Archived: College Road Surgery

Updated 14 June 2018

College Road surgery provides services to approximately 3400 registered patients in an urban area of South Birmingham. The practice is run by two GP partners, one male and one female. The practice employs a long standing GP (male). They also employ a practice nurse who works closely with the GPs and a healthcare assistant. Other support staff include a practice manager and six reception staff including a head receptionist. The practice holds a general medical services (GMS) contract with NHS England.

The practice is open from 8.20am till 6.30pm Monday to Friday, with extended hours to 8.30pm on Mondays to accommodate high demand for appointments.

Urgent appointments are available for people that need them, as well as telephone appointments. Online services are available for patients including, making appointments online and accessing online medical records summaries

When the practice is closed patients are automatically diverted to the GP out of hour’s service provided by Primecare. Patients can also access advice via the NHS 111 service.

We reviewed the most recent data available to us from Public Health England which showed the practice have a higher proportion of patients aged 0 to 65 years old, compared with the national average. It has a smaller proportion of patients aged 65 and over compared to the national average. Income deprivation affecting children was 25%, which was lower than the CCG average of 30% and national average of 20%. Income deprivation affecting older people was 36%, which was lower than the CCG average of 37% but higher than the national average of 20%. The practice’s overall deprivation decile for the whole population was reported as two out of 10, (10 being the least deprived and one being the most deprived) 65% of the patients serviced by this practice were from BME (Black, Minority, Ethnic) groups.

Updated 14 June 2018

We previously carried out an announced comprehensive inspection at College Road surgery on 27 June 2017. The overall rating for the practice was Good. The full comprehensive report on the 21 July 2017 inspection can be found by selecting the ‘all reports’ link for College Road Surgery on our website at www.cqc.org.uk.

This inspection was an announced Comprehensive inspection carried out on 15 March 2018. This report covers our findings in relation to this inspection.

This practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable - Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

At this inspection we found:

• There were areas where systems for identifying and managing risks had not been established, for example fire risk assessment.
• The systems for monitoring training were present but were not effective. For example, we found that not all clinical staff completed training which the practice identified as mandatory.
• The practice had systems around complaints but these were not always effective and were not used as opportunities for learning.
• We found that exception reporting at the practice was high in a number of areas. (Exception reporting relates to patients on a specific clinical register who can be excluded from individual QOF (Quality and Outcomes Framework) indicators. For example, if a patient is unsuitable for treatment, is newly registered with the practice or is newly diagnosed with a condition.) The practice had recently become aware of this and had established a coding issue in their registers and had begun actions rectify to this.
• National patient GP survey data for the practice was generally good overall. The practice were aware of areas that were highlighted as being lower than others and practice had taken some action to start to address this, for example, the practice had increased hours to improve access for patients.
• The practice accommodated a range of languages other than English appropriate to their population group.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment and ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvements are:

• Develop a plan to improve the uptake of national screening programs such as cervical, breast and bowel screening.
• Continue to improve uptake of childhood immunisations in line with national standards and targets.
• Continue to proactively identify and support carers in line with national standards.
• Develop a plan to respond to issues identified from national GP patient surveys to improve patient satisfaction.
• Review the locum induction pack to ensure it is practice specific.
• Consider further ways to raise patient awareness in relation to access to appointments via the Hub.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 21 July 2017

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

• The practice held registers of those patients 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 nursing staff utilised, reviewed and kept up to date care plans for patients with long term conditions.

• Performance for diabetes related indicators was higher overall than CCG and national averages. For example, 87% of patients with diabetes had a blood pressure reading at or under the recommended level, compared with CCG and national averages of 77% and 78% respectively. The practice’s exception reporting rate for this indicator for 2015-16 was 9%, compared with the CCG and national averages also of 9%.

• Longer appointments and home visits were available when needed.

• All patients with long-term conditions had a named GP clinical lead.

• Structured annual reviews were provided to check health and medicine 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.

Updated 21 July 2017

The practice is rated as good for the care of families, children and young people.

• Children and young people were seen on the same day if they needed an appointment.

• There were systems to identify and follow up children who were at risk, for example, children and young people who had a high number of Accident and Emergency (A and E) attendances.

• Immunisation rates were high for all standard childhood immunisations.

• Children and young people were treated in an age-appropriate way and were recognised as individuals. We saw evidence to confirm this including care planning.

• Performance for cervical screening indicators was in line with CCG and national averages. For example the percentage of women aged 25-64 receiving a cervical screening test in the last five years was 82%, compared with CCG average of 80% and the national average of 81%.

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

• The practice provided combined parent and baby clinics carrying out post-natal and early child development checks.

• We saw positive examples of engagement and joint working with midwives and health visitors.

Updated 21 July 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.

• The practice offered double appointments for older people.

• The practice was responsive to the needs of older people, and offered home visits and urgent same-day appointments when needed.

• Practice staff worked closely with other health care professionals to deliver care to older people, for example community nursing staff.

• The practice offered enhanced checks for all patients aged 65 years and above. 97% of these patients had received a health check in the last six months.

• The practice held regular multidisciplinary team meetings to discuss the needs of older patients.

• The practice directed older people to appropriate support services.

Updated 21 July 2017

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 offered extended hours appointments two days a week up to 8pm, and one day a week up to 7.30pm.

• 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.

Updated 21 July 2017

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

• Performance for mental health related indicators was higher overall than CCG and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan recorded in the preceding 12 months was 100%, compared with CCG and national averages of 93% and 89% respectively. The practice’s exception reporting rate for this indicator for 2015-16 was 4% (one patient), compared with the CCG average of 8% and the national average of 13%.

• Patients experiencing poor mental health (including those with dementia) were placed on a register, had a care plan in place and were invited to see a GP for a comprehensive review at least once a year.

• Longer appointments were available for those patients with mental health needs or dementia.

• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

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

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

• The practice worked with a qualified psychologist who provided in-house counselling for patients.

Updated 21 July 2017

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

• The practice held registers of patients living in vulnerable circumstances.

• We saw evidence that circumstances were considered in care planning and treatment for vulnerable patients and the practice regularly worked with other health care professionals to deliver care and treatment.

• The practice had a dedicated list of patients registered as having a learning disability and had offered health checks for all of these patients. The practice used information to support care planning and offered longer appointments for patients with a learning disability.

• The practice provided help and support for patients who were carers.

• 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.

• Staff were trained and 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.