Archived: Midlands Medical Partnership - Sutton Coldfield

Updated 22 March 2017

Mere Green Surgery is located in Sutton Coldfield and is one of four registered providers within the Midlands Medical Partnership (MMP) group of practices. The four registered providers include four locations with an additional six branches and are across the busy inner city of Birmingham providing care for a large, diverse, multicultural population. The Midlands Medical Partnership – Sutton Coldfied has a location at Mere Green Surgery.

The other registered providers in the group are: Erdington Medical Centre, serving Birmingham north east, with four branch surgeries; Dudley Park Medical Centre in Acocks Green, covering Birmingham south east and Old Priory Surgery in Kingsheath, covering Birmingham south with two branch surgeries. All four registered locations were visited by the inspection team including all six branches.A total of 61,163 patients are registered across Midlands Medical Partnership.

The group of practices is served by a team of 200 staff. There are 44 GPs working across the sites, 25 five male and 19 female GPs. Twenty two GPs are partners and the others are salaried. There are also 21 nurses, 10 health care assistants, four phlebotomists, two advanced nurse practitioners and a respiratory nurse specialist. Each site has a team leader supported by administrative and reception staff, including secretaries and call handlers.

The group of practices offers training and teaching facilities, which means GP trainees and foundation year doctors are able to undertake part of their training at the practices.

The Mere Green practice is open between 8:30am and 6:30pm Monday, Tuesday, Wednesday and Friday and between 8.15am and 6pm on Thursday. Appointments are from 8.30am to 12am and 4pm to 6pm on Monday and Tuesday. On Wednesday, Thursday and Friday the appointments are between 9am and 12am. On Wednesday afternoon and on Thursday afternoon the surgery is open but there are no appointments available. On Friday afternoon, appointments are available between 4pm and 6pm.Patients can access appointments at any MMP practice across the group whilst Mere Green practice face to face appointments are not available. Patients could also undertake telephone consultations with clinicians.

Patients requiring a GP outside of normal working hours are advised to call the Badger Out of Hours service.

Information published by Public Health England rates the level of deprivation within the Mere Green Surgery population group as eight on a scale of one to ten, with level one representing the highest level of deprivation.

MMP is part of NHS Birmingham and Crosscity CCG and had a General Medical Services contract.

Updated 22 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Midlands Medical Practice (MMP) - Sutton Coldfield, Mere Green Surgery on 18 and 19 October 2016. Mere Green Surgery is located in Sutton Coldfield.

Mere Green Surgery is one of four registered providers within the Midlands Medical Partnership (MMP) group of practices. The four registered providers include four locations with an additional six branches.The other registered providers in the group are: Erdington Medical Centre, serving Birmingham north east, with four branch surgeries; Dudley Park Medical Centre in Acocks Green, covering Birmingham south east and Old Priory Surgery in Kingsheath, covering Birmingham south with two branch surgeries. All four registered locations were visited by the inspection team including all six branches.All of the practices share one practice list and have a central management team with shared policies, procedures and governance arrangements. We have produced four reports to reflect the four provider/location registrations; however due to the structure of the practice much of the detail included in the reports will be replicated.

Overall the practice is rated as outstanding.

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

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). In response to patient feedback a central telephone hub was created with support from the PPG. This had improved telephone access to all 11 MMP practices with call abandonment rates reduced by up to 90% and demonstrated improved patient satisfaction. Feedback from patients about their care was consistently positive.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The organisation actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

These are the outstanding features:

• Staff had been trained to identify and support patients at risk of domestic violence. Over a six month period referral rates to services providing specialist support increased six-fold and staff told us patients said they felt supported and listened to.
• An event in August 2016 for all of the practice staff focussed on reporting of significant events. As a result all practice staff were aware of their responsibility in responding to risks. They were discussed weekly at practice meetings and there was a strong emphasis on learning. The events were analysed, actions agreed and learning points shared.
• There was evidence of quality improvement including clinical audits. There had been 25 clinical audits undertaken in the last two years across MMP with the learning shared across all practices. These were completed audits where the improvements made were implemented and monitored. Findings were used by the practice to improve services.
• Staff offered kind and compassionate care. For example a dementia drop in service had been established in conjunction with the Alzheimer’s Society which ran monthly. Patients and their carers were free to drop in without appointment to access support and advice.
• MMP’s ethos was “Taking Care” which was applied at all levels to both patients and staff. The management group had set objectives to achieve consistently exceptional care, to demonstrate leadership in service redesign and promote patient engagement and empowerment.
• A comprehensive understanding of the performance of the practice was maintained through the elected management board. Performance was managed centrally and managers could examine achievement and compliance at each location and cross-organisationally. We saw individual practice dashboards which were discussed with staff to motivate them to seek further improvement.
• Staff said they felt respected, valued and supported. For example,an employee of the month scheme motivated staff to perform well and all members of staff could identify opportunities to improve the service delivered through the staff forum.

