The Spires Health Centre

Updated 3 July 2018

The Spires Health Centre is located in Wednesbury, an area of the West Midlands. The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract is a nationally agreed contract to ensure practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care.

The practice provides primary medical services to approximately 4,900 patients in the local community. The practice is located in a temporary purpose built building and is in an area with high levels of social and economic deprivation, compared to England as a whole. Based on data available from Public Health England, the practice deprivation level is ranked as two out of 10, with 10 being the least deprived. Many of the people in the practice area are of white ethnicity, with 79.7% of the practice population being within this group.

The practice staffing comprises of two GP partners (1 male and 1 female) and one long term locum GP (male). The nursing team consists of one practice nurse. The non-clinical team consists of a practice manager, administrative and reception staff.

The practice is open between 8am and 8pm on Mondays and 8am to 6.30pm Tuesday to Friday. Extended opening hours are provided by the practice on Monday evenings from 6.30pm to 8pm and Tuesday and Wednesday morning from 7.30am to 8am. The practice is part of a local federation and patients are able to access appointments through the ‘hub’ from 6.30pm to 8pm Monday to Friday and at weekends. Emergency appointments are available daily and telephone consultations are also available for those who need advice. Home visits are available to those patients who are unable to attend the practice. When the practice is closed the out of hours service is provided by Primecare and the NHS 111 service.

Updated 3 July 2018

This practice is rated as Good overall. (Previous inspection June 2017 – Good overall, with requires improvement rating for providing Safe services).

The key question is rated as:

Are services safe? – Good

We carried out a focused inspection at The Spires Health Centre on 1 June 2018. This inspection was in response to previous comprehensive inspection at the practice in June 2017, where breaches of the Health and Social Care Act 2008 were identified. You can read the report from our last comprehensive inspection on 29 June 2017; by selecting the 'all reports' link for The Spires Health Centre on our website at www.cqc.org.uk.

At this inspection we found:

The practice had reviewed their system for receiving and managing alerts including those from the Medical and Healthcare products Regulatory Agency (MHRA) and had strengthened their processes to ensure alerts were managed and actioned appropriately.

The practice had clear systems to manage risk so that safety incidents were less likely to happen. Since the last inspection the practice had completed a range of risk assessments to identify and manage risks appropriately. When incidents did happen, the practice learned from them and improved their processes.

• The practice had established processes to increase the identification of carers in order to provide further support where needed. This included staff training.
• A review of the induction programme had been completed to ensure new staff received training on infection prevention and control.
• A review of the complaints process had been completed to ensure verbal complaints were logged and discussed with the team and to monitor any trends through analysis. The practice also shared relevant complaints through a reporting incident web tool to the clinical commissioning group.
• The practice continued to try and encourage patients to join the patient participation group and had seen a small increase in patients expressing an interest. The practice had asked the CCG for advice on how to improve patient uptake and notices were on display in the waiting room encouraging patients to join and the date of the next meeting.
• The practice’s outcomes for national screening programmes continued to be low in comparison to national averages, however the practice was able to demonstrate how they monitored patients’ attendance for screening and they systems they had in place to follow up patients who did not attend.
• Since the last inspection the practice had reviewed their governance arrangements to ensure they were embedded within the team.
• The practice had implemented a prescription logging system to ensure all blank prescription pads were recorded before being used for home visits. The practice had also updated their prescription security protocol.

The areas where the provider should make improvements are:

• Continue to encourage patients to attend screening programmes.
• Continue to review the process to increase interest in patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Updated 21 July 2017

• The practice nurse had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. The latest QOF results (2015/16) showed performance for diabetes related indicators was 88% which was comparable to the CCG average of 88% and the national average of 90%.

• Patients with long-term conditions received annual reviews of their health and medication. 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. We saw evidence that meetings were held every six weeks.
• The practice supported regular Diabetes in Community Extension (DiCE) clinics with a specialist diabetic nurse every three months.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

Updated 21 July 2017

• 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 accident and emergency (A&E) attendances.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a full range of family planning services including Intrauterine Contraceptive Device (IUCD) fittings contraceptive implants.
• The practice worked with midwives and health visitors to support this population group. For example, the midwife held ante-natal clinics once a week and meetings with the health visitors were held every six weeks.
• Childhood immunisation rates for under two year olds ranged from 94% to 100% compared to the national average of 90%. Immunisation rates for five year olds ranged from 94% to 100% which were higher than the national average of 88% to 94%.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice’s uptake for the cervical screening programme was 73% which was lower than the national average of 81%.

Updated 21 July 2017

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• The practice had participated in the avoiding unplanned admissions scheme which identified elderly vulnerable patients at risk of hospital admission. The practice had seen a reduction in hospital admissions from 10% to 4.7% during the past 12 months and had set up a dedicated phone line for these patients.
• Older patients were offered vaccinations for flu, pneumonia and shingles. Data provided by the practice showed 75% of patients had received a flu vaccination in comparison to the CCG average of 69%.
• Documentation provided by the practice showed patients on the palliative care register were discussed at six weekly meetings and their care needs were co-ordinated with community teams. On the day of inspection, we received feedback from the palliative care nurse who told us the practice were very supportive.

Updated 21 July 2017

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours were available early morning and late evening.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice offers NHS health checks for patients aged 40-70 years. Data provided by the practice showed 126 patients had received a health check in the past 12 months.
• Patients who required support with diet and fitness had access to a health trainer who held support sessions at the practice twice a week.
• The practice used a stop smoking service, which held clinics at the practice on a weekly basis. Data provided by the practice showed 202 patients had received support to stop smoking and 63 patients had successfully quit smoking within three months.
• The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 21 July 2017

• The latest QOF data (2015/16) showed 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
• Patients requiring support with mental health needs were referred to the local counselling team who held sessions at the practice on a weekly basis.
• Unverified data provided by the practice showed 30 patients on the mental health register and the latest QOF data (2015/16) showed 63% of patients had had their care plans reviewed in the last 12 months, which was lower than the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 21 July 2017

• The practice held a register of vulnerable patients. This included patients with drug and alcohol dependency, patients living with a learning disability, frail patients and those with caring responsibilities and regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice offered longer appointments and annual health checks for people with a learning disability. Unverified data provided by the practice showed 26 patients on the learning disability register and 83% had care plans in place.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. This included referral to the local drug and alcohol support service which held a clinic once a week at the practice.
• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.
• The practice’s computer system alerted GPs if a patient was also a carer. There were 33 patients on the practices register for carers; this was 0.7% of the practice list.