Archived: Sai Medical Practice

Updated 26 June 2017

Sai Medical Practice is located in Walsall, West Midlands situated on the first floor in a multipurpose modern NHS owned building. Sai Medical Practice was originally a single-handed practice; Intra Health took over the contract in April 2015. Intra Health is a provider of NHS primary care services; founded by NHS professionals who operate a network of NHS GP practices throughout the UK.

Based on data available from Public Health England, the levels of deprivation in the area served by Sai Medical Practice are significantly below the national average, ranked at one out of 10, with 10 being the least deprived. Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial. The practice serves a higher than average patient population aged from birth to 39 and below average for ages 40 to 85 and over.

The patient list size is approximately 3,700 patients. Services to patients are provided under an Alternative Provider Medical Service (APMS) contract with the local Clinical Commissioning Group (CCG). APMS is a contract between general practices and the CCG for delivering primary care services to local communities. Public Health England data shows the estimated ethnicity of the practice patient population is 45% white British, 56% Asian, 4% mixed heritage, 4% black and 2% other non-white ethnic groups.

The surgery has expanded its contracted obligations to provide enhanced services to patients; for example, Childhood Vaccination and Immunisation Scheme. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

On-site parking is available and there is designated parking spaces for cyclists and for patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staff comprises of two male salaried GPs, one nurse practitioner, one practice nurse and two health care assistants. Service delivery is supported by an office manager and a team of five reception and administration staff members.

The practice is open between 8am and 8.30pm Mondays, 8am and 6.30pm Tuesdays, Thursdays and Fridays and between 7.30am and 6.30pm on Wednesdays.

GP consulting hours are from 8am to 8.30pm Mondays, 8am to 6.30pm Tuesdays, Thursdays, Fridays and 7.30am to 6.30pm on Wednesdays. The practice has opted out of providing cover to patients in their out of hours period. During this time, services are accessed through NHS 111.

Updated 26 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Sai Medical Practice on 21 March 2017. Overall the practice is rated as requires improvement.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. Lessons were shared with clear evidence of actions taken to improve safety in the practice.
• The practice had clearly defined and embedded systems in some areas to minimise risks to patient safety. Although, during the inspection the practice was unable to demonstrate an effective system for disseminating actions taken following the receipt of safety alerts, we saw that safety alerts were managed centrally.
• We identified issues relating to the management of some patients on high risk medicines where prescriptions had been authorised without evidence of a completed review of patients’ blood results.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice carried out annual health reviews; however, there were some areas where staff were not effectively utilising care plan templates or attending palliative care meetings. The practice did not have systems for routinely reviewing unplanned hospital admissions.
• Data showed patient outcomes were below local and national averages in a number of clinical areas. The practice was aware of this and was actively addressing identified issues.
• Clinical audits had been carried out, we saw evidence that audits were driving improvements to patient outcomes in the areas identified.
• Results from the July 2016 national GP patient survey showed patients were involved in their care and decisions about their treatment. However, survey results showed that patients’ satisfaction relating to GP consultations, accessing care and treatment was mostly below local and national averages. The practice used a variety of methods to monitor and measure patient satisfaction such as mystery patient shoppers and the practice took action such as implementing a new telephone system and reviewing their appointment system to improve access.
• Patients who completed a Care Quality Commission comment card said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice had policies and procedures to govern their activities. However, there were areas where governance arrangements were not effectively operated to ensure the quality of care was assessed, monitored and risks mitigated.

We saw one area of outstanding practice:

• The practice understood their population profile and used this understanding to meet the needs of their population. For example, clinicians attended the local Mosque and the local homeless centre to encourage the uptake of flu vaccines during the seasonal flu campaign.

The areas where the provider must make improvement are:

• Establish effective systems to ensure the practice follows good practice guidance and adopt control measures to ensure arrangements are in place to respond appropriately and in good time to prevent unplanned admissions.

• Ensure oversite and governance of performance are carried out effectively and take proactive steps to identifying and address areas of lower performance. For example, in relation to patient satisfaction and areas of high exception reporting.

The areas where the provider should make improvement are:

• Develop an internal system to ensure actions taken in relation to patient safety alerts and medicines alerts from the Medicines and Healthcare products Regulatory Agency (MHRA) are recorded and disseminated throughout the practice.

• Continue to consider ways of encouraging the uptake of national screening programmes such as cervical, bowel and breast cancer.

• Continue exploring and establishing effective methods to identify carers in order to provide further support where needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 June 2017

The practice is rated as requires improvement for effective, caring, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• Nursing staff had lead roles in long-term disease management . The practice offered a one-stop shop to enable patients with multiple long-term conditions to be reviewed in one appointment.

