The Peel Medical Practice

Updated 31 May 2017

Peel Medical Practice is situated in the town centre of Tamworth. The practice was established in 1985 and shares a building with a pharmacy that is not connected to any of the partners or employees. Tamworth is one of the largest towns in Staffordshire with a population of approximately 77,000. The area has pockets of deprivation but overall is in line with the national average. There is a large variation in life expectancy dependent on which part of the practice catchment the patients live, with the most deprived areas having a life expectancy of seven years less than the less deprived areas. The practice has a list size of 14,125 which has increased by 1500 patients in the past 18 months. The age profile is typical of a town centre practice with the percentage of patients under 65 years being higher and the percentage over 65 years lower than the national averages.

The practice has five GP partners and five salaried GPs whose combined number of clinics is equal to eight whole time equivalents. The partners are assisted by a clinical team consisting of an advanced nurse practitioner, four practice nurses, one healthcare assistant and a phlebotomist. The administration team consists of an acting practice manager, reception supervisor, ten administrative and seven reception staff. It is a training practice and has links with Birmingham University Medical School.

The practice is open from 8am to 6.30pm from Monday to Friday and offers extended hours between 7.30am and 8am in the morning and between 6.30pm and 8pm in the evening. When the practice is closed patients are signposted to the NHS 111 service using a telephone message. The practice opted out of providing an out of hours service, choosing instead to use a third party provider. The nearest hospitals with A&E units are situated at Good Hope Hospital, Sutton Coldfield and Queen’s Hospital in Burton-Upon-Trent. There is a minor injury unit at the Sir Robert Peel Hospital in Tamworth.

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Peel Medical Practice on 8 February 2016.

We found that there were a number of breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment:

• The practice had not undertaken regular infection prevention control audits and had not completed a risk assessment on the consulting rooms that were carpeted.
• Prescription pads and forms were not stored securely and a robust system was not in place to track their use (a tracking system for controlled stationary such as prescriptions is used by GP practices to minimise the risk of fraud).
• The provider could not evidence that the appropriate recruitment checks had been completed on all staff employed.

A requirement notice was served on the practice in respect of theses breaches of regulations. The practice subsequently sent us an action plan to say what they would do to meet legal requirements.

The overall rating for the practice at the original inspection was good and the full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Peel Medical Practice on our website at www.cqc.org.uk.

We undertook an announced focused inspection on 18 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our February 2016 inspection. We did not visit the practice but reviewed information sent to us by the provider. This report only covers our findings in relation to those requirements and additional improvements made since our last inspection. The legal requirements had been met and the rating in the safe key question changed from requires improvement to good.

Our key findings were as follows:

• In March 2016, the practice implemented a new induction checklist supported by a step by step guide for recruitment. This included recruitment checks required under Section 13 of the Health and Social Care Act 2008. The induction programmes were role specific; there were separate inductions for nurses, non-clinical staff and locum GPs.
• We were sent two completed checklists from personnel files of existing staff that included evidence that the appropriate checks had been undertaken. The provider told us that these checks had been carried out on all staff.
• The practice told us that they had implemented a system to secure and account for prescription pads and forms within the practice. Evidence sent showed that the prescriptions used were recorded on a monthly report that followed the sequential numbering on the prescription forms.
• The practice had completed risk assessments that included risk of infection in consulting rooms that had carpets.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 April 2016

The practice is rated as good for the care of people with long-term conditions. Patients were reviewed in nurse led chronic disease management clinics and written management plans had been developed for patients with chronic obstructive pulmonary disease (COPD), asthma and diabetes. The patient triage protocol stated that patients with long term conditions should be offered same day appointments with a GP or the advanced nurse practitioner. We found that the nursing staff had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and asthma. Longer appointments and home visits were available when needed and reviews were coordinated to minimise the required number of patient visits. All patients with a long term condition were offered a review to check that their health and medication needs were met. For those people with the most complex needs, the GPs worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

Updated 11 April 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 who were at risk, for example, children and young people who had protection plans in place. Appointments were available outside of school hours and the premises were suitable for children and babies. A number of treatment rooms were upstairs but there was no lift in the building. However clear signage informed patients that consultation rooms were available downstairs if required. Same day emergency appointments were available for children. There were screening and vaccination programmes in place and the child immunisation rates were comparable with the local Clinical Commissioning Group averages. The practice worked closely with the health visiting team to encourage attendance. New mothers and babies were offered post-natal checks. The emergency equipment included a separate paediatric resuscitation box.

Updated 11 April 2016

The practice is rated as good for the care of older people. Every patient over the age of 75 years had a completed care plan, a named GP and all hospital admissions were reviewed. This included patients who resided in nursing and care homes. Care homes each had an allocated GP and an emergency contact number had been provided to care home staff to contact the practice. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, risk profiling and case management. The practice was responsive to the needs of older people and offered home visits and longer appointments as required.

Updated 11 April 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. A range of on-line services were available, including repeat prescription requests, booking appointments and access to health medical records. The practice offered all patients aged 40 to 75 years old a health check with the nursing team. The practice offered a full range of health promotion and screening that reflected the needs for this age group. For example, a chlamydia testing kit was positioned in a discrete area of the waiting room for patients to self-screen without the need to make an appointment.

Updated 11 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients who presented with an acute mental health crisis were offered same day appointments. People experiencing poor mental health were offered an annual physical health check. Dementia screening was offered to patients identified in the at risk groups. The practice carried out advance care planning for patients with dementia.

The practice regularly worked with multi-disciplinary teams in the case management of patients with mental health needs. This included support and services for patients with substance misuse and screening for alcohol misuse with onward referral to the local alcohol service if required. The practice also worked closely with the health visiting team to support mothers experiencing post-natal depression. It had told patients about how to access various support groups and voluntary organisations and signposted patients to the advocacy service where appropriate.

Updated 11 April 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. We found that the practice enabled all patients to access their GP services and assisted those with hearing, sight and language difficulties.

The practice held a register of patients with a learning disability and had developed individual care plans for each patient. The practice carried out annual health checks and offered longer appointments for patients with a learning disability.

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. 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. There was a policy for how to register patients with no fixed address.