Archived: Surgery Aubery Road

Updated 18 September 2017

Surgery Aubery Road is located in Small Heath, Birmingham. It is an inner city practice in an area of high deprivation and moderate unemployment. The patient list of 2,700 is a multi-ethnic group predominately of South Asian origin and, as such, there is a high prevalence of diabetes. The practice located within the Birmingham Cross City Clinical Commissioning Group (CCG) and holds a General Medical Services (GMS) contract with NHS England.

The practice has a higher than average proportion of registered patients aged from 0 to 44 years old who are predominantly male. Conversely there is a lower than average proportion of registered patients aged from 44 to 85+ years for both sexes.

The practice had become part of The Modality Partnership, a corporate partnership provider in April 2016. Modality Partnership has a number of GP partners with two being based at Surgery Aubery Road , one of whom is in the process of retiring. At the time of the inspection the GPs were being supported by a Practice Operations Manager and other supporting staff including one practice nurse, one healthcare assistant and four reception/administrators.

The nursing staff carry out reviews of patients who have long term conditions such as asthma and hypertension. They also provide cervical screening, immunisations and blood pressure monitoring services.

There is a small parking area at the rear of the practice that is usually used by staff but there is accessible parking on the surrounding roads. The premises are step free and suitable for access by wheelchair users. There is a toilet that is adapted for use by people who have restricted mobility.

The practice is open from 9am until 1pm and 2:30pm to 6:30pm every weekday with reception staff present to deal with patients requests and queries. Phone lines are open 9am to 1pm and from 4:30pm to 6:30pm on Monday, Tuesday, Wednesday and Friday whilst on Thursday the lines are open between 9am and 1pm. Core hours are between 8am and 6:30pm and if the practice is closed between these hours, GP services are provided by PrimeCare. The practice has opted out of providing GP services to patients out of core hours and during these times, there is a recorded message giving out of hours’ details. The practice leaflet includes contact information and there are out of hours’ leaflets in the waiting area for patients to take away with them.

Requests for home visits are assessed by telephone to enable GPs to prioritise which patients should be visited first.

Updated 18 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Surgery Aubery Road on 17/07/2017. Overall the practice is rated as good.

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.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• 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.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• 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 provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvements are to:

• review patient responses to the patient survey so as to identify areas for further improvement and monitoring.
• Review arrangements for telephone access in line with feedback from patient survey

Dr Janet Williamson

Deputy Chief Inspector of Primary Medical Services and Dentistry

Updated 18 September 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice operated specialist clinics to review and monitor patients with specific long term conditions such as diabetes, hypertension, asthma and COPD.
• 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.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health. 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.
• Medication reviews were undertaken whenever patients with long term conditions were seen.

Updated 18 September 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were 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.
• Patients told us, on the day of inspection and via comment cards, that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were always available on the day for children under the age of 5 and also available outside of school hours. The premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group by the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 18 September 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• 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 identified at an early stage patients who may need palliative care as they were approaching the end of life. It involved patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services. For instance, PrimeCare, the out of hours provider were provided with details of all palliative care patients so that they could be assisted as quickly as possible. These details were checked and updated monthly.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice also regularly met as part of a multi-disciplinary team to discuss and review the care of those with end of life care needs.

Updated 18 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• 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 on Tuesday evening until 7:30pm.
• The practice was proactive in offering online services, including booking of appointments and ordering of repeat prescriptions, as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 18 September 2017

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

• The practice carried out advance care planning for patients living with dementia.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• 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 spoken with had a good understanding of how to support patients with mental health needs and dementia.

Updated 18 September 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice would register patients living in vulnerable circumstances including homeless people and travellers.
• A register was kept of 19 patients with a learning disability and health reviews were being offered to all those patients on the list. Since April 2017 nine patients had received a health check. Patients with a learning disability were also offered guidance, signposted to support groups and offered them the influenza vaccination each year.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• 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.
• The practice had identified 2% of their patients as carers and maintained a register.