Archived: All Saints and Rosevillas Medical Practice

Updated 16 May 2017

All Saints and Rosevillas Medical Practice is registered with the Care Quality Commission (CQC) as a partnership and provides services over two sites within the Wolverhampton area. The practice is easily accessible by varied public transport links or car. The practice has access for patients who use a wheelchair and parents using push chairs.

The practice has a registered list size of approximately 6000 patients. The population served is younger than the national average. The practice is located in one of the most deprived areas in the country. The practice is part of the NHS Wolverhampton Clinical Commissioning Group. The practice has a contract to provide General Medical Services (GMS) for patients. This is a contract for the practice to deliver general medical services to the local community or communities. The practice provided Directed Enhanced Services, such as the childhood vaccination and immunisation scheme and minor surgery. The practice provides a number of clinics for example long-term condition management including asthma, diabetes and high blood pressure.

The practice team consists of two GP partners and one salaried GP, (one male and two female), who provide services which equate to two whole time equivalent GPs. The practice also use regular GP locums to support the clinicians and meet the needs of patients at the practice. The clinical practice team includes a practice manager, an advanced nurse practitioner who is also a prescriber, a practice nurse and two healthcare assistants. There are nine practice support staff, seven receptionists/administration staff, two secretaries, an administration apprentice and a cleaner. In total there are 12 staff employed either full or part time hours.

The practice is open between 8am to 6.30pm Monday to Friday. Appointments are from 8.30am to 11.00am and 3.30pm to 6pm Monday to Friday. Extended surgery hours are from 6pm to 7.20pm on Tuesdays. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service Vocare via the NHS 111 service.

Updated 16 May 2017

Letter from the Chief Inspector of General Practice

This was a desk-based focussed review of All Saints and Rosevillas Medical Practice carried out on 16 March 2017. During our previous inspection on 19 January 2016 we found that the practice performance related to the care of people experiencing poor mental health (including people with dementia) was significantly lower than the local Clinical Commissioning Group (CCG) and National averages. After this desk-top review we found the practice had made improvements for this population group. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for All Saints and Rosevillas Medical Practice on our website at www.cqc.org.uk.

• The practice was rated as requires improvement for the population group ‘People experiencing poor mental health (including people with dementia)’

This inspection was a desk-based review carried out on 16 March 2017 to confirm that the practice had implemented its plan to improve its performance in meeting the care needs of people experiencing poor mental health (including people with dementia). This report covers our findings in relation to those requirements and also additional improvements made since our last inspection

Our key findings were as follows:

• The practice performance for the care and treatment of patients experiencing poor mental health (including patients with dementia) had improved over the past two years. The practice had put systems in place to ensure ongoing improvements and monitoring of its performance.

During our previous inspection in January 2016, we found that there were areas that the practice should make improvements. For this review the practice provided information to demonstrate the action they had, and were continuing to take to address these areas. This included:

• At the inspection in January we found that a Legionella risk assessment had been carried out but the practice had not acted on the recommendations made in the assessment report, which included the need to flush taps and check water temperatures to monitor and control the risk of legionella. Information provided by the practice manager for this desk-top review showed that the practice had addressed these concerns. Information and documents we received showed that the practice had worked with a health and safety team and had repeated a legionella risk assessment. The outcome showed that the level of risk at the practice was low and appropriate health and safety risk assessments were in place to ensure the safety of patients, visitors and staff. The cleaning company used by the practice flushed the water system within the practice, and reported any problems to the practice manager. A named group of staff were responsible for recording the water temperatures. These staff carried out these tasks on a rota basis to ensure that the monitoring continued during annual leave or staff sickness. Staff had also received training to ensure that they knew how to use the equipment and record accurate data. This data was recorded on a monthly basis to ensure the safety of staff, visits and patients.

• At the inspection in January 2016 we found some gaps in training for both clinical and non-clinical staff. A staff training matrix showed that some staff had received training in basic life support, infection control, fire safety and safeguarding. Information we received for the desktop review showed that

To improve communication with all staff a practice wide meeting was introduced every first Thursday of the month. This included, administration staff, reception staff, practice nurses, healthcare assistant and GPs. Guest speakers were also invited to attend these meetings. An example of the minutes for meeting held in 2017 showed that the topics discussed included operational changes at both sites, significant events, infection prevention, health & safety, complaints and the training needs of staff.

