included:

  • Holding a community health and wellbeing awareness raising event.

  • The utilisation of social media to promote health messages and to improve communication between the surgery and patients.

  • Active support and promotion of other campaigns and messages on behalf of other organisations such as “Safe and Well” checks delivered by the local fire and rescue service.

  • Patients were actively encouraged to participate in the Expert Patient Programme (which offered patients access to learning which supported them to build their confidence, skills and knowledge to more effectively manage their own chronic health conditions such as asthma, diabetes). Over the past 18 months the practice had written to 439 patients to promote the programme (over 15% of the patient list) and to invite them to participate.

• Clinical pharmacists and nurses delivered a minor ailments clinic. This freed GPs to deal with patients with more complex needs as well as increasing capacity and accessibility.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 March 2017

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. It had recognised that it had a higher rate of patients diagnosed with certain chronic conditions and put in place services to meet this demand. The practice supported and reviewed patients for conditions which included coronary heart disease, chronic obstructive pulmonary disease (COPD) and asthma and diabetes. At the time of inspection of the 293 patients on the asthma register 77% had received an annual review and of the 125 patients on the COPD register 81% had received an annual review. The practice felt that they would be on track to complete these reviews by the end of 2016/2017. Where possible patients with multiple conditions were reviewed at one time. This reduced the need for patients to make repeated visits to the surgery. One of the practice nurses had received specialist training and was able to deliver spirometry services (spirometry is testing that can help diagnose various lung conditions, most commonly COPD).

• The practice actively worked with other healthcare services to provide care for patients with long term conditions. For example, they hosted a dedicated diabetes clinic staffed by a diabetes specialist nurse for patients with more complex needs.

• Performance for diabetes related indicators was generally either comparable to or above local and national averages. For example, t he percentage of patients on the diabetes register, with a record of a foot examination and risk classification was 94% compared to a CCG average of 90% and a national average of 89%.

• The practice attended multidisciplinary team meetings with partners such as palliative care nurses, district nurses and the community matron on a quarterly basis where they discussed individual patients. This facilitated the provision of joined up care and enabled all parties to be kept up to date with the care needs of the patient.

• Staff encouraged patients to engage with and participate in the Expert Patients Programme (a self-management programme for people living with long term conditions. The programme supports patients by increasing their knowledge and confidence, improving quality of life and helping them to manage their condition more effectively). Over the past 18 months the surgery had contacted 439 patients to inform them of the programme and received a 4% response rate.

• Longer appointments and home visits were available for patients when these were required.

Updated 24 March 2017

The practice is rated as outstanding 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. The practice also had systems in place for identifying and following up children who fail to attend hospital appointments to detect any safeguarding concerns. Practice staff met on a quarterly basis with other health professionals to discuss safeguarding issues.

• Childhood immunisation rates were above the 90% national expected range for vaccinations. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 96% to 100%. For five year olds vaccination rates ranged from 93% to 96%. The practice was working with local health visitors to develop a formal policy in dealing with families who did not attend child immunisation appointments.

• The practice’s uptake for the cervical screening programme was 83%, which was similar to the CCG and national averages of 81%.

• Patients and their children told us that children and young people were treated in an age-appropriate way and were recognised as individuals

• Over 50% of appointments were available outside of school hours and in addition to this the practice had introduced urgent child appointments to ensure early and timely access for children whose health might deteriorate suddenly. The practice premises was modern, light, warm and suitable for children and babies.

• A full range of family planning services were provided from the surgery, these included, free condoms for young people on request, and the fitting of contraceptive implants and intrauterine devices (an intrauterine device or IUD is a small birth control device that is inserted into a woman's uterus to prevent pregnancy).

Updated 24 March 2017

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. All older patients had a named GP and those on long term medication received a regular assessment and review.

• The practice provided or hosted a number of services which could benefit older patients; these included an anticoagulation clinic (anticoagulants are used to prevent the formation of blood clots in the blood vessels and their migration elsewhere in the body), ultrasound scanning and advanced dressings. In addition staff worked closely with the local integrated care team to treat patients with conditions which could be safely managed in the community such as cellulitis and deep vein thrombosis (a blood clot that develops within a deep vein in the body).

