Kingsfield Medical Centre

Updated 14 February 2017

Kingsfield Medical Centre is registered with the Care Quality Commission (CQC) as a partnership GP practice in Kings Heath, Birmingham. 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 area has overall levels of deprivation below the Clinical Commissioning Group (CCG) average and similar to the national average. At the time of our inspection the practice had 9,400 patients. The practice age distribution is similar to the national average. There is a higher percentage of older patients when compared to the CCG average (18% of the practice population is aged 65 and over compared to the CCG average of 12% and the national average of 17%). The percentage of patients with a long-standing health condition is 51% which is slightly below the CCG of 52% and the national average of 54%.

The practice is open between 8.30am and 6.30pm Monday to Friday with the exception of Wednesdays when the practice closes at 1pm (there is a dedicated pre-booked diabetic clinic held on a Wednesday afternoon). Booked appointments are provided throughout the day from 8.30am to 6.30pm. There are a number of urgent appointments reserved for on the day booking. Appointments can be booked up to four weeks in advance. 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, Badger or South Doc when the practice is closed. The nearest accident and emergency department is Queen Elizabeth Hospital, Edgbaston, Birmingham and the nearest walk in centre is at South Birmingham GP Walk-In Centre, Selly Oak, Birmingham.

The practice team consists of:

• Five GP partners (three female, two male)
• Two salaried GPs ( both female)
• One GP registrar

• Three practice nurses
• A health care assistant
• A practice manager
• A medical secretary
• Eight reception and administrative staff.

The practice provides a number of specialist clinics and services. For example long term condition management including asthma, diabetes and high blood pressure. It also offers services for child health developmental checks and immunisations, travel vaccinations and NHS health checks.

Updated 14 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Kingsfield Medical Centre on 5 December 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and reported to external agencies when required.
• Required recruitment checks had been made before members of staff were employed to work at the practice. However, the physical and mental health of newly appointed staff had not been considered.
• Effective systems were in place to mitigate risks to patients who took high risk medicines.
• An overarching training matrix and policy was in place to monitor that all staff were up to date with their training needs and received regular appraisals.
• Patients 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
• Feedback from patients about their care was consistently positive and was reflected in the national patient survey published in July 2016.
• The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice provided an anticoagulation (medication used to prevent blood clots) service for registered and non-registered patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs. The premises included a dedicated training area for medical students.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had a strong culture for education and learning and was an established, approved provider for a number of services that reduced the need for secondary care.
• The practice had visible clinical and managerial leadership. Governance and audit arrangements were comprehensive and effective.

The areas where the provider should make improvement are:

• Implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.
• Improve the prescription tracking system to minimise the risk of fraud.
• Ensure that staff remove their smart cards from computers when not at the workstation.
• Review the lone working policy to ensure the policy is effective.
• Implement a system to check that clinical guidelines have always been implemented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 February 2017

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

• Nursing staff were supported by the GP in chronic disease management and patients at risk of hospital admission were identified as a priority.
• A nominated clinical lead was in place for all chronic diseases.
• Longer appointments were offered to those patients with a chronic disease.
• For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Dedicated diabetic clinics were held weekly at the practice on a Wednesday afternoon.
• The practice provided an anticoagulation (a high risk medication used to prevent blood clotting) monitoring service to registered and non-registered patients.
• The practice arranged educational meetings with Consultants specialising in disease areas. These were held at the practice but other local practices were invited to attend.
• The practice had a proactive approach to prevention. For example, patients identified as at risk were invited to engage in educational and lifestyle session to reduce their risk of developing diabetes.

Updated 14 February 2017

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

• The practice had a policy to offer same day appointment to unwell children.
• The practice offered family planning services that included the fitting of contraceptive implants.
• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 79% and the 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 and health visitors. The practice also engaged with the local school nurse.
• New mothers were offered post-natal checks and development checks for their babies. These were coordinated so that mothers and babies could have both checks performed at the same appointment.
• Data from NHS England for the time period 1 April 2015– 31 March 2016 showed that childhood immunisation rates for the vaccinations given were similar to the national average.
• The Practice had signed up to the local CCG “St. Basil’s Charter” which looked at young people and their experience of attending GP Practices and how to capture this age group to engage in services. The patient group were devising a questionnaire intended to be sent out to this young age group for feedback on their views on the Practice and how any improvements could be made in the services provided for them.

Updated 14 February 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Older patients at higher risk of hospital admission had written care plans.
• Patients over 75 years of age were invited for an over 75 health check. The provider had started doing these assessments using their own risk stratification tool. A template developed by the practice that explored both medical and social needs was subsequently adopted by other practices in the CCG.

Updated 14 February 2017

The practice is rated as good 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.
• An electronic prescription service was available for patients to nominate a convenient Pharmacy to collect medication from.
• The practice signposted retired patients to various groups/hubs in the area if they were socially isolated.
• 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 provider had enrolled 931 of its patients for the online services.
• All patients between the age of 40 and 74 years of age were offered NHS health checks and healthy living advice.

Updated 14 February 2017

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

• Eighty two per cent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was slightly below the Clinical Commissioning Group (CCG) average of 86% and national averages of 84%. The exception reporting rate of 4.7% was comparable to the CCG average of 4.3% and below the national average of 6.8%.
• The percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 91%. This was similar to the CCG average of 93% and the national average of 89%. The exception reporting rate was 6.8% which was below the CCG average of 7.6% and the national average of 13% meaning more patients had been included.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Patients could access counselling services though the Birmingham Healthy Minds service (BHM) by either self-referral or referral by a GP. The BHM team offered appointments at the practice on a weekly basis.

Updated 14 February 2017

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

• The practice held a register of patients living in vulnerable circumstances.
• The practice offered longer appointments for patients with a learning disability and had an effective patient call/recall system that invited patients for annual health check.
• The practice regularly worked with external health and social care professionals, to provide effective care to patients nearing the end of their lives and other vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Patients on the vulnerable register who did not attend an appointment were followed up with a telephone call.
• 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.
• The GPs were trained in the assessment of deprivation of liberty safeguards (DOLS). These safeguards ensure that important decisions are made in people’s best interests.
• The practice had shared information with the out of hours service for patients nearing the end of their life. For example, if they had a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) plan in place.
• The Practice was part of the IRIS Domestic Violence project. There was a named Women’s Aid worker assigned to the Practice and the GP’s could refer patients direct. The patients could be seen at the practice in an allocated private room.