Halesowen Medical Practice

Updated 20 March 2017

Halesowen Medical Practice is a long established practice located in the Halesowen area of Dudley, in the West Midlands. There are approximately 9,515 patients of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. 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 clinical team includes three female GP partners and two male GP partners. There is also a female salaried GP, a senior nurse and prescriber, two practice nurses and two health care assistants. The GP partners and practice manager form the management team and they are supported by a team of 18 support staff who cover reception, secretarial and administration roles. The practice is also an approved training practice and provides training to GP Registrars (qualified doctors training to become GPs). At the time of our inspection there were two GP Registrars in post.

The practice is open for appointments between 8am and 6:30pm during weekdays. There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 20 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Halesowen Medical Practice on 20 January 2017. Overall the practice is rated as good.

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

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

• We saw that when significant events were formally recorded, they reflected a best practice process. The practice as a whole encouraged a culture of openness and honesty and staff at all levels were supported and encouraged to raise concerns. There was a nominated staff member as a ‘freedom to speak up’ guardian, this enabled staff to feel confident in speaking freely, safely and in confidence.

• The practice was proactive in identifying patients with complex health conditions. The practice used effective principles to streamline processes. Staff effectively monitored quality and collated and analysed information to support practice capacity and service demand.

• We saw how the practice maximised use of their IT system in an innovative way to develop effective pathways within their patient record system. This included the development of an effective recall system where patients were called in to the practice for monitoring and reviews, based on their conditions and personal needs. Practice data highlighted that 98% of their patients with a long term condition had received a medicines review within the last 12 months.

• The practice took a proactive approach to understanding the needs of their patients who were carers. Due to ongoing work to identify and support carers, the practices carers register had steadily increased from 1% to 3% since 2015 and carers were offered support and regularly reviewed by the practice.

• A programme of continuous clinical and internal audit was used to monitor quality and to make improvements. This was with the exception of the minor surgery infection control audit, which did not demonstrate actions taken as a result of improvements identified.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients, staff and from the patient participation group (PPG).

• The PPG regularly carried out fund raising for the practice through practice events and practice raffles. The monies raised were invested in to the practice through purchasing medical equipment to benefit patients. Equipment purchased was often as a result of feedback from staff. For example, staff had identified that blood pressure monitors would be useful for patients who required monitoring at home.

• We observed the premises to be visibly clean and tidy. There were accessible facilities for patients with mobility needs and translation services available at the practice. The practice also had a portable hearing loop; staff explained how the GPs were able to take this on home visits whilst visiting patients with hearing difficulties.

• The practice had a clear vision which had quality and safety as its top priority. The practice team was forward thinking and the practice was involved in a number of local pilot projects developed to respond and meet people’s needs.

• The practice had a regular schedule of practice meetings and there was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care.

The areas where the provider should make improvements are:

• Continue to ensure that records are kept to support monitoring of emergency equipment and effective management of uncollected prescriptions.

• Ensure systems are in place to monitor and improve infection control procedures. This should include acting on findings of audits and maintaining records that demonstrate cleaning of all equipment and practice carpets.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 March 2017

The practice is rated as good 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.

• Performance for overall diabetes related indicators was 92%, compared to the CCG average of 86% and national average of 89%.

• One of the GP partners had successfully developed an effective review and recall system to call patients based on the level of need and the level of risk. Patients with long term conditions or comorbidities had their conditions coded on their records to ensure they were managed based on need. Patients with the most need were seen as a priority. Data provided by the practice highlighted that 98% of patients with a long term condition had received a medicines review within the last 12 months.

• We saw evidence that multi-disciplinary team meetings took place on a monthly basis with regular representation from other health and social care services. We saw that discussions took place to understand and meet the range and complexity of people’s needs and to assess and plan ongoing care and treatment.

Updated 20 March 2017

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 had a high number of A&E attendances.

• Childhood immunisation rates for under two year were at 100% compared to the national average of 90%. Immunisation rates for five year olds were ranged from 95% to 97% compared to the CCG average of 87% to 93%.

• The practice offered urgent access appointments for children, as well as those with serious medical conditions.

• The practice’s uptake for the cervical screening programme was 80%, compared to the CCG average of 80% and national averages of 81%.

• Information was made available to patients in a variety of formats; the practice also provided information according to each population group. For example, the practice had developed a folder for young people containing information on services available and how to access specific care and support if needed.

Updated 20 March 2017

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. All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

• Patients aged 95 and over were automatically added to the practices vulnerable patient register. All patients on the vulnerable patient register had a care plan in place. There was a lead for care planning in the practice that actively monitored hospital discharges and followed up on vulnerable patients within a week of being discharged from hospital.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Immunisations such as flu and shingles vaccines were also offered to patients at home, who could not attend the surgery

• The  practice also monitored patients without a long term condition, who were aged 75 and over and not seen by a clinician within a 12 month period. These patients were contacted and given the option of a consultation and a health check.  

Updated 20 March 2017

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

• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group.

• Practice data highlighted that they had identified and offered smoking cessation advice and support to 37 of their patients and 54% had successfully stopped smoking.

• Patients could access appointments and services in a way and at a time that suited them. Appointments could be booked over the telephone, face to face and online.

• The practice was also taking part in the Sense.ly app pilot. This was a downloadable application where patients could access appointment booking and a nurse triage system through devices such as smart phones and tablets. The outcome of the assessments resulted in advice which could include an appointment request or onward referral to other health care services.

• The practice also offered an online blood pressure monitoring clinic. Patients who were identified as being able to monitor their blood pressure at home were provided with a monitoring device and could submit their results electronically. Staff explained how this improved access to care, particularly for working age patients who couldn’t always attend in surgery hours.

Updated 20 March 2017

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

• The practice regularly worked with other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia.

• The GPs carried out weekly ward rounds for their patients at a local advanced dementia nursing home. These patients were monitored during multidisciplinary team meetings, they were on the practices admission avoidance register and all had care plans in place.

• 83% of patients diagnosed with dementia had their care plans reviewed in a face-to-face review in the preceding 12 months, compared to the CCG average of 78% and national average of 82%.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. 

Updated 20 March 2017

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

• The practice took a proactive approach to understanding the needs of different groups of people, this included identifying carers in order to offer them with support where needed. As a result, the carers register had increased from 140 coded carers (1%) in January 2015, to 276 carers on the carers register in January 2017 and 3% of the practices list had been identified and offered carer support
• The practice regularly worked with other health and social care organisations in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.

• The practice worked with the local Dudley Council for Voluntary Service (CVS) team to help provide social support to t patients who were living in vulnerable or isolated circumstances.

• There were accessible facilities for people with mobility needs and translation services available at the practice. The practice also had a portable hearing loop; staff explained how the GPs were able to take this on home visits whilst visiting patients with hearing difficulties.