Archived: The Jacey Practice

Updated 6 June 2016

The Jacey Practice has two sites, one in Solihull and a branch surgery in Dickens Heath, during this inspection we did not visit the branch site. The practice is situated in a purpose built building which is shared with another GP practice and pharmacy. The practice provides primary medical services to approximately 9700 patients in the local community. The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some directed enhanced services such as minor surgery, childhood vaccination and immunisation schemes. The practice runs an anti-coagulation clinic for the practice patients and a full range of family planning including implants. The branch practice is also an accredited yellow fever vaccination centre and can offer this service to both the practice patients and the local population.

There are six GP partners (three male, three female). The practice is a teaching practice for the University of Warwick Medical School and also teaches medical students from Kings College and University College, London and Oxford. The nursing team consists of a nursing team leader, who is a nurse prescriber and two practice nurses. The non-clinical team consists of administrative and reception staff, a practice manager and office manager.

The practice serves a higher than average population of children. The area served has lower deprivation compared to England as a whole and ranked at ten out of ten, with ten being the least deprived.

The practice is open to patients between 8.30am and 6.30pm Monday to Fridays and offers a Saturday morning surgery at the branch site from 9am to 11.30am. Emergency appointments are available daily. Every weekday morning the practice has a duty GP available who deals with urgent requests for appointments and queries which cannot be dealt with by reception. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. The out of hours service is provided by NHS 111 service and information about this is available on the practice website, patient leaflet and telephone line.

The practice is part of NHS Solihull Clinical Commissioning Group (CCG) which has 38 member practices. The CCG serve communities across the borough, covering a population of approximately 238,000 people. A CCG is an NHS organisation that brings together local GPs and experienced health care professionals to take on commissioning responsibilities for local health services.

GPs within Solihull have formed a local federation called Solihealth. This enables practice to share some costs and bid for local services that become available. One of the GPs at the practice is the chair of this federation.

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Jacey Practice on 18 March 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment and had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses, however actions needed to be documented for all concerns reported.
• Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients said they found it easy to make an appointment with a named GP and that 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 management. 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 June 2016

The practice is rated as good for the care of people with long-term conditions. Due to the lack of nursing staff, the doctors had taken on some of the long term condition monitoring to support the agency nurses they had temporarily employed. One of the GPs had a specialist interest in diabetes and the practice did insulin initiation and monitoring. The practice ran an anti-coagulation clinic service for their patients and also carried out DMARD monitoring for patients on methotrexate and other associated medication. (DMARD monitoring involves a series of tests to check patients for adverse effects). With many of these medicines regular blood and/or urine monitoring is required to check for adverse effects on the liver, immune system etc.

Longer appointments and home visits were available when needed. All patients with a long-term condition 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, alerts were added to the patients records and the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 6 June 2016

The practice is rated as good for the care of families, children and young people. The practice had some children with long term and life limiting conditions and worked closely with the community children’s nurses. Immunisation rates were 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 carried out an access audit with patients at the branch surgery to identify patients' preferences to appointment times with the increase of housing developments.

The practice’s uptake for the cervical screening programme was 82% which was in line with the national average of 82%. The practice offered a full range of family planning services, including implants. The practice used a telephone triage system for patients who required advice; children were seen the same day if requested. Appointments were available outside of school hours. The premises were suitable for children and babies. The practice held nurse-led baby immunisation clinics and vaccination targets were in line with the national averages. We saw positive examples of joint working with midwives and health visitors and the midwife ran an ante natal clinic at the practice on a weekly basis.

Updated 6 June 2016

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, this included enhanced services for dementia and end of life care. The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required. Patients over 75 years of age were offered an annual face to face review with a GP and all patients had a named GP. The practice worked closely with multi-disciplinary teams so patients conditions could be safely managed in the community and with with local pharmacies to support the provision of blister packs for medicines.

The practice was taking part in the Delivering Excellence in Solihull programme which incorporated elements of hospital admission avoidance and other local priorities. The practice used the urgent care dashboard IT system to monitor the patients on their unplanned admissions list, which were discussed at weekly clinical meetings. The practice worked closely with local pharmacies to support the provision of blister packs for medication and the practice telephone system had a priority bypass option for care home staff, ambulance crews and hospitals that required urgent information.

Updated 6 June 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 such as appointment booking and repeat prescriptions services and telephone consultations, as well as emails and a contact form was available on the practice website, Facebook and Twitter for patients to use to request further information or contact with a GP. A full range of health promotion and screening that reflected the needs for this age group was also available. The practice offered Saturday morning appointments. It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years. The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 6 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). There were 42 patients on the dementia register and 40 had had their care plans agreed in a in the last 12 months. All the GPs were dementia friends and dementia screening was offered during flu clinics. The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact. We saw that there were 60 patients on the mental health register, 33 had had care plans agreed and the remaining patients were being invited to attend reviews. Patients experiencing poor mental health were signposted to various support groups and voluntary organisations. Staff had a good understanding of how to support patients with mental health needs and dementia and had access to psychological support through Solihull Healthy Minds (IAPT) and also had a counselling service available for all patients based at the branch surgery. The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Updated 6 June 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. We saw that there were 36 patients on the learning disability register; 20 of these patients had received an annual health check. The practice had a system in place to monitor when patients required their annual review, which was updated on a quarterly basis. The practice supported a local home that had 12 residents with learning disabilities. The practice held a register of carers and had 107 carers registered. Information about local services was available in the waiting room. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations and there was a system in place to identify patients who required additional support and extra time during appointments. Staff had received safeguarding training 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.