Archived: Fernbank Medical Practice

Updated 28 April 2017

Fernbank Medical Practice is located on a busy main road in a residential part of Ward End, Birmingham, West Midlands within a large health centre. The practice provides a service to patients who live in Saltley, Washwood Heath and Small Heath. The premises are owned by the principal GP and has consulting rooms on two floors with access by lift. There is easy access to the building and accessible facilities are provided. There is very limited car parking on site for patients.

The practice holds a General Medical Services (GMS) contract 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 and is a nationally agreed contract.

The practice forms part of NHS Birmingham CrossCity Clinical Commissioning Group (CCG).

There are 4,593 registered patients on the practice list. The practice has a high number of patients from a minority ethnic group (82%); with 69% under the age of 18 years and 6% over 65 years. 25% of the local population is unemployed in comparison with 9% within the CCG and 5% nationally. There are a number of patients who do not speak English as a first language including patients from Afghanistan, Romania and Slovakia, with a number of patients who are transient such as the Roma community. Information published by Public Health England rates the level of deprivation within the practice population group as one on a scale of one to ten, with level one representing the highest level of deprivation.

There are four GPs working at the practice, a principal GP, one salaried and two long term locum GPs. Three of the GPs are male and one is female. There is one female nurse and one female health care assistant. (HCA). The practice nurse works part time and the HCA full time. There are two practice managers who job share, a full time medical secretary and a team of administrative staff. The practice has significant problems in recruiting clinical staff and the principal GP returned to work from retirement to keep services sustainable. Several attempts have been made to recruit additional partner GPs.

The practice opening times are 8.30am until 6.30pm Mondays, Tuesdays, Thursdays and Fridays. On Wednesdays the practice is open from 8.30am until 2pm. There are extended hours opening Mondays, Tuesdays and Fridays from 6.30pm to 7.15pm. Appointments are available 9am to 12pm, 12.45pm to 7.15pm Mondays, Tuesdays, and Fridays, until 2pm on Wednesdays and until 6.30pm on Thursdays.

Patients requiring a GP outside of normal working hours are advised to call the NHS 111 service who will advise the patient on action required for example contact with the out of hours provider BADGER.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fernbank Medical Centre on 17th November 2016. Overall the practice is rated as requires improvement.

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

• Systems and processes were not robust to keep patients safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment.
• Performance levels on the Quality and Outcomes Framework (QOF) showed patient outcomes were consistently below the national average.
• Staff were clear about reporting incidents, near misses and concerns and there was evidence of sharing learning with staff to prevent incidents re-occurring.
• The practice had a leadership structure, however, there were no formal governance arrangements to monitor the quality of the service.
• The practice had a number of policies and procedures to govern activity, but some had not been reviewed to ensure they were up to date.
• Patients said they were treated with compassion, dignity and respect and felt cared for, supported and listened to but national patient survey data showed the practice was rated lower than others for several aspects of care.

The areas where the provider must make improvements are:

• Ensure that persons providing care or treatment have the qualifications,competence skills and experience to do so safely. Recruitment procedures must be effective and include all necessary pre-employment checks for staff including Disclosure and Barring Service (DBS) checks where appropriate, references and indemnity insurance.
• Review governance arrangements to ensure systems arein place to assess, monitor and mitigate the risks relating to the health,safety and welfare of service users. This must include:
• Effective systems to monitor any emerging trends from complaints which require service improvement.
• Reviewing and update procedures and guidance such as the protocol for managing patients with diabetes to ensure they reflect current best practice.
• Identifying areas of lower performance and having a clear plan to improve and address this to ensure the health and wellbeing of patients
• Records relating to the care and treatment of each person using the service were fit for purpose in that care plans were integrated into patient’s electronic records and updated regularly.

In addition the provider should:

• Be proactive in promoting cervical screening and raise awareness of the national breast and bowel screening program.
• Review the system to monitor the use of prescription forms and pads.
• Update the information leaflet for patients which was significantly out of date.
• Should consider ways to increase the patient voice and identify any further service improvements required.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as requires improvement for the care of people with long-term conditions. We did however see some areas of good practice.

