Archived: Stratford House Surgery

Updated 1 December 2016

Stratford House (formally known as Sparkhill Surgery) is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

The practice was previously inspected by CQC in December 2015 and placed into special measures following an inadequate rating. Enforcement action was taken in relation to breaches in regulation 12 Safe Care and Treatment and conditions were placed on the practice’s registration. In addition the practice was also found to be in breach of Regulation 16 Receiving and acting on complaints and Regulation 17: Good governance. Following the inspection in December 2015 the practice received support through their local CCG, Midlands Medical Partnership (MMP) and the Royal College of General Practitioners to help turn around the practice and deliver improvements in the service.

Stratford House is currently registered with the Care Quality Commission to provide primary medical services. On the 1 August 2016 Stratford House merged with MMP, a group of 11 practices that provide primary medical services across Birmingham under a single GMC contract. Within this partnership central functions and resources are shared. The practice has notified us of changes in the provider status but now needs to ensure applications are made to ensure the changes in registration are completed and accurate.

The practice is located in purpose built accommodation. There is no specific patient parking available and parking in the area can be difficult. Based on data available from Public Health England, deprivation in the area served is among the highest 10 per cent nationally. The practice has a registered list size of approximately 6,000 patients. The practice population is younger than the national average and located in an ethnically diverse area of Birmingham.

The practice is open 8.15am to 6pm daily with the exception of Wednesday afternoon when it closes at 1pm for the afternoon. Appointment times vary between clinicians and on a daily basis but are usually between 8.30am and 12pm and between 3pm and 6pm. When the practice is closed during core hours and the out of hours period services are provided by another out of hours provider (Primecare). However, in line with other MMP practices that are opted in to the out of hours contract, there are plans to change to Birmingham and District General Practitioner Emergency Room Group (BADGER). The practice does not currently offer extended opening hours although we were advised that now that they had become part of MMP patients would be able to access services at any of the practices within this partnership including extended hours, this had yet to be fully implemented.

The practice has two partners (both male), a female salaried GP has been recruited starting at the end of September 2016. In the interim additional GP support has been provided through locum GPs. There is also a practice nurse. A second practice nurse has been recruited to replace a nurse who recently retired and is due to start in October 2016. Other practice staff include a health care assistant and an administrative team led by a team leader (formerly the practice manager). The practice team is supported by the MMP management team following the merger in August 2016.

As part of the turnaround programme the practice has received support one day each week from the MMP specialist respiratory nurse to review patients.

Updated 1 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Stratford House Surgery on 7 September 2016. The practice was formerly known as Sparkhill Surgery until 1 August 2016 when it merged with Midlands Medical Partnership (MMP). The practice is in the process of merging and making these changes to their CQC registration.

Sparkhill Surgery was previously inspected on 3 December 2015 and placed into special measures following an inadequate rating. We found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations breached were:

Regulation 12: Safe care and treatment

Regulation 16: Receiving and acting on complaints

Regulation 17: Good governance

Enforcement action was taken and a notice was served placing conditions on the original providers registration.

At this inspection we found the practice had made sufficient improvements. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Systems for managing patient safety had been reviewed since our previous inspection and effective systems put in place to manage risks identified. We saw significant improvements, specifically in relation to the management of medicines and infection control.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. We saw improvements in the management of patients with long term conditions.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. The skills needed to deliver care and treatment had been reviewed and where needed training put in place.
• Feedback we received from patient comment cards about care and treatment was positive. However, results from the latest GP national patient survey found patient satisfaction scores for consultations, involvement in care and decisions about treatment were below CCG and national averages.
• Information about services and how to complain was available and easy to understand. Complaints were monitored and learning shared.
• Patients frequently found it difficult to make an appointment, we saw action had been taken but these had yet to clearly show improvements in patient satisfaction.
• The practice was accessible to patients and we saw improvements in the facilities available since our previous inspection.
• There was a clear leadership structure and staff felt supported by the new management structures of MMP.
• The practice had re-launched the patient participation group and had proactively sought feedback in delivering service improvements.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure systems and processes recently implemented for improving patient care and outcomes are fully embedded within the practice and sustained in the long term.
• Review systems for managing uncollected prescriptions and for maintaining accurate records of hand written prescription pads so that it is clear if any are missing.
• Ensure risk assessments are fully completed to mitigate against all potential risks and that actions have been reviewed for completion.
• Continue to improve the working arrangements with health and social care professionals in order to deliver a multi-disciplinary package of care to those with complex care needs.
• Identify systems for recording verbal complaints to support the identification of themes or trends and for service improvement.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service. However, we are aware that the provider is in the process of setting up a new registration with Midlands Medical Partnership (MMP).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 December 2016

The provider was rated as requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group the care of older people. There were, however, examples of good practice.