• Performance for diabetes related indicators was similar to the CCG and national averages. For example, 80% of patients diagnosed with diabetes had a blood sugar reading which showed that the condition was being controlled appropriately, compared to CCG average of 79% and national average of 78%. However, exception reporting rates in relation to these patients were above CCG and national averages. For example, 21%, compared to CCG average of 10% and national average of 13%.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• The practice offered a range of services in-house to support the diagnosis and monitoring of patients with long-term conditions including spirometry, phlebotomy, followed recognised asthma pathways and an in-house clinical pharmacist provided medicine reviews and reconciliation.

• Patients had access to in-house electrocardiogram ECG (a test that can be used to check the heart's rhythm and electrical activity), anticoagulation clinic (monitoring and advisory service for patients receiving medicines to treat and prevent blood clots) was available in-house as well as home visits and a diabetic specialist nurse attended the practice.

• All these patients had a named GP and there was a system to recall patients for 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.

Updated 26 June 2017

The practice is rated as requires improvement for effective, caring, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice was able to demonstrate systems 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.

• Staff we spoke with were able to describe how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

• Immunisation rates were relatively high for all standard childhood immunisations.

• The practice provided support for premature babies and their families following discharge from hospital. For example, Community midwives deliver antenatal checks and post-natal examinations from the practice and GPs carried out eight-week baby checks.

• Appointments were available outside of school hours, daily appointment slots were allocated to ensure timely response to un-well children. The premises were suitable for children and babies, rooms were available for breast-feeding and there were baby-changing facilities.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• A full range of contraceptive services were available along with referrals to family planning clinics. Staff we spoke with were able to demonstrate the use of Gillick competencies (a framework used to decide whether a child aged 16 years or younger is able to consent to his or her own medical treatment, without the need for parental permission or knowledge when prescribing to under age patients).

• Staff we spoke with explained that they worked to improve access for this population group. For example, the practice used text messaging services, twitter and Facebook.

Updated 26 June 2017

The practice is rated as requires improvement for effective, caring, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered care to meet the needs of the older patients in its population. For example, they offered vaccinations and immunisations to protect against shingles, pneumonia and influenza.

• Personalised care was not formalised as the practice were not using care planning or holding palliative care meetings with the wider multi-disciplinary team. There was no system to review patients who had unplanned admissions to hospital.

• The practice offered home visits and urgent appointments for those with enhanced needs. GPs were also offering mobile spirometry testing during home visits.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life.

• Older patients were provided with health promotion advice and support to help them to maintain their health and independence for as long as possible. For example, the practice had a comprehensive elderly care information board situated in the reception area and patients were sign posted to services such as Age UK.

• Patients had access to Abdominal Aortic Aneurysm (AAA) screenings (a screening to detect swelling of the main blood vessel that runs from the heart, down through the abdomen to the rest of the body) within the practice.

Updated 26 June 2017

The practice is rated as requires improvement for effective, caring, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• 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 on a Monday until 8.30pm and Wednesday mornings from 7.30am for patients who could not attend during normal opening hours.

• 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. For example, on-line pre-bookable appointments to allow booking after standard work hours, test results were available on-line as well as on-line prescription requests.

• Staff we spoke with explained that the practice were trialling quick response (QR) codes as a quick method to access medical information.

• The practice offered travel vaccinations available on the NHS and staff sign posted patients to other services for travel vaccinations only available privately such as yellow fever centre (vaccination for a tropical virus disease transmitted by mosquitoes, which affects the liver and kidneys).

• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.

Updated 26 June 2017

The practice is rated as requires improvement for effective, caring, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• 100% of patients diagnosed with dementia had their care reviewed in the preceding 12 months, compared to CCG and national average of 84%; with an exception reporting rate of 14%, compared to CCG and national average of 7%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, a Mental Health Nurse attended the practice, GPs carried out home visits for patients living with agoraphobia. .

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs. Unverified data provided by the practice showed that 48% of patients diagnosed with a mental health related disorder and 80% of patients diagnosed with dementia received a medicines review in the past 12 months.

• 98% of patients diagnosed with a mental health related disorder had a comprehensive, agreed care plan documented in the records, in the preceding 12 months (01/04/2015 to 31/03/2016), compared to CCG average of 92% and national average of 89%. However, the practice exception reporting rate was 26%, compared to CCG average of 5% and national average of 13%.

• Patients at risk of dementia were identified and offered an assessment.

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

• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia and explained that training received further extended their knowledge. The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 26 June 2017

The practice is rated as requires improvement for effective, caring, responsive and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• 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.

• The practice staff were not completing care plan templates, and were therefore unable to demonstrate how they worked with other health care professionals in the case management of vulnerable patients. Staff we spoke with explained that the practice was developing their care plan templates.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. Staff used a comprehensive communication folder, which aided effective communication during appointments.

• There were working arrangements in place for registered patients who resided in local supported housing and the practice worked in collaboration with the local addiction service to manage the general health care of patients receiving interventions for substance and alcohol dependency.

• Staff interviewed 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.