Heathview Medical Practice

Updated 14 June 2017

Heathview Medical Practice is registered with the CQC as a partnership provider in Tamworth, Staffordshire. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

Over a two year period three GP practices merged to form Heathview Medical practice. One of the practices had previously been placed into special measures. Heathview Medical Practice now has the main surgery at Glascote Heath Centre and two branches, one in Wilnecote and a second in Dosthill.

Glascote Health Centre is a purpose built building owned by NHS Properties. Wilnecote and Dosthill buildings are owned by one of the GP partners. At each site, all rooms are situated on the ground floor of the building and consist of a reception area, treatment rooms and consultation rooms. There is a pharmacy at the Dosthill site that is unaffiliated to the provider and partners. The practice has level access from the car park and is accessible for wheel chair users; there is a disabled toilet facility at each site.

The practice area is one of lower deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. However, two of the three sites are based in low socio-economic areas. At the time of our inspection the practice had 12,000 patients. Demographically the population is 90% white British with the remaining patients being Asian and mixed race. The practice age distribution is similar to the national and CCG area in all age groups. The percentage of patients with a long-standing health condition is 56% which is comparable with the local CCG average of 55% and national average of 53%. The practice is a training practice for GP registrars and medical students to gain experience and higher qualifications in general practice and family medicine.

The practice staffing comprises of:

• Six GP partners (all male) 4.2 whole time equivalent (WTE)
• A salaried GP (female) (0.4 WTE) and a long-term Locum GP (female) working a varied pattern (0.6 WTE).
• An advanced nurse practitioner (ANP) (0.8 WTE)
• Three practice nurses (1.5 WTE)
• Two healthcare assistants (HCA) (1.6 WTE)
• A regional manager (0.7 WTE)
• Three site managers (2.8 WTE)
• Sixteen members of administrative staff working a range of hours (10.9 WTE).

The practice is open between 8.30am and 6pm Monday to Friday. On a Thursday afternoon, the Wilnecote site remains open when the Dosthill and Glascote Health Centre sites close at 2pm. On a Thursday afternoon, all telephone calls are diverted to Wilnecote. Telephone consultations are available and extended hours appointments are offered between 6.30pm and 7.30pm on a Monday at Glascote Health Centre and between 6.30pm and 8pm on a Wednesday at Wilnecote Surgery. Appointments can be pre-booked up to four weeks in advance and urgent appointments are available for those that need them. 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 14 June 2017

Letter from the Chief Inspector of General Practice

Heathview Medical Practice was formed following a merger between Dr Faisal Yunas and Anchor Medical Centre in November 2015. In November 2016, there was a second merger which saw Heathview Medical Centre merge with Dosthill Surgery.

We previously carried out an announced comprehensive inspection of Dr Faisal Yunas on 7 March 2016 (at the time of inspection, the registration process with the Care Quality Commission (CQC) to change the name to Heathview Medical Practice had not been completed). The practice was rated as requires improvement for providing safe services and good for providing effective, caring, responsive and well led services. The inspection report can be found by selecting the ‘all reports’ link for Dr Faisal Yunas on our website at www.cqc.org.uk.

We previously carried out an announced comprehensive inspection of Dosthill Surgery on 28 September 2015; we found three breaches of legal requirements. As a result, we issued two warning notices in relation to:

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

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Good governance.

We also issued a requirement notice in relation to:

• Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Fit and proper persons employed.

We undertook an unannounced focussed inspection on 17 March 2016 to follow up on the warning notices. Further concerns were identified and the practice was required to complete an urgent response to demonstrate that these concerns had been addressed. A weekly report was sent to the CQC between 17 March 2016 and 23 May 2016 to demonstrate that improvements have been sustained. We undertook another announced comprehensive inspection on 23 May 2016 to check that the practice now met legal requirements. The practice was rated as requires improvement in safe, effective, caring and responsive, and inadequate in well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dosthill surgery on our website at www.cqc.org.uk.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We undertook a further announced comprehensive inspection of Heathview Medical Practice on 3 May 2017 to check that action had been taken to comply with legal requirements relating to providing safe and well led services. Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and there had been significant improvements in reporting and recording significant events.
• The practice had clearly defined systems to minimise risks to patient safety.
• Staff were aware of and seen to be providing treatment in line with current evidence based guidance.
• Clinical staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The provider had a training programme that included all staff. We saw that training requirements had been completed or planned.
• Results from the national GP patient survey published in July 2016 for both Heathview Medical Practice and Dosthill Surgery showed below average scores when patients were asked if they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. Verbal complaints were recorded but not collated therefore missed opportunities to further improve care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff spoke positively about the support from the new management team. Leadership within the nursing team was being addressed at the time of the inspection.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Review the system for managing alerts to include a check that appropriate action has been taken.
• Implement systems to record verbal complaints so that trends can be identified.
• Add alerts to the records of the parents and siblings of children with a child protection plan in place.
• Consider role-specific training for the infection prevention control leads.
• Implement effective systems to ensure items such as syringes, dressings and dressing packs are in date.
• Ensure that fridges used to store medicines can provide data for the minimum and maximum temperatures.
• Implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.
• Implement a cohesive system for following up non-attenders for cancer screening.
• Review the availability of protected learning time available to allow for members of staff to complete training.
• Explore how the patient feedback can be improved, most notably in response to the consultations with GPs.
• Review the process for recording verbal complaints to allow trends to be identified and actioned.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 June 2017

