Birches Head Medical Centre

Updated 23 August 2017

Birches Head Medical Centre is located in Stoke-on-Trent and is registered with the CQC as a partnership provider. The provider holds a General Medical Services contract with NHS England and is a member of the NHS Stoke-on-Trent Clinical Commissioning Group (CCG). A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the most common form of GP contract. The practices provides Directed Enhanced Services, such as childhood immunisations, family planning services and minor surgery.

The practice has approximately 7,200 registered patients. An increase of 500 patients since the last inspection. The area is one of higher deprivation when compared with the national average. The practice has 8% of unemployed patients compared to the local average of 7% and the national average of 4%. The practice has 50% of patients with a long standing health condition compared to the local average of 57% and the national average of 53%.

Patients can access services at either of the practices two locations at their convenience:

• Birches Head Medical Centre, Diana Road, Stoke-on-Trent, ST1 6RS (main practice).

• Hulton House Surgery, 1479 Leek Road, Stoke-on-Trent, ST2 8DA (branch practice).

The practice is an accredited teaching practice for medical students and is also involved with medical research in partnership with a local university.

Both the main and branch practices are open between 8.30am and 6pm Monday to Friday and 8am to 1.00pm on a Thursday. Extended opening hours are provided on a Monday evening from 6pm to 8.15pm at the main practice. Surgery times are from 8.30am to 12.30pm and from 2pm to 5.30pm and until 8.15pm on a Monday at the main practice. Routine appointments can be booked in person, by telephone or on-line. Home visits are triaged by a GP to assess whether a home visit is clinically necessary and the urgency of the need for medical attention.

The practice staffing comprises of:

• Four male GPs

• Two nurses

• One health care support worker

• One practice manager

• One assistant practice manager

• Two secretaries and a team of seven reception and administrative staff.

The practice has opted out of providing cover to patients in the out-of-hours period. During this time services are provided by Staffordshire Doctors Urgent Care, patients access this service by calling NHS 111.

Updated 23 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Birches Head Medical Centre on 18 January 2016. The overall rating for the practice was Good with requiring improvement in providing safe services. We found one breach of a legal requirement and as a result we issued a requirement notice. The practice provided us with an action plan detailing how they were going to make the required improvements in relation to:

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Safe care and treatment.

You can read the report from our inspection on 18 January 2016 by selecting the 'all reports' link for Birches Head Medical Centre on our website at www.cqc.org.uk.

We undertook a comprehensive follow up inspection of Birches Head Medical Centre on 24 July 2017. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Our key findings were as follows:

• There was effective system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Effective systems were now in place for identifying, assessing and mitigating the risks to the health and safety of patients and staff.
• The practice had clearly defined and embedded safeguarding procedures in place. A system was now in place to alert staff to known vulnerable adults.
• The practice system for prescribing high risk medicines on a shared care basis had improved ensuring patients had received the recommended monitoring before prescriptions were issued.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver care and treatment.
• Patients said they were treated with kindness, dignity and respect and they were involved in their care and decisions about their treatment.
• Data from the national GP patient survey published July 2017 showed patient satisfaction continued to be above local Clinical Commissioning Group (CCG) and national averages for most areas measured.
• Patients found it easy to make an appointment, with urgent appointments available the same day and routine appointments available within 48 hours.
• There was a clear leadership structure in place and staff felt supported by the partners and practice management team. Staff were aware of the vision and values for the delivery of services.
• The practice was proactive in gaining feedback from patients and staff and made improvements following suggestions.
• The provider was aware of and complied with the requirements of the Duty of Candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are:

• Consider anonymising significant events in addition to completing an analysis of significant events to identify any common trends and embed learning.
• Review the process for the monitoring of uncollected prescriptions.
• Consider expanding the availability of staff to chaperone to provide a more flexible service for patients.
• Consider developing a documented business plan.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 August 2017

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

• There was a system to recall patients for ongoing monitoring and regular review to check their health and medicines needs were being met.

• Self-management plans were in place for patients with specific conditions such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).

• The practice followed up on patients with long-term conditions discharged from hospital within two days of discharge and ensured their care plans were updated to reflect any additional needs.

• Staff were qualified to perform lung function testing.

• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care and held.

Updated 23 August 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 children who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances and those who did not attend (DNA) their appointments.

• Immunisation rates for the vaccinations given were above standard for childhood vaccinations for children aged two and comparable to the Clinical Commissioning Group (CCG) for children aged five.

• Same day appointments were available for children aged 12 and under with urgent medical need.

• Appointments were available outside school hours and the premises were suitable for children and babies.

• Maternity care was provided twice a week by a visiting midwife.

Updated 23 August 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 patients in its population.

• The practice was responsive to the needs of older patients and requests for home visits were triaged by GPs within an hour to help prevent hospital admissions.

• The practice provided holistic assessments and care plans for older people.

• The practice followed up on older patients when discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• Patients aged 75 years or over had a named GP and details of the GP were printed on the back of their prescription.

Updated 23 August 2017

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

• The needs of these populations 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, extended hours were provided on a Monday evening until 8.15 pm at the main 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.

• Telephone consultations were available to benefit patients that worked away from home and the practice was looking to introduce video consultations in the future.

• New patient health checks in addition to NHS Health checks for patients aged 40 to 74 years were available.

• The practice enabled  the temporary registration of students whilst home on holiday leave.

Updated 23 August 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 multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. An external counsellor from Healthy Minds held a weekly clinic at the practice to see patients. Appropriate referrals were made to the mental health team, Child and Adolescent Mental Health Service (CAMHS) for patients under 18 and the alcohol team for counselling.

• The practice had information available to signpost patients experiencing poor mental health. Patients with severe mental health conditions were seen the same day, their medicines were reviewed by a GP and weekly prescriptions issued if deemed appropriate to help safeguard these patients.

• Performance for mental health related indicators was comparable to the local CCG and national averages. For example, the percentage of patients with an agreed care plan documented in the preceding 12 months was 90%, which was the same as the CCG average and comparable with the national average of 89%. However, the practice clinical exception rate of 0% was lower than the local CCG average of 12% and the national average of 13%.

• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the last 12 months was 73%, which was lower than the CCG and national averages of 84%. However, the practice clinical exception rate of 3% was lower than the CCG and the national averages of 7%, meaning more patients were included.

Updated 23 August 2017

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

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice had 47 patients recorded with a learning disability. Twenty one of these patients had received an annual health assessment since 1 July 2016. There were plans for more reviews to be scheduled shortly.

• The practice had information available for patients about how to access various support groups and voluntary organisations.

• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable.