The Castle Practice

Updated 23 June 2016

The Castle Practice was originally founded by the grandfather of one of the current GPs in 1930. The practice is situated in a purpose built building which is shared with a pharmacy. The practice provides primary medical services to approximately 12, 000 patients in the local community. The practice has a General Medical Services contract (GMS) with NHS England. (A GMS contract is a nationally agreed contract which ensures practices provide essential services for people who are sick and including 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 services.

There are seven GP partners; (four male, three female) and one salaried GP (male or female?). The practice is a teaching practice for the University of Birmingham Medical School and at the time of the inspection had one GP trainee. The nursing team consists of four nurses; one who is a nurse practitioner, and three health care assistants. The non-clinical team consists of a practice manager, administrative and reception staff.

The practice serves a higher than average population of children. The area served has higher deprivation compared to England as a whole and ranked as three out of ten, (with ten being the least deprived). Over the last ten years the practice has seen an increase in patients from 8, 500 to nearly 12, 000 patients due to changes in services within the local community.

The practice is open to patients between 8.15am and 7pm Mondays to Thursdays and Fridays 8.15am to 6.30pm. Emergency appointments are available daily. Every weekday morning the practice offers a rapid access clinic, for patients who need to be seen urgently. Telephone consultations are also available along with home visits for patients who are unable to attend the surgery. The out of hours service is provided by Badger Out of Hours Service and NHS 111 service and information about this is available on the practice website.

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).

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Castle Practice on 13 April 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 had effective procedures in place to ensure care and treatment was delivered in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise safety concerns and to report incidents and near misses.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Some staff had not received updates on mandatory training, but were aware of the procedures to follow.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a system in place to identify carers, but the numbers on the register were low due to the practice not coding the information on the medical records.
• 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 Candor. The practice encouraged a culture of openness and honesty.

The areas where the provider should make improvement are:

• Effectively code all patients identified as carers.

• Continue to monitor and improve access to the practice.

• Review telephone access as results from the January GP patient survey showed 44% of patients said they could get through easily to the practice by phone (CCG average of 68%, national average of 73%).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2016

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

• The practice ran an anti-coagulation clinic service for their patients and also carried out DMARD monitoring for patients on methotrexate and other associated medicines. (DMARD monitoring involves a series of tests to check patients for adverse effects).

• 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.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• For those patients with more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care and the practice had a separate telephone line so that patients could access the practice urgently.

Updated 23 June 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 may be at risk, for example, children and young people who had a high number of A&E attendances.

• 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’s uptake for the cervical screening programme was 86% which was higher than the national average of 82%.

• The practice offered a full range of family planning services, including implants.

• The practice used a rapid access system for patients who required to see a doctor the same day. 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 held an ante natal clinic twice weekly at the practice.

Updated 23 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 care planning to avoid hospital admissions.

• 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.

• The practice reserved an appointment slot every morning for patients who were on the hospital admission avoidance list so they could access a GP immediately.

Updated 23 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 on line services such as appointment booking and repeat prescriptions services, later evening appointments and telephone consultations were also available.

• A full range of health promotion and screening that reflected the needs for this age group was also available.

• The practice 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 enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

• The health care assistant offered a stop smoking service with support from an external provider and the Citizens Advice Bureau held a weekly service at the practice to offer advice and support.

Updated 23 June 2016

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

• There were 96 patients on the dementia register and 89% (85 patients) had had their care reviewed in a face to face meeting in the last 12 months
• The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact. We saw that there were 82 patients on the mental health register and 94% (77 patients) had had care plans agreed.
• Patients experiencing poor mental health were signposted to various support groups and voluntary organisations and the community psychiatric nurse held twice weekly clinics at the practice.
• Staff had a good understanding of how to support patients with mental health needs and dementia and one of the GPs had completed training to prescribe specific medicines used in mental health to support patients in the community.
• The practice had access to psychological support through Solihull Healthy Minds (IAPT) and regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Updated 23 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 50 patients on the learning disability register, 64% (32 patients) of these patients had received an annual health check and the practice was encouraging the other patients to attend their health reviews.

• The practice offered longer appointments for patients with a learning disability and worked with other health care professionals in the case management of vulnerable patients.

• The practice held a register of carers and had 73 carers registered, which represented 0.6% of the practice list. This number was considered low in proportion to the number of patients at the practice, on further investigation we found that carers were being identified by the practice, but the information was not being recorded in the patient’s records effectively.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice told vulnerable patients 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.

• All staff had received safeguarding training, and knew how to recognise signs of abuse in vulnerable adults and children and the procedures to follow. 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.