Archived: The Slieve Surgery

Updated 23 December 2016

The Slieve surgery is situated in the inner-city area of Handsworth Wood in Birmingham, the surgery has a multicultural patient list of approximately 6,000 patients from different cultural and religious backgrounds. Information published by Public Health England rates the level of deprivation within the practice population group as five, on a scale of one to ten, with level one representing the highest level of deprivation.

Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contractual obligations to provide enhanced services to patients. An enhanced service is above the contractual requirements of the practice and is commissioned to improve the range of services available to patients. The practice is a teaching practice for Birmingham University Medical Students, since 2001.

The clinical team includes two GP partners, both male, the practice have a regular locum female GP providing four sessions per week. There are two practices nurses and a nurse manager. The GP partners and the practice manager form the management team and they are supported by the office manager and six reception and administration staff.

The practice is open between 8am and 6.30pm on Mondays, Tuesdays, Wednesdays and Fridays, 8am and 8pm on Thursdays. Appointments are available all week from 8am to 11am, and 2pm to 5pm. Additional appointments are available between 6.30pm and 7.30pm on Thursdays and 11.30am and 12.30pm all week for the cough and cold clinic. When the practice is closed the out of hours provision is provided by Primecare.

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Slieve Surgery on 26 October 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Risks to patients were assessed and well managed.

• 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.

• Clinical audits had been triggered by new guidance and from learning from significant events.
• The practice had developed and adapted several templates to improve process, services and patient care.
• The practice were proactive in encouraging patients to attend for cervical screening resulting in higher than average attendances.

• The practice provided health care for patients in a local care home and had provided training to staff for management of nutrition, prescriptions and phlebotomy.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs. 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 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was a strong team culture and the practice was cohesive and organised.

We saw some areas of outstanding practice:

• The practice were proactive in educating patients regarding the use of antibiotics, the antibiotic prescribing was 50% below target. They had developed information leaflets and poster displays in the waiting area to educate patients on the use of antibiotics. The ‘cough and cold’ clinic also had an impact. The practice developed templates and ‘pop ups’ on the clinical system reminding prescribers of current guidance.

• The practice’s uptake for the cervical screening programme was higher than the local and national average with 0% exception rates. The practice were proactive in encouraging patients to attend for cervical screening. For example, when patients attend to see the nurse, they would, where appropriate take the smear at that time, or book the appointment for the patient, the practice manager sent letters to all patients due their smear in a particular month and the following month if they did not attend, the nurse was then alerted to the non-attenders.

However there were areas of practice where the provider should make improvements:

• The practice should consider how they ensure staff are kept up to date with practice information including those unable to attend practice meetings

• The practice should consider how they assure themselves that appropriate processes are in place in the absence of fire drills to ensure emergency procedures are safe.

• The practice should review the process in place for the security of prescription stationary

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

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

• The practice had developed toolkits for patients with pre-diabetes, raised cholesterol and abnormal vitamin D levels, these generate personalised patient information letters

• Care plans were reviewed for all patients with long term conditions, palliative care patients and the patients resident in the care home. Newly diagnosed patients records were reviewed monthly and three to six monthly when there condition is stable. Patients with long term conditions were provided with the practice mobile emergency number to contact at any time if they had concerns.

• 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.

• 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.

• The practiced provided health education classes for patients, topics included diabetes, dementia and hypertension.

• The practice had developed templates and toolkits for headaches, low back pain, anaemia and lower urinary track symptoms. They included guidance on diagnosis, investigations, management and referral.

Updated 23 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 had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 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 school nurses.

• The practice provided a lunch time ‘cough and cold’ clinic.

• The practice’s uptake for the cervical screening programme was 96%, which was better than the local and national average of 82%. The practice were proactive in encouraging patients to attend for cervical screening. For example, when patients attend to see the nurse, they will where appropriate take the smear at that time, or book the appointment for the patient, the practice manager sends letters to all patients due their smear in a particular month and the following month if they did not attend, the nurse are then alerted to then non-attenders.

Updated 23 December 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provides health care for patients in a local care home and had provided training to staff for management of nutrition, prescriptions and phlebotomy. The practice also received the GP resilience fund to enable them to support other practices that looked after care homes.

• The practice maintained a palliative care register and held monthly palliative care meetings that included reviews of patients with other conditions for example, dementia and heart failure.

Updated 23 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 on a Thursday evening until 8pm for working patients who could not attend during normal opening hours.

• The practice was proactive in offering online services, appointments could be booked over the phone, face to face and online. The practice offered extended hours on Thursdays.

• A full range of health promotion and screening that reflects the needs for this age group.

Updated 23 December 2016

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

• 74% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months compared to the CCG and national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had received training on dementia awareness and had a good understanding of how to support patients with mental health needs and dementia.

• The practice provided patient education sessions on Dementia awareness.

Updated 23 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 patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. Patients received an annual review.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The practice told vulnerable patients how to access 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.