Linkway Medical Practice

Updated 5 December 2016

Linkway Medical Practice is registered with the Care Quality Commission (CQC) as a partnership of two with a senior GP partner and a second GP partner. The practice is located in West Bromwich. The practice has good transport links for patients travelling by public transport but parking facilities are limited. The practice is situated within the Lyng Centre, a joint healthcare facility that houses four GP practices, phlebotomy, family planning and podiatry services as well as the District Nursing Team. The practice is situated on both the ground floor and second floor of the building and there is a lift for public use. The provider has dedicated rooms within the premises that included nine consulting rooms. There are three treatment rooms, two on the ground floor and one on the second floor. There is level access to the building and doors to the building are automated. All areas within the practice are accessible by patients who use a wheelchair or parents with a pushchair.

The practice team consists of two partners, both male. The partners are supported by three salaried GPs (two female, one male) working a combined 33 sessions per week. There are two GP registrars and one foundation year GP working a combined 24 sessions per week. The nursing team consists on an advanced nurse practitioner (ANP), one specialist practice nurse, two practice nurses and a healthcare assistant (HCA). Clinical staff are supported by a practice manager, a deputy practice manager, administration and reception staff. In addition to the GP partners, there are a total of 27 staff employed either full or part time hours to meet the needs of patients.

The practice is open every week day between 8am and 6.30pm. Appointments are available from 8.30am to 1pm and from 3pm to 6pm. The practice does offer extended hours on a Saturday morning from 8am to 12.30pm. 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, provided by Primecare, via the NHS 111 service.

The practice has a General Medical Services contract with NHS England to provide medical services to approximately 10,400 patients. It provides Directed Enhanced Services, such as the childhood immunisations, extended hours and asthma and diabetic reviews. The Local Incentive Schemes (LIS) consist of a combined package of services coordinated through the primary care commissioning framework (PCCF). These include improving on patient survey results, access improvement and a falls service. Separately the practice provided a number of screening services that included cardiovascular disease (CVD) screening. The practice demographics were similar to national averages, for example the proportion of patients aged under 18 is 23% compared to the national average of 21%. The proportion of patients aged 65 and over is 17%, the same as the national average. The income deprivation affecting children of 31% was higher than the national average of 20%. The level of income deprivation affecting older people of 32% was higher than the national average of 16%.

Updated 5 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Linkway Medical Practice on 3 October 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 a system in place for reporting and recording significant events.
• Staff understood their responsibilities to raise concerns and to report incidents and near misses. The practice had a formal system in place for the ongoing monitoring of significant events, incidents and accidents.
• Arrangements were in place to ensure that risks to staff and patients were assessed and managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• The practice had completed some clinical and administrative audits but there was no programme of internal audits in place to monitor quality and make improvements.
• The practice invested in staff development and training.
• 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.
• 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 and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by the 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.

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

• Ensure all patients on repeat medications receive regular reviews.
• Improve the signage offering a chaperone service to patients.
• Implement a programme of internal audits that monitor safety and drives improvement within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 December 2016

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

• A GP partner was the lead for diabetes and supported a specialist diabetic nurse employed by the practice. The advanced nurse practitioner had a lead role in chronic obstructive pulmonary disorder (COPD).
• Two per cent of patients had been identified at higher risk of hospital admission and were proactively managed using written care plans and regular discussions with other healthcare professionals.
• The practice Quality and Outcomes Framework (QOF) for the care of patients with long-term conditions was similar to or better than the local and national averages. For example the practice performance for diabetes related clinical indicators was higher than the local Clinical Commissioning Group and England average (97% compared to the local average of 88% and the national average of 90%).
• Longer appointments were available when needed and home visits made to patients who were housebound or too ill to attend the practice.
• The GP and practice nurses worked with relevant healthcare professionals to deliver a multidisciplinary package of care to patients with complex needs.
• All newly diagnosed diabetic patients and patients with poorly controlled diabetes were provided a diabetic education programme.

Updated 5 December 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 did not attend hospital appointments.
• Immunisation uptake rates for standard childhood immunisations were similar to the local clinical commissioning group (CCG) and national averages.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered contraceptive services and the nurse provided condoms to patients and chlamydia testing kits.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 82%.
• All pregnant patients were contacted to provide prescriptions for folic acid.

Updated 5 December 2016

The practice is rated as good for the care of older people.

• The practice offered personalised care to meet the needs of the older people in its population and provided a befriending service to elderly patients.
• The practice offered GP, nurse and healthcare assistant to perform home visits to older people who were housebound only. For example to perform heart monitoring and diabetic foot checks
• Flexible appointments were available for older patients.
• All patients aged 65 and over were offered a health check including blood tests.
• A GP was allocated to each nursing and care home housing elderly patients. Staff had been trained and the practice had purchased machines to take blood samples and blood pressures in patients homes.

Updated 5 December 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 offered extended opening hours and the appointment telephone line was easily accessible to patients who worked during the day.
• 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 5 December 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia.
• The practice held a register of patients who experienced poor mental health. Clinical data for the year 2014/15 showed that 107 of 114 patients on the practice register who experienced poor mental health had a comprehensive agreed care plan. This was equivalent to 92%, higher than the CCG average of 87% and national average of 88%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. For example, the community mental health team.
• The percentage of patients diagnosed with dementia, whose care had been reviewed in a face to face review in the preceding 12 months was 83%, which was comparable with the CCG and national average of 84%. The exception reporting rate was 2.4% which was lower than the CCG average of 8.4% and the national average of 8.3% meaning more patients had been seen.

Updated 5 December 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of 104 patients with a learning disability and annual health checks were carried out on 63 of these patients within the last 12 months. The practice experienced a high number of non-attenders and planned to pilot consultations by video link to improve the number of checks completed for this cohort of patients.
• 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. For example the adult ability team, a service that included physiotherapy and counselling.
• Staff told us of a number of patients who were offered emergency appointments to reduce A&E attendances. Flexible appointments were offered to patients with learning disabilities.