Archived: Hawkesley Medical Practice

Updated 10 October 2016

Hawkesley Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider and delivers a full range of family medical services, as well as providing a minor surgery service. Hawkesley Medical Practice holds a General Medical Services (GMS) contract with NHS England. (The GMS contract is a nationally agreed contract between general practices and NHS England for delivering primary care services to the local communities).

At the time of the inspection, Hawkesley Medical Practice was providing medical care to approximately 4,800 patients.

The practice is located in purpose built premises in Kings Norton, Birmingham, and is situated in an area with high levels of social and economic deprivation. The building is owned by NHS Property Services, who are responsible for the common areas of the site. The Birmingham South Central Clinical Commissioning Group arranged for a consultant to inspect the building in February 2016. Recommendations included a full refurbishment for the treatment room and the removal of a carpet in a consulting room. At the time of the CQC inspection, these recommendations had not been actioned.

The practice has a large car park on site and there is a bus stop on the opposite side of the road.

All consulting rooms are on the ground floor of the building and the automated front door provides easy access for patients with mobility problems.

There are two GP partners (both male) and two salaried GPs (one male, one female). The GPs are supported by a practice manager, an assistant practice manager, an advanced nurse prescriber, three practice nurses, one health care assistant and administrative and reception staff.

Hawkesley Medical Practice is an approved training practice for trainee GPs. (A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice). There are two GP trainers. A trainee had just finished and one was due to start at the practice the day after our inspection.

The practice is open from 8.30am to 7.30pm on Mondays and Tuesdays, from 8.30am to 6.30pm on Wednesdays and Fridays and from 8.30am to 1.30pm on Thursdays. Appointments are available during these times.

South Doc provides cover when the practice does not answer the phones between 8am and 8.30am, 1pm to 3pm and on Thursday afternoons. At all other times when the practice is closed patients are asked to ring Primecare. Alternatively, patients can go to the walk-in centre in Selly Oak, Birmingham, which is open from 8am to 10pm seven days a week.

Updated 10 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hawkesley Medical Practice on 3 August 2016. Overall the practice is rated as good.

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

• The practice had systems for monitoring and maintaining the safety of the practice and the care and treatment they provided to patients.

• The practice had systems for reducing the risks to patients from healthcare associated infections.

• Patients’ needs were assessed and the practice planned and delivered care in line with best practice guidance.

• The practice had established a well-trained team with expertise and experience in a range of health conditions.

• Patients said that they were treated with kindness, dignity and respect and that GPs and nurses involved them in discussions about their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand. Improvements were made to the way that services were delivered as a result of complaints and concerns.

• Patients told us that they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available 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 GP partners and the practice manager. The practice proactively 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 practice had recognised the interplay between health and social issues and had introduced a service from the Citizens’ Advice Bureau (CAB) whereby an advisor came to the practice every Monday in order to help patients with a variety of non-clinical issues including housing, benefits and employment.

The areas where the provider should make improvements are:

• Establish a system for uncollected prescriptions.

• Take action to ensure that emergency evacuation drills are carried out.

• Continue to monitor and ensure improvement to patient survey results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 October 2016

People with long-term conditions

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.
• 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.
• During the annual flu clinics, additional staff were available to undertake opportunistic screening, which resulted in long term conditions being diagnosed. The nurses administered the vaccinations and a GP was on duty to see patients as required.
• The practice was supported by a case manager for the care of patients with long term conditions. The practice nurses used a case management model where this was considered to be beneficial and the patient was in agreement.
• Patients who were at risk of developing diabetes were monitored annually and invited to take part in lifestyle educational sessions to help them reduce their risk of developing diabetes.
• A GP was the clinical lead for diabetes for the Birmingham South Central Clinical Commissioning Group (CCG). A GP and a practice nurse had completed the Warwickshire Diabetes course, which meant that they had additional expertise in this field.
• The percentage of patients with diabetes on the register, in whom the last diabetic reading was at an appropriate level in the preceding 12 months was 76% which was slightly below the national average of 78%.
• Patients with inflammatory arthritis were monitored in the practice under a shared care agreement with secondary care and their blood tests were monitored before prescriptions were issued. There was liaison with rheumatology specialists and staff attended training.
• A practice nurse was the lead for the asthma and chronic lung disease service. The nurse held diplomas in asthma and chronic lung disease, plus a certificate in spirometry.
• A home visit service was offered for patients with severe respiratory conditions who were unable to attend appointments at the practice.

