Archived: Bloxwich Medical Practice

Updated 11 December 2017

Bloxwich Medical Practice is registered with the Care Quality Commission (CQC) as a partnership provider in Bloxwich, West Midlands. The practice is part of the NHS Walsall Clinical Commissioning Group (CCG). The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract.

The practice operates from Pinfold Health Centre, Field Road, Bloxwich, West Midlands, WS3 3JP.

There are approximately 4,951patients of various ages registered and cared for at the practice. Demographically the practice has a lower than average young population with 19% of patients being under 18 years old compared with CCG average of 23% and national average of 21%. Twenty-three per cent of the practice population is above 65 years which is higher than the CCG and the national averages of 17%. The percentage of patients with a long-standing health condition is 72% which is higher than the local CCG average of 57% and national average of 53%. The practice provides GP services in an area considered as one of the more deprived within its locality. 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 staffing consists of:

• Two GP partners (one male / one female) and one male salaried GP.
• Two practice nurses, a health care assistant and a part time phlebotomist (all female).
• A practice manager and administration/reception staff.

The practice is open between 8am and 6.30pm Monday to Thursday and 8am and 1pm on Friday. Extended hours GP appointments are offered between 6.30pm and 7.45pm on Mondays (Tuesdays if there is a Bank Holiday). GP clinics operate between 8.30am and 11.30am Monday to Friday, and 3.30pm and 6.30pm Monday to Thursday. The practice is closed on the last Wednesday of each month for training. On Friday afternoons and the last Wednesday of every month between 1.00pm and 6.30pm the practice had an arrangement with WALDOC, who answer the telephones. Pre-bookable appointments can be booked up to three months in advance and urgent appointments are available for those that need them. Telephone consultations are also available to suit the needs of the patient. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to the out of hours service, via the NHS 111 service when the practice is closed.

The practice is a training practice for GP Registrars to gain experience in general practice and family medicine.

The practice offers a range of services for example: management on long term conditions, child development checks and childhood immunisations, contraceptive and sexual health advice. Further details can be found by accessing the practice’s website at www.bloxwichmedicalpractice.co.uk.

Updated 11 December 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. The practice was rated as Good at our previous inspection on 16 October 2014).

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Bloxwich Medical Practice on 14 November 2017. We carried out this inspection as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learnt from them and improved their processes.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks and patient specific directions.
• The practice worked closely with other health and social care professionals involved in patient’s care. Regular meetings were held with the community nursing teams and palliative care teams to discuss the care of patients who were frail / vulnerable or who were receiving end of life care, and with the health visitor to discuss any children in need or on the at risk register.
• The practice had responded to an unmet need in the local community and carried out eight-week baby checks on behalf of two neighbouring practices where this service was not available.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. The practice had carried out a number of audits which demonstrated health improvement activity. The practice was a training practice for GP Registrars to gain experience in general practice and family medicine.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed. For details, please refer to the requirement notice at the end of this report.
• Ensure care and treatment is provided in a safe way to patients. For details, please refer to the requirement notice at the end of this report.

The areas where the provider should make improvements are:

• Continue to review and update the risk assessments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 March 2015

There was evidence that patients with long term conditions were reviewed regularly. The practice offered clinics for management of long term conditions and also provided services such as weight management, Influenza and pneumonia vaccinations to support patients live healthier lives. There were systems in place to ensure patients had regular review of their medicines. The GPs were aware of prescription medication abusers and only small quantities were prescribed to them. The appointment system was flexible and allowed pre bookable appointments three months in advance. Same day and urgent appointments were also available which allowed better management of patients with long term conditions. Patients with dementia and learning disabilities had annual reviews undertaken by the GPs and there were arrangements to review patients in their own home if they were unable to attend the practice. This included visits to care homes. We spoke with local care home managers about the arrangements for reviewing patients who were unable to attend the practice. They were very positive about the service received from the practice. They told us that the GPs were approachable and undertook home visits on request. Health checks and medication reviews took place.

