Rotton Park Medical Centre

Updated 5 April 2017

Rotton Park Medical Centre is located in Edgbaston, a suburban area of central Birmingham. It is approximately two miles from Birmingham city centre.

There is access to the practice by public transport from surrounding areas. There are also parking facilities on site.

The practice currently has a list size of 4674 patients.

The practice holds a General Medical Services (GMS) contract with NHS England. The GMS contract is held between general practices and NHS England for delivering primary care services to the local communities. The practice provides GP services commissioned by NHS Sandwell and West Birmingham Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

The practice is situated in an area with high levels of deprivation (level two, Indices of Multiple Deprivation decile, IMD). Level one IMD represents a most deprived area and level ten, the least deprived. A higher number of patients registered at the practice are unemployed (17%) compared with the CCG average (12%) and national average (5%).

The practice has a higher than national average number of young children and adults in their 20’s 30’s and 40’s living within the practice area. It has a lower than national average number of people in their late 50’s and older adults. The patient population is mixed. This includes patients with a white British ethnicity, Eastern European, Asian and African.

The premises have recently been updated with new heating, flooring, emergency lighting and infection control compliant sinks. Patient services are all available on the ground level of the building.

The practice is currently managed by two GP partners. (one male, one female). The partners share the role of practice manager. The partners also employ two salaried GPs. They are supported by one practice nurse and a small team of administrative and clerical staff. The practice had recently appointed a healthcare assistant who had not started in post at the time of our inspection.

The practice is a training practice for GP trainees. There are two trainees working within the practice currently.

One of the GP partners is the Vice Chair of the ICOF (Intelligent Commissioning Federation) Locality Commissioning Group and clinical lead for Information Technology at Sandwell and West Birmingham CCG.

The practice opens at 8am daily until 6.30pm on Wednesday and Friday and closes at 7pm on Monday, Tuesday and Thursday. GP consultations commence on each weekday from 9am until 12pm and on Wednesday and Friday afternoons from 3.30pm to 6.30pm. Afternoon surgery on Monday, Tuesday and Thursday commences at 4pm to 7pm. The practice is also currently open on Saturday from 9.30am to 12.30pm for pre-booked appointments only.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed, patients are directed to Badger (the out-of-hours service) via the 111 service.

Updated 5 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rotton Park Medical Centre on 19 December 2016. Overall the practice is rated as outstanding.

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 for reporting and recording significant events. Learning outcomes were shared with staff and were embedded within the practice.
• Risks to patients were assessed and well managed. These included safeguarding of children and vulnerable adults, medicines management and health and safety precautions which included the practice’s ability to respond to an emergency.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audit drove quality improvement in all areas of activity. Staff had been trained to provide patients with the skills, knowledge and experience to deliver effective care and treatment.
• Patient feedback from CQC comment cards showed that patients 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.
• 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.
• The practice had good facilities, which had been recently updated 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 practice was forward thinking and was involved in a local pilot aimed at improving healthcare for its patients.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• The practice held a register of 22 patients who had experienced FGM (female genital mutilation) or who were at risk of FGM. We saw specific examples of interventions made by practice GPs to reduce the risk of FGM occurring. We also reviewed examples where the practice had liaised with and made appropriate referrals to specialist healthcare professionals when FGM had been identified.

• The practice were responsive to the needs of its local population. They offered a latent tuberculosis (TB) testing screening service because they were aware of the high prevalence for latent TB within the locality. The practice were assisting in designing a new service for HIV and chlamydia screening, as it was identified there was a high prevalence for HIV within the local area. The initiative was planned to be rolled out to other GP practices within the locality once the pilot was completed.
• The practice had designed a bespoke template for use as part of an audit involving MHRA alerts received. The practice were taking steps to share the template and subsequent learning from the audit amongst other local practices.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 April 2017

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

• Nursing staff had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.

• National data showed the practice was performing above averages for its achievement within 11 diabetes indicators. The practice achieved 96% of the available QOF points compared with the CCG average of 88% and national average of 90%.

• Two of the practice GPs had obtained certificates in Diabetes Care from the University of Warwick and one had also obtained an Insulin for Life diploma. The practice provided a clinic for patients with diabetes who had complex needs. The clinic was delivered in collaboration with a specialist nurse and consultant.