• During our previous inspection in January 2016, we found that the practice had plans in place to encourage more structured and regular feedback from patients. This included actively advertising and encouraging patients to form a patient participation group (PPG) to work with the practice and be involved in its future plans for development. Information provided by the practice for this review showed that progress had been made to encourage patients to be involved in the running of the practice. The practice manager and one of the GP partners told us that although the PPG had been slow to build and gain momentum, meetings had been held. Five patients had attended the last PPG meeting. The practice found that patients were reluctant to take on the responsibility of chairing the meetings but were keen to listen and make comments and suggestions. Minutes of these meetings were completed and copies were seen for meetings held in May 2016 and January 2017. The practice was looking at other ways to encourage the growth of the PPG, which included an open day to showcase the work of the PPG.

There were areas of practice where the provider should make improvements:

• Ensure that records are up to date to accurately demonstrate all relevant training undertaken by all staff.

At our previous inspection on 19 January 2016, we rated the practice as requires improvement for the care of people experiencing poor mental health (including people with dementia). The practice had acted on the concerns and as a consequence ratings for the practice in this population group has been updated to reflect our most recent findings. The practice is now rated as good for this population group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 2016

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. Performance for diabetes assessment and care was much lower than the national average (56.97% as compared to the national average of 94.41%). The practice had taken action to identify the causes and it planned to be involved in a local Clinical Commissioning Group (CCG) initiative to improve the care and treatment of patients with diabetes. Longer appointments and home visits were available when needed. All these patients had a named GP and structured annual reviews to check their health and medicines needs were being met had been planned for. The practice was working to re-establish formal multidisciplinary meetings with relevant professionals to support the care of patients with palliative care needs. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

Updated 17 March 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 similar to local and national averages for all standard childhood immunisations. Data showed that 69.05% of patients on the practice register had had an asthma review in the last 12 months. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw positive examples of joint working with midwives, health visitors and the practice maintained a register of school nurses in the local area. The practice’s uptake for the cervical screening programme was 62.71%, which was lower than the national average of 81.83%.

Updated 17 March 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. The practice offered home visits and urgent appointments for those older patients with enhanced needs. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice had a proactive working relationship with a care home for older people who required rehabilitation following discharge from hospital. There was effective communication between the practice and care home staff. Planned regular visits as well as requested visits were made to the home.

Updated 17 March 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 appointment telephone line was open between 8.30am and 6.30pm and extended hours were offered one evening per week. 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 16 May 2017

At a comprehensive inspection we always inspect the quality of care for these six population groups:

• Older people
• People with long-term conditions
• Families, children and young people
• Working age people (including those recently retired and students)
• People whose circumstances may make them vulnerable
• People experiencing poor mental health (including people with dementia)

For this desk-top review we only looked at the quality of care for people experiencing poor mental health (including people with dementia). This was because we rated the practice as requires improvement for this population group at the inspection in January 2016.

The provider had addressed the concerns identified and improved their performance for the care of people experiencing poor mental health including people with dementia. This population group rating has been updated to reflect this. The practice is now rated as good for 'People experiencing poor mental health (including people with dementia)'.

• Performance for poor mental health indicators although still lower than the local and national averages, showed improvements. For example, the percentage of patients with severe poor mental health that had a recent comprehensive care plan in place for the 2015/16 QOF year had increased from 53% to 70%. (CCG and England averages 89%). The clinical exception report rate was lower 5.7% compared with the CCG average of 7.6% and the England average of 12.7%.
• Performance for dementia related indicators showed significant improvements and was overall higher than the local CCG and national averages. For example, patients diagnosed with dementia who received a face-to-face review in the preceding 12 months was 87%, which was higher than the local CCG and national averages of 84%. The practice clinical exception rate of 0% was lower than the local CCG average of 6.1% and the England average of 6.8%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 people with mental health needs and dementia.

Updated 17 March 2016

The practice is rated good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients with a learning disability and carried out annual health checks for these patients. An easy read (pictorial) letter was sent to patients with a learning disability inviting them to attend the practice for their annual health check. Staff had been trained 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. 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.