Updated 26 March 2015

Midwife led clinics were available every Wednesday and the GPs undertook eight week checks for babies. This was coordinated with the babies first set of childhood vaccinations and the practice nurse delivered the childhood vaccination programmes. The most recent data available to us showed that the practice was achieving a high rate of vaccinations. The practice had achieved 100% vaccination rates for children aged 24 months and five years. There was a recall system in place for cytology screening which was carried out by the practice nurse to encourage women to attend this important check. Young adults had access to sexual health services. Information, including lifestyle advice on healthy living was given to expectant mothers and fathers by the midwife. GPs also provided preconception counselling upon request. There was a lead GP for children’s safeguarding. We were sent a training log which demonstrated that staff that had completed training. An alert system was in place to highlight vulnerable children. There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children. All consultation rooms were on the ground floor and access was via automatic doors that made the practice accessible for pushchairs. We saw that patients with push chairs were able to access the practice.

Updated 26 March 2015

The practice had allocated a designated GP for all patients over the age of 75. This is a named accountable GP assigned to each patient to ensure they receive co-ordinated care. Patients over 75 years old had a personalised care plan to enable increased monitoring and follow up. The practice was providing an enhanced service to avoid unplanned hospital admissions. This focused on coordinated care for the most vulnerable patients and included emergency health care plans. The aim was to avoid admission to hospital by managing their health needs at home. An enhanced service is a service that is provided above the standard general medical service contract (GMS). Patients were contacted after discharge from unplanned hospital admissions and monthly meetings were held between the GPs and practice nurse to review unplanned admissions and liaise with other professionals for better management of their care. This helped to prevent unnecessary admission to hospital. We spoke with local care home managers about the arrangements for reviewing patients who were unable to attend the practice. They were positive about the service received from the practice. They told us that the GPs were approachable and undertook home visits on request. Health checks and medication reviews took place and repeat prescriptions were easily accessible. One home manager told us that the nurse undertook home visits to offer people the flu vaccines. These arrangements help to minimise unnecessary admissions to hospital. A care home manager also praised the practice for supporting the staff at the care home as well as the family of a resident after bereavement.

Updated 26 March 2015

The practice opened extended hours on Monday evenings from 6:30pm to 7:45pm to accommodate the needs of working age patients. Patients were able to book non urgent appointments around their working day by telephone or on line. Telephone consultations were available so patients could call and speak with a GP or a nurse where appropriate if they did not wish to or were unable to attend the practice. NHS checks were available for people aged between 40 years and 74 years. The practice offered a range of health promotion and screening services which reflected the needs for this age group. Opportunistic health checks and advice was offered such as blood pressure checks and advice on smoking and obesity. The practice nurse led weight management and smoking cessation clinics. Access to further services was available including phlebotomy (collection of blood from patients for examination in laboratories), spirometry (test that can help diagnose various lung conditions, most commonly chronic obstructive pulmonary disease (COPD)), ear syringing and holiday vaccination and family planning advice was also available through consultation with a practice nurse. Information leaflets and posters were available in the patient waiting area and on the practice website to support and signpost people to support groups and organisations and provide information about self-management of minor illnesses. The practice website had a 'live well’ area which provided health information on a wide range of conditions. Patients were offered choices when referred to other services. The practice used ‘choose and book’ for hospital referrals. Choose and Book is an electronic service that enables patients needing an outpatient appointment to choose which hospital they are referred to by their GP, and to book a convenient date and time for their appointment.

Updated 26 March 2015

The practice offered (depot) injections used for some types of mental distress or illness. Patients with mental health problems had the choice of having this injection at their GP surgery rather than an outpatient clinic or mental health clinic. Patients on the mental health register were offered an annual review of their physical and mental health needs. Patients were also offered mental health checks at post natal reviews. Both GP partners had received training in areas such as dementia and alcohol, management of drug misuse and introduction to psychiatry. We saw that the primary care mental health services team were based in the same building but were due to move away. We spoke with a mental health nurse who told us that the practice referred patients appropriately and sought further help and advice if necessary.

Updated 26 March 2015

There were appropriate safeguarding policies in place. Staffs had appropriate training and were clear and confident on how they would respond to any concerns. The practice ensured it invited all patients with a learning disability along with any carers, where appropriate, for a review by searching its patient database. Vulnerable patients with long term conditions were assessed and patients over 75 years old were started on a care plan to enable increased monitoring and follow up. The practice stated that they did not have groups of patients who lived in vulnerable circumstances such travellers, homeless people and vulnerable migrants. However, records showed that most staff had received training in equality and diversity. This ensured that staff recognised, respected and valued differences and allowed patients access to the practice’s services without fear of stigma and prejudice.