• Data also showed that 100% of patients with chronic obstructive pulmonary disease (COPD) had received a confirmed diagnosis. This was above the CCG and national averages of 89%.E

• Longer appointments and home visits were available when needed.

• All these patients 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, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 5 April 2017

The practice is rated as outstanding 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 accident and emergency (A&E) attendances.

• The practice had undertaken a safeguarding review of all its patients on its safeguarding register and female genital mutilation (FGM) register. This was to ensure information was accurate, up to date and to identify if any other action was required. Outcomes from the review included a patient recall and additional coding placed on a number of patient records.

• The practice held a register of 22 patients who had experienced FGM or who were at risk of FGM. We were provided with specific examples of interventions made by practice GPs to reduce the risk of FGM occurring. We were also provided with examples where the practice had liaised with and made appropriate referrals to specialist healthcare professionals when FGM had been identified.

• The practice had designed and implemented a bespoke patient registration form for completion by new patients who were aged under 18 years old. The form helped to identify safeguarding issues at an early stage. All forms were reviewed by one of the practice GPs. We were provided with specific examples whereby the use of the form had identified concerns.

• Immunisation rates for all standard childhood immunisations ranged from 70% to 90%. This was comparable to CCG averages which ranged from 41% to 95%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 5 April 2017

The practice is rated as outstanding 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 reviewed all its elderly patients who were at risk of falling or who had experienced a fall within the previous 12 months. Those identified at risk were referred for further assessment and discussed in regular multi-disciplinary team meetings with other health care providers.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included carers of housebound patients.

• Data showed that 100% of patients aged over 75 years with a fragility fracture and a confirmed diagnosis of osteoporosis were receiving appropriate treatment. Achievement was above the CCG average of 90% and above national average of 84%.

Updated 5 April 2017

The practice is rated as outstanding 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 provided evening appointments on weekdays up until 6.30pm and 7pm for working aged patients and on Saturday mornings from 9.30am to 12.30pm.

• A range of online services were offered which included appointment booking and prescription ordering. The practice participated in the electronic prescription service, enabling patients to collect their medicines from their preferred pharmacy without having to collect the prescription from the practice. Appointments could also be booked via a downloadable App.

• The practice offered a full range of health promotion and screening that reflects the needs for this age group.

• 72% of women aged over 25 but under 65 had received a cervical screening test in the previous five years. The practice was performing below the CCG average of 79% and national average of 81%.

Updated 5 April 2017

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

• 95% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was above the CCG average of 91% and above the national average of 89%. The practice exception reporting rate was 4.8% which was below the CCG average of 14.7% and national average of 12.7%.

• 93% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG and national averages of 84%. The practice had not exception reported any patients.

• The practice had undertaken an audit of the care provided to patients with mental health problems in 2014/15 and re-audited it in 2015/16. In 2014/15, 91% of reviews were completed. Following additional measures put in place to contact patients, in 2015/16, 95% of reviews were completed.

• Three of the practice GPs had expertise in managing patients with poor mental health as a result of their previous work experience and additional training.

• 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.

Updated 5 April 2017

The practice is rated as outstanding 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. There were 14 patients on the learning disability register. The practice offered longer appointments for patients with a learning disability.

• The practice had undertaken an audit of the care provided to patients with learning disabilities in 2014/15 and re-audited it in 2015/16. In 2014/15, 57% of patients with a learning disability were invited for an annual review and 21% attended a review. Following additional measures put in place, in 2015/16, 100% of patients were invited for a review and 92% received a review.

• The practice had undertaken a number of safeguarding audits of its patients who had experienced or were at risk of domestic violence utilising best practice guidelines. An outcome from a review included assurance received externally that highly effective systems were in place. A further outcome included a specific example of intervention made in relation to patient safeguarding.

• A member of the Dementia Information and Support for Carers (DISC), a service provided to give support to carers of people with confusion and memory problems, regularly attended multi-disciplinary meetings. This ensured that carers' needs were appropriately identified and addressed.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. The practice used ‘route to wellbeing’, a website to signpost their patients.

• 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.