The provider should:

• Continue to identify and support carers in order to be responsive to individual needs.

  
  

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 2017

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

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

• Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients in whom the last BP reading (measured in the preceding 12 months), was 140/80mmHg or less was 79%, compared to a national average of 78%.

• 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 MMP central target team ensured patients on disease registers were actively recalled and monitored. For example, there was an agreed care plan with 100% of eligible patients (aged 18 and over) and 98% had received a care plan review as of March 2016. In addition, designated staff were responsible, across all sites for facilitating active recall of all patients via a central hub.

• The chronic obstructive pulmonary disease (COPD) specialist nurse had plans in place for health promotion events, including a World COPD day event due to take place in November 2016. The nurse had also been liaising with secondary care colleagues across University Hospitals Birmingham and Heart of England NHS Foundation Trust (HEFT) to help improve COPD patient pathways and reduce hospital admissions. All patients admitted to hospital with chronic obstructive pulmonary disease (COPD) were reviewed within two weeks of discharge.

• Diabetic management and injectable therapy was provided through an extensive training programme for clinical staff and support from the diabetic specialist nurse. This improved accessibility for vulnerable and working patients who could be seen locally.

Updated 22 March 2017

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. Childhood immunisation rates for the vaccinations given to two year old’s and younger were up to 100% and five year old’s from 87% to 93%.

• 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.

• The practice’s uptake for the cervical screening programme was comparable to the national average. For example,79% of women aged 25-64 were recorded as having a cervical screening test in the preceding five years. This compared to a CCG average of 79% and a national average of 81%.

• 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.

• Children were offered same day appointments

Updated 22 March 2017

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 had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.

• The practice maintained a register for patients who were carers to ensure they received appropriate support including a review of their health. The practice worked closely with local community services to improve their care for example, joint working with Birmingham Carers Hub to devise a drop-in service.

• Frailty screening and assessments for all over 75 year old patients was currently being used to identify patients at risk of falls.

• All staff had completed training to meet the communication needs of specific patient groups such as the elderly. Staff supported patients with hearing and visual impairment to access the service.

• All MMP practices provided a core service with home visiting for housebound and elderly patients.

Updated 22 March 2017

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 was proactive in offering online services for booking appointments and to order repeat medications well as a full range of health promotion and screening that reflected the needs for this age group.

• Patients were able to access any of the 11 practices across Birmingham from 8.15am to 6.30pm. This was facilitated by the use one clinical system allowing access to patient records and centralised booking at any site. Telephone consultations were encouraged and patients could pre-book these or request one on the day.

• In order to help patients’ access medical care more conveniently, the provider had invested in ambulatory care provision where all of the sites were able to offer ECG and interpretation, 24 hour blood pressure monitoring, diabetic injectable therapies and spirometry.

Updated 22 March 2017

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

• 93% of patients with schizophrenia, bipolar effective disorder and other psychoses had a comprehensive, agreed care plan documented in their records, in the preceding 12 months. This was 4.6% higher than the CCG and 4% above the national average.

• 93% of patients diagnosed with dementia had had their care reviewed in a face- to- face meeting in the last 12 months. This was 9% above the CCG and 10% above the national averages.

• 93% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months. This was 5% above the CCG average and 4% above the national average.

• 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 a good understanding of how to support patients with mental health needs and dementia.

• This group of patients were offered an annual health review. The practice had wanted to engage with local mental health services to enable a more collaborative approach in the case management of these patients but had experienced difficulties in developing these local links.

• The practice worked in partnership with the Alzheimer’s Society and ran dementia drop-in clinics, which included a GP assessment and input from a pharmacist. These clinics were popular and available to all patients registered with MMP. The plan was to extend this service to additional locations as well as joint home visits.

• Healthy Minds Improving Access to Psychological Therapies (IAPT) service operated out of the surgeries which enabled people to be seen in a non-clinical environment where they may feel more relaxed.

Updated 22 March 2017

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

• Longer appointments were offered for patients with a learning disability.

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

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. These included community

• 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.

• Staff had been trained to identify and support patients at risk of domestic violence. Over a six month period referral rates to services providing specialist support increased six-fold and staff told us patients said they felt supported and listened to.

• The practice staff had identified that within the practice population there were a large proportion of people who were vulnerable, this included people experiencing poor mental health or learning difficulties. Staff were trained to support these patients to access healthcare.

• There was a high incidence of substance dependency in some of the areas covered by the practices. As a response to this GPs with a special interest in substance misuse were located across Birmingham to provide an in-house service working with a local voluntary agency to support these patients by monitoring their health needs and prescribing suitable medicines.

• End of life care patients received a priority service. All sites worked to the Gold Standard Framework and had close links to two hospices in Birmingham and regular multidisciplinary team meetings were held.