Archived: Solihull Healthcare Partnership

Updated 18 August 2016

Bernays & Whitehouse Group Practice was the first GP partnership in Solihull area of the West Midlands and began in 1883. There are two surgery locations that form the practice; these consist of Shirley Medical Centre and their sister practice, Grove Surgery. There are approximately 20,000 patients of various ages registered and cared for across the practice and as the practice has one patient list, patients can be seen by staff at both surgery sites. Systems and processes are shared across both sites. During the inspection we visited both locations. As the locations have separate CQC registrations we have produced two reports. However where systems and data reflect both practices the reports will contain the same information.

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 enhanced services such as advanced minor surgery, childhood vaccination and immunisation schemes. The practice has been a training practice since 1976. The practice also manages provides intermediate and urgent care in Solihull at the walk in centre based at Solihull Hospital.

There are seven GP partners (5 male, 2 female) and seven salaried GPs (2 male, 5 female). The practice currently has two GP registrars. The nursing team consists of nursing manager, seven nurses and three health care assistants. The non-clinical team consists of a practice manager, administrative and reception staff.

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 8am and 6.30pm Monday to Friday. Extended hours appointments are available 7.30am to 8am Monday, 6.30pm to 8pm Tuesday and 6.30pm to 8.30pm Wednesday at the sister practice Grove Surgery. A Saturday morning surgery is available every week from 8am to 10am; this is alternated between each site. Emergency appointments are available daily. 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 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 18 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bernays & Whitehouse Group Practice, Shirley Medical Centre, Solihull on 17 May 2016. Overall the practice is rated as outstanding. There are two surgery locations that form the practice; these consist of Shirley Medical Centre and their sister practice, Grove Surgery.There are approximately 20,000 patients of various ages registered and cared for across the practice and as the practice has one patient list, patients can be seen by staff at both surgery sites. Systems and processes are shared across both sites. During the inspection we visited both locations. As the locations have separate CQC registrations we have produced two reports. However where systems and data reflect both practices the reports will contain the same information.

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

• The practice had defined and embedded systems in place to keep people safeguarded from abuse. There was a system in place for reporting and recording significant events and staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses.
• Risks to patients were assessed and well managed.
• Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment; results were circulated and discussed in the practice.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, through discussions at clinical meetings the practice had setup alerts for possible serious conditions, to support the GP with their examinations.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice offered an in house counselling service.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Feedback from patients about their care was consistently positive.
• 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. We saw evidence that multidisciplinary team meetings took place every six weeks. Staff spoke positively about the team and about working at the practice.

We saw several areas of outstanding practice including:

• The practice has set up a dementia café every three months to support patients and their carers with the support of the patient participation group (PPG). The practice opened this up to the local community and had a positive response and is now looking to develop this further, with the support of local agencies and the practice staff who are dementia friends.
• The practice has started a free weight clinic on a Saturday morning which was an open invitation to all patients. We saw evidence to confirm effective weight loss had been achieved.
• As a result of incidents outside of the practice that had to come light through appraisals and discussions at clinical meetings the practice decided to set up alerts that highlight possible ‘serious conditions’. The practice has produced specific leaflets for patients so they are fully involved and aware of the possible complications and the importance of seeking medical help should any of the symptoms appear. For example, cauda equina. This is a rare but very significant and serious complication of sciatica/back pain which can result in permanent nerve damage.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 August 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed and housebound patients received reviews at home. For example, blood tests for warfarin monitoring were carried out by the Health Care Assistant.
• All patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had a screening programme in house for patients with suspected diabetes and a lead GP and nurse carried out initiation of insulin.
• We saw minutes of meetings to support that joint working took place and that patients with long term conditions and complex needs were discussed as part of the practices multi-disciplinary (MDT) team meetings every six weeks. .
• The practice had developed a deep vein thrombosis (DVT) service with the support of Solihull CCG, which had been adopted within the local community to offer to the whole population.
• The partners had developed a local improvement scheme with the support of the Solihull Clinical Commissioning Group for a prostate cancer service, which was in use by the Pan Birmingham Cancer Network (PBCN).
• The practice offered a range of clinical services which included care for long term conditions and offered health promotion support, for example stop smoking service.