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Staff from the surgery worked in collaboration with the local fire and rescue service to promote “Safe and Well” checks. These checks aimed to assess fire risks in patients’ homes and to provide health and wellbeing information to the elderly and vulnerable.

Updated 24 March 2017

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. For example, the practice offered early morning appointments from 7.30am on four mornings a week. Patients who could not attend the practice could access telephone consultations.

• The practice was proactive in offering online services and patients could book and cancel appointments, order repeat medication and access medical records online. Over 10% of the practice patient list had signed up to access online services.

• The practice utilised social media to improve health and wellbeing. For example, to deliver health promotion advice to patients with regard to smoking cessation and dementia. In addition to this, patients were sent text message reminders for appointments and were able to cancel appointments via text messages. The practice also used text messages to deliver key messages such as health advice during hot weather.

• A health and wellbeing awareness event had recently been held which  included input from a local recruitment agency who provided information to patients seeking work.

• Patients could access a full range of health promotion and screening that reflects the needs for this age group.

• The practice had recognised that bowel cancer screening rates were below the national average and undertook a campaign to raise awareness and participation in the screening programme. This activity involved writing to and personally calling patients. At the end of this exercise the practice had contacted 94% of all eligible patients.   

Updated 24 March 2017

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

• Performance for mental health related indicators were either comparable to or above local and national averages. For example, 97% of patients with schizophrenia, bipolar affective disorder or other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months compared to a CCG average of 92% and a national average of 89%.

• 91% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was slightly above the local CCG and national averages of 84%.

• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. In addition the surgery hosted a weekly clinic run by the community mental health nurse who saw on average four to six patients a session.

• The practice told patients experiencing poor mental health and dementia how to access various support groups and voluntary organisations. For example, the practice worked closely with, and signposted patients to, a local support group. The group offered specific dementia advice and support and also organised a monthly dementia café.

• At the time of inspection 35 of the 43 patients (81%) on the mental health register had received a physical health check as well as being in receipt of mental health support.

• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice health care assistant apprentice acted as the surgery dementia champion and worked to raise staff awareness in this area. Local dementia services had attended awareness days organised by the practice.

• Patients presenting with depression were routinely assessed using a suicide risk assessment tool and were offered additional support should risks be identified.

• Reception staff made personal calls to patients with memory issues to remind them of upcoming appointments and reviews. 

Updated 24 March 2017

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

• The practice held registers of patients living in vulnerable circumstances including travellers, those with a learning disability, carers, patients with dementia and mental health problems and children on the child protection register. There were alerts on patients electronic records to identify patients who had been subject to domestic abuse. This ensured staff were aware of the specific needs of these patients and could target and manage services such as health checks and reviews. Where possible patients with a learning disability had reviews carried out in their own home environment to minimise disruption and patient distress.

• At the time of inspection 34 patients were recorded on the learning disability register and 74% of these patients had had a learning disability review completed in the previous nine months. Additionally staff worked closely with the local cancer screening outreach nurse to offer breast and cervical screening for patients with a learning disability patients .They had supported the outreach nurse to deliver services to these patients in their own home environment.

• The practice offered longer appointments for patients when this was required such as for those with language needs or patients with complex conditions.

• To help reduce the challenges that homeless people faced when registering with a GP due to having no fixed address, the practice registered patients who were homeless against the address of a local hostel to ensure they had access to health care services.

• The practice delivered an avoiding unplanned admissions service for patients who had complex needs and were at risk of an unplanned hospital admission. This involved advanced care planning and close working with other care and support organisations.

• The practice regularly worked with other health and care professionals in the case management of vulnerable patients. For example, they provided a shared care service for patients with opiate dependency which allowed them to obtain medication and monitoring services via the surgery. The practice also hosted a monthly substance misuse outreach clinic.

• The practice nurse and locality manager had attended a local traveller site in 2016 to encourage the uptake of child immunisations within the traveller community. During this visit they spoke with 14 families and this led to the vaccination of three children.

• 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 told us that ensured that ex-military personnel received priority referrals to secondary/primary care services as it was recognised that their condition could be related to past service. Patient records were coded to ensure that referrals were completed in a timely manner.

• Patients were regularly screened to identify alcohol dependency on registration and during reviews. We saw evidence to show that in the previous 12 months screening had increased by 18%.