• The management of patients with long term conditions had been a major concern at our previous inspection which had led to enforcement action being taken. However, we saw significant improvements had been made. We reviewed patient records for patients with diabetes, respiratory conditions and on high risk medicines which demonstrated patient’s care needs were being met.
• Nationally reported data for 2015/16 showed patient outcomes for many long term conditions were below CCG and national averages. For example, As this data was prior to our first inspection in December 2015 we looked at practice data which identified significant improvements in the management of patients for long term conditions. For example, a retrospective audit evaluating the effectiveness of the diabetic recall system showed improvements in the number of patients reviewed over the last 12 months as 83% compared to 67% in the previous year.
• We saw similar improvements in other areas. Data comparing the practice with MMPs member practices showed Strafford House performing well in terms of QOF (2016/2017). For example, to date 45% of diabetes reviews had been completed compared to the MMP average of 35% and 55% of COPD reviews had been completed compared to the MMP average of 31%.
• The practice was receiving support from the MMP respiratory nurse and the practice nurse was due to commence training to undertake respiratory reviews.
• The practice had been proactively reviewing long term condition registers to ensure relevant patients had been identified.
• For those patients with the most complex needs, the GPs were working with relevant health and care professionals to deliver a multidisciplinary package of care.
• A range of services were being offered in-house for example, spirometry, ambulatory blood pressure monitoring, electrocardiographs (ECGs) and phlebotomy to support the diagnosis and monitoring of patients with long term conditions.

Updated 1 December 2016

The provider was rated as requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group the care of older people. There were, however, examples of good practice.

• The practice worked with other health care professionals to support children at risk or disadvantaged circumstances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The premises were accessible to pushchairs and baby changing facilities were in place. Patients could request a private room for breast feeding.
• Six week baby checks were available at the practice.
• Cervical screening rates (2015/16) were 65% which was below the CCG average of 79% and the national average of 82%. The practice were aware they needed to now prioritise this and were reviewing data to check for accuracy and appropriate recalls in place.

Updated 1 December 2016

The provider was rated as requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group the care of older people. There were, however, examples of good practice.

• At our previous inspection nationally reported data for 2014/15 showed outcomes for patients with conditions commonly found in older people were lower than CCG and national averages. The latest published data for 2015/16 which related to a period prior to our first inspection in December 2015 also showed lower outcomes overall for patients than the CCG and national averages. Data available from the practice identified improvements in patient outcomes for those with conditions such as chronic obstructive pulmonary disease and osteoporosis.
• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits. Urgent appointments were available for those who needed them however, patients did not always find it easy to access the service.
• We saw evidence of multi-disciplinary team meetings with other health professionals to discuss those with complex and end of life care needs.
• The premises could be accessed by patients with mobility difficulties although areas for improvement had been identified. A hearing loop was also available.

Updated 1 December 2016

The provider was rated as requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group the care of older people. There were, however, examples of good practice.

• The practice was proactive in offering online services for booking appointments and for repeat prescriptions.
• The practice made use of text messaging to remind patients of their appointments.
• The practice offered NHS health checks and screening services that reflects the needs of this age group.
• Extended opening hours were not currently available.
• Patients could receive travel vaccinations that were available on the NHS at the practice and were signposted to other services for those only available privately.
• Health promotion advice was available through the wider MMP organisation but staff were not yet fully clear of what was available for patients.

Updated 1 December 2016

The provider was rated as requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group the care of older people. There were, however, examples of good practice.

• The most recently published data (2015/16) showed 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average (85%) and national average (84%). Although exception reporting was also higher than CCG and national averages.
• Data available from the practice showed the practice was currently performing well against QOF for 2016/2017 with 53% of patients reviewed compared to the MMP average of 45%. We saw comprehensive care plans in place for patients with dementia.
• Information about dementia support was displayed in the waiting area.
• Nationally reported data (2015/16) showed 62% of patients with poor mental health had an agreed documented care plan in the preceding 12 months. This was higher than the CCG average of 88% and national average of 89%.
• The practice found it difficult engaging with the mental health team but had recently met with a consultant psychiatrist to review the care of patients on their mental health register.

Updated 1 December 2016

The provider was rated as requires improvement for effective and responsive. The issues identified as requiring improvement overall affected all patients including this population group the care of older people. There were, however, examples of good practice.

• The practice had systems in place to identify patients with specific needs for example patients with no fixed abode who were registered with the practice address.
• Patient registers were maintained for those living in vulnerable circumstances for example patients with a learning disability.
• Patients with a learning disability were offered health reviews. All 20 patients on the learning disability register had been invited for a review, to date five had been completed and eight had an appointment booked. This was an improvement on our previous inspection in which no patients had been reviewed.
• The practice worked with other health care professionals in the case management of vulnerable patients.
• The practice provided support and signposting to those who were vulnerable for example, carers, the recently bereaved and those at risk of harm.
• Staff 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.