• There was a system in place to review and recall patients with long term conditions and nursing staff had lead roles in chronic disease management.Patients at risk of hospital admission were identified as a priority.

• 85% of patients with diabetes had received the flu vaccination in the preceding August to March 2015 compared to the national average 95%. The practice had achieved 61% of available points for patients with diabetes who had a foot examination (national average 88 %). Longer appointments and home visits were available when needed.

• All patients with long term conditions had a named GP. For those patients with the most complex needs, the named GP worked with relevant health care professionals to deliver a multidisciplinary package of care. However, the practice told us of the difficulties they had experienced in engaging with some community health care teams. They had written to the teams involved and informed the CCG but the situation had not improved.

• Regular staff meetings and audits were used to help plan care.

• Staff supported patients to access to their test results and enable them to self-manage their conditions. For example, patients were provided with diabetes management plans, blood pressure monitoring advice sheets and “my breathing book” for COPD patients.

• Patients were offered home monitoring of their blood pressure, dietary advice, and referral to exercise and lifestyle management groups.

Updated 28 April 2017

The practice is rated as requires improvement for the care of families, children and young people. We did however see some areas of good practice.

• 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.

• There was a follow up system for children who did not attend appointments.

• Immunisation rates were relatively high for all standard childhood immunisations. For example the practice achieved between 94-95% uptake for two year olds in 2015/16 compared to a national target of 90%.

• 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 who held twice weekly clinics at the practice and health visitors with whom staff planned and undertook joint reviews of patients who had missed immunisation appointments.

Updated 28 April 2017

The practice is rated as requires improvement for the care of older people. We did however see some areas of good practice.

• The practice offered proactive, personalised care to meet the needs of the older people in its population. However we saw that some care plans were not live documents and had not been updated where necessary.

• The practice was responsive to the needs of older people, offered home visits, coordinated patients appointments to reduce repeat visits to the surgery and urgent appointments were available for those with enhanced needs. Staff worked with the community matrons and palliative care staff to meet the needs of older patients.

• Joint safeguarding work was carried out with the Clinical Commissioning Group (CCG) and lessons learnt were shared across the team and locality group.

• The practice worked with other agencies including Age UK, the Integrated Care Team, Stroke Association and Wellbeing Service.

Updated 28 April 2017

The practice is rated as requires improvement 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 online services for booking appointments and requesting repeat prescriptions as well as a full range of health promotion and screening that reflects the needs of working age patients.

• 63% of women had received cervical screening. This compared to a CCG average of 79% and national average of 82%.

• The performance in respect of national screening programmes for bowel and breast cancer screening were lower than local and national averages. For example 51.5% of patients attended for breast screening which was below the CCG average of 69% and national average of 72%. 28% of patients (45 people) who were offered the opportunity attended for bowel screening. This was lower than the CCG average of 50% and national average of 58%.

• The practice offered NHS health checks for those between 40-74 years.

• Evening appointments were available until 7.15pm on three days each week.

• Patients were signposted to a local smoking cessation service or were supported by the health care assistant.

Updated 28 April 2017

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

• 15.5% of patients with schizophrenia, bipolar disease and other psychoses had a comprehensive agreed care plan documented in the preceding 12 months compared to the national average 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Whilst the practice had a register of patients diagnosed with dementia we saw no evidence of care plans for these patients.

• 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.

Updated 28 April 2017

The practice is rated as requires improvement 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. Health checks were scheduled at accommodating times and were GP led.

• The practice regularly worked with community matrons and social services teams in the case management of vulnerable patients.

• Care plans written for vulnerable patients in 2014 had not been scanned into electronic records or updated since then.

• 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.

• There was ongoing support for carers, such as health checks and flu vaccinations and signposting to local support services which were culturally appropriate, for example an Asian carers group.

• Staff accommodated those patients with alcohol and drug dependency and severe mental health conditions who may need a more flexible approach with their appointments.