Updated 10 October 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 had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 78% which was slightly lower than the CCG average of 80% and slightly lower than the national average of 82%.

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

• Same day appointments were available for any unwell child under the age of five years.

• Clinical rooms were all situated on the ground floor with easy access.

• An immunisation clinic was held every Wednesday. No appointments were necessary and the clinic ran at the same time as the health visitor’s baby clinic.

• Due to the high demand for sexual health and contraceptive services, the practice had a GP and an advanced nurse practitioner who could offer coil and implant fitting and screening for sexually transmitted infections.

• There was regular liaison with midwives, health visitors, social workers and school nurses in order to ensure that accurate records and registers were maintained.

Updated 10 October 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of this population group.

• Home visits and urgent appointments were available for those with enhanced needs.

• Patients who were housebound were able to have flu immunisations at home.

• The practice had responsibility for patients at a local nursing home. A GP undertook a weekly ward round, so that continuity of care was provided.

• All patients who were over the age of 75 had been offered a health check in the last 12 months.

• The practice followed the Gold Standard Framework for end of life patients. Meetings were held every two to three months and attended by the GP lead, a hospice nurse specialist, district nurses, a case manager and GP trainees.

Updated 10 October 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 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 reflected the needs for this age group.

• Extended opening hours were provided to enable working age people to attend without having to take time off work. Evening appointments were offered with GPs and nurses. Cytology appointments were also available during these times.

• One of the annual flu clinics was held on a Saturday morning, which provided more flexibility for working age patients.

• Patients could book routine GP appointments online as well as request repeat prescriptions at a time that was convenient for them.

• Telephone consultations could be booked, which provided additional flexibility.

• NHS health checks were offered to patients aged between 40 and 75 years.

Updated 10 October 2016

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

• 83% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
• 76% of patients with poor mental health had a care plan documented in the last 12 months, which was lower than the CCG average of 91% and lower than the national average of 88%. This was one of the areas targeted for improvement in 2016.
• Patients were able to access Improving Access to Psychological Therapies (IAPT) services through the Birmingham Healthy Minds (BHM) service either on referral by a GP or by self-referral. The BHM service was an NHS primary care psychological therapies service, which was available at the practice.
• Patients up to the age of 25 with poor mental health could be referred to the Forward Thinking Birmingham service, which provided support, care and treatment tailored to the patient’s needs.
• Longer appointments were available for patients with poor mental health.
• The clinical staff were sensitive to the lifestyle of some patients, which made it difficult for them to pre-book appointments or to attend appointments on time. Adjustments were made wherever possible, so that the patient was seen.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Liaison with community mental health teams was viewed as an important part of patient care.
• Patients with poor mental health were offered regular reviews. Screening was offered for conditions that their lifestyle or medicine might put them at greater risk of developing.
• The practice carried out advance care planning for patients with dementia.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
• Staff showed that they clearly understood how to support patients with mental health needs and dementia.

Updated 10 October 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 including those with a learning disability. There were no homeless people registered at the time of our visit, but the practice was able to explain how they would be seen. Staff knew many of the most vulnerable patients by name.

• There was a residential care facility in the local area for patients with moderate to severe learning disabilities. Approximately 40 residents who lived in the six houses were registered with the practice. A GP visited regularly. Care plans were in place and annual reviews were undertaken at the home.

• 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.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice had high levels of children at risk of harm and all members of staff had received child safeguarding training appropriate to their role. 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.

• Staff were alert to the signs of domestic abuse and were able to support patients by signposting them to the relevant agencies.

• The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 53 patients as carers, which represented 1% of the patient population.