Updated 18 August 2016

• The practice’s uptake for the cervical screening programme was 81% which was comparable to the national average of 82%.
• The practice held nurse-led baby immunisation clinics and vaccination targets were in line with the national averages.
• Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines. For example, the practice had set up a clinical pathway to support clinicians within the practice to identify children with sepsis
• Urgent appointments were available for children and were also available outside of school hours.
• The practice offered a full range of family planning services including implants and intrauterine contraceptive device (IUCD) fittings.
• The premises were suitable for children and babies. We saw positive examples of joint working with midwives and health visitors with monthly meetings been held.
• The midwife held an ante natal clinic once a week at the practice.

Updated 18 August 2016

• 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 and urgent appointments for those with enhanced needs.
• Regular audits were carried out and the practice were able to demonstrate improvements to patient care and treatment as a result. For example, a review of elderly patients with type II diabetes who were at risk of hypoglycaemia was completed. The audit identified 13 patients who required a medicine review and when the audit was repeated there was a reduction in patients who were at risk. In order to further improve performance in this area, the practice developed a ‘live’ clinical alerting system, which alerted the GP to review each patient who was at risk.
• The practice carried out weekly ward rounds at the local nursing home and residential home and there were nominated GP partner leads for the care homes. Feedback from the homes confirmed a supportive service was offered by the practice and advice and help were readily available from the GPs.
• The practice had systems in place to identify and assess patients who were inpatients or recently discharged from hospital. This was reviewed daily via the Heart of England iCare electronic system, which enables practices to review patients currently in hospital. All patient discharged were contacted by telephone or visited within three days and care plans were updated.
• Clinical meetings were held monthly by the GPs to review patient outcomes and the nurses held weekly meetings to share information.
• Monthly reviews were carried out of unplanned admissions and the practice worked closely with multi-disciplinary teams so patients conditions could be safely managed in the community.

Updated 18 August 2016

• 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 as well as a full range of health promotion and screening that reflected the needs for this age group, including smoking cessation and weight management.
• The practice has started a weight clinic on a Saturday morning with an open invitation to all patients
• A full range of health promotion and screening that reflected the needs for this age group was also available. It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years, this service was also available on a Saturday morning for patients who were unable to attend the surgery during the week.
• The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• Appointments were available on Tuesday and Wednesday evenings until 8pm and on Saturday mornings to support patients who could not attend the practice during normal working hours.

Updated 18 August 2016

• The practice held a register of patients experiencing poor mental health. We saw that there were 163 patients on the mental health register and 94% had had care plans agreed.
• The practice had 246 patients on the dementia register and 88% had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
• As a result of feedback we had received we reviewed in depth the mental health support and clinical reviews offered by the practice and found that the systems in place were robust and informative.
• The practice runs a dementia café with the patient participation group (PPG) every three months to offer support to patients and their carers. Due to the popularity of the cafe, the practice are currently reviewing how to offer this service to the local population with the support of local agencies and groups.
• Staff had a good understanding of how to support patients with mental health needs and dementia and many of the staff were dementia friends
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 and offered same day appointments.
• To improve access for counselling, the practice had an in house counsellor who worked on a voluntary basis to support patients with bereavement and minor mental health concerns. Improving Access to Psychological Therapies (IAPT) counselling services also held a clinic once a week to support patients with more complex needs.
• Alcohol support services were available and held regular sessions at the practice.

Updated 18 August 2016

• The practice offered longer appointments for patients who required them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. We saw that there were 47 patients on the learning disability register 27 of these patients had received an annual health checks.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.
• The practice held a register of carers and had 120 carers registered, which represented 0.6% of the practice list. This number was low for the number of patients at the practice. The practice told us that patients in nursing and residential homes who have carers are not added to the carers register.