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

• Patients at risk of hospital admission were identified as a priority.

• 85% of patients at Heathview Medical Practice with chronic obstructive pulmonary disease (COPD) had had a review undertaken including an assessment of breathlessness using a recognised scale in the preceding 12 months. This was lower than the CCG average of 91% and the national average of 90%.
• 74% of patients at Dosthill Surgery with chronic obstructive pulmonary disease (COPD) had had a review undertaken including an assessment of breathlessness using a recognised scale in the preceding 12 months. This was lower than the CCG average of 91% and the national average of 90%.
• The percentage of patients at Heathview Medical Practice with diabetes, on the register, whose last measured total cholesterol was within recommended limits, was 77%. This was comparable to the CCG and national averages of 80%.
• The percentage of patients at Dosthill Surgery with diabetes, on the register, whose last measured total cholesterol was within recommended limits, was 72%. This was lower than the CCG and national averages of 80%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 14 June 2017

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

• There were systems and procedures in place to safeguard children from the risk of abuse. Safeguarding meetings were held six weekly.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child development clinics.
• Alerts were placed on patient records to make staff aware of children who had a child protection plan in place. Alerts were in place to inform staff of the parents of children with a child protection plan in place.
• On the day appointments were available for children.
• There was a system in place to follow up children who did not attend (DNA) for hospital appointments. GPs sent tasks to receptionists for DNAs.
• A contraception service was offered and condoms were available free of charge from the practice.
• Access was available to male and female clinicians on request (both the locum and salaried GPs were female).

Updated 14 June 2017

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

• Patients aged 75 years or over had been written to advise them of a named GP and were invited annually to attend for a health check. (There were 640 patients on the register, 66% had been completed)
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• 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 offered home visits and urgent appointments for those with enhanced needs.
• The practice followed up older patients discharged from hospital and liaised with GPs and district nursing staff so that patients’ care plans were updated to reflect any extra needs.
• The practice identified older patients who needed palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

Updated 14 June 2017

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

• The needs of this population group had been identified and the practice had adjusted the services it offered to respond to patients’ needs. Extended opening hours were available at the practice and telephone consultations were available for working age people.
• 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.
• The provider offered NHS Healthchecks but had only completed 61 out of an eligible population of 2,472 in the previous 12 months. The provider was aware of this performance and highlighted it as a priority over the next 12 months.

Updated 14 June 2017

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

• The practice had identified a higher percentage of their patients as having dementia (1%) when compared to the national average (0.4%).
• The practice carried out advance care planning for patients living with dementia.
• The practice hosted an in-house clinic from a dementia consultant.
• 83% of patients at Heathview Medical Practice diagnosed with dementia had a care plan in place that had been reviewed in a face-to-face review in the preceding 12 months. This was lower than the Clinical Commissioning Group (CCG) average of 88% and national average of 84%.
• 74% of patients at Dosthill Surgery diagnosed with dementia had a care plan in place that had been reviewed in a face-to-face review in the preceding 12 months. This was lower than the CCG average of 88% and national average of 84%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• 84% of patients at Heathview Medical Practice with a diagnosed mental health condition had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was lower than the CCG and national averages of 89%.
• 96% of patients at Dosthill Surgery with a diagnosed mental health condition had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was higher than the CCG and national averages of 89%. However the exception reporting rate of 47% was significantly higher than the CCG average of 16% and national average of 13% meaning fewer patients had been included.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Staff were aware of where to refer patients for supporting services. For example, the early intervention team for patients who experienced psychotic symptoms.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 14 June 2017

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 carers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.
• Support had been given to asylum seekers, homeless people and vulnerable migrants. For example; two patients on the homeless register were supported by signposting to services, assisted in form filling and offered same day appointments.
• A translation service was available, hearing loops at each reception and the building had disabled facilities.
• There was a register of 58 patients with learning disabilities, 30 had received health checks in 2015/16 (a total of 18 out 39 were completed on Dosthill patients, and12 of 19 carried out on Heathview patients). A patient call/recall system had been introduced following the merger.