Keats Grove Surgery

Updated 18 August 2017

Keats Grove Surgery is registered with the Care Quality Commission (CQC) as a partnership. The practice is located in Wolverhampton and has good transport links for patients travelling by public transport. Parking is available for patients travelling by car. The practice is a single story building and all areas are easily accessible by patients with mobility difficulties, patients who use a wheelchair and families with pushchairs or prams.

The practice team consists of three GP partners, two male and one female. All the GPs work full time, nine to 10 sessions per week. The GPs are currently supported by a practice pharmacist, two practice nurses and a healthcare assistant. Clinical staff are supported by a practice manager, an assistant practice manager and eight administration / receptionist staff and a cleaner. In total there are 17 staff employed either full or part time hours to meet the needs of patients. The practice also use GP locums at times of absence to support the clinicians and meet the needs of patients at the practice. The practice is a training practice for GP registrars.

The practice is open between 8am and 7.30pm Monday and Tuesday, 8am to 8pm Wednesday and Friday, and Thursday and 8am to 1pm. Appointment times for patients vary for the GPs, practice nurse and healthcare assistant and include both morning and afternoon clinic sessions. Extended hours appointments are available Monday morning between 8am and 8.30am and late evening appointments from 6.30pm to 7.45pm on Wednesday and Friday. The practice also offers a walk in clinic system between 9am and 10.30am each week day morning for patients registered with the practice. All the GPs are involved in the walk in clinic until 10.30am. After 10.30am one of the GPs continues seeing the remaining patients and the other GPs see the patients who have booked appointments. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service provided by Vocare via the NHS service.

The practice has a General Medical Services contract with NHS England to provide medical services to approximately 6,388 patients. It provides Directed Enhanced Services, such as childhood vaccinations and immunisations and the care of patients with a learning disability. The practice is located in one of the most deprived areas of Wolverhampton. People living in more deprived areas tend to have a greater need for health services. There is a higher practice value for income deprivation affecting children and older people in comparison to the practice average across England. The level of income deprivation affecting children of 38% is higher than the national average of 20%. The level of income deprivation affecting older people is higher than the national average (32% compared to 16%).

Updated 18 August 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Keats Grove Surgery on 9 August 2016. After the comprehensive inspection, the practice was rated as requires improvement for providing safe services.

We issued a requirement notice in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Safe care and treatment.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Keats Grove Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection on 9 August 2016. This report covers our findings in relation to those requirements.

Our key findings 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 reviewed and implemented systems to minimise risks to patients.
  • The practice had reviewed its systems and procedures to ensure the safe management of medicines and introduced ongoing monitoring to check improvements were maintained.
  • Full employment checks as required by legislation for all staff employed were carried out and records were available to confirm this.
• Effective systems were in place to monitor the management and care review of patients with long term health conditions and data showed that patient attendance at reviews had improved.
• The number of patients attending national screening and immunisation programmes had improved.
• Staff were aware of how to use equipment installed to support patients with a hearing impairment.
• Staff had clear guidance on maintaining the privacy and dignity of all patients when receiving treatment in consulting rooms without privacy curtains or screens. Patients were offered access to an alternative room if requested.

There was one area where the provider should make improvements:

• Ensure that the plans to monitor the systems introduced to improve medicine practices are carried out.

At this inspection we found that the practice had addressed all the concerns raised and is now rated as good for providing safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 August 2017

The practice is rated as good for this population group.

• The practice performance for the management of patients with long term conditions had improved over the past two years. Quality Outcomes Framework (QOF) data for 2016/17 showed significant improvements in all clinical areas and demonstrated the practice was focused on improving its management of patients with long-term conditions. For example:
  • the percentage of patients on the diabetes register, in whom a specific blood test was recorded was 78%. This was higher than previous achievements of 64% over the past two years.
  • Further data showed that the percentage of patients with Chronic Obstructive Pulmonary Disease (COPD) who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale (the degree of breathlessness related to five specific activities) in the preceding 12 months was 97%. This was a significant improvement on the 79% achieved in the previous two years. COPD is the name for a collection of lung diseases.
• The GPs, nurses and healthcare assistant had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The GPs and nurses worked with relevant health care professionals to deliver a multidisciplinary package of care to patients with complex needs.

Updated 28 December 2016

The practice is rated as good for effective, caring, responsive and well-led services and this gives an overall rating of good for the care of families, children and young people. The practice was rated as requires improvement for safe services. The concerns which led to these ratings in safe apply to everyone using the practice, including this population group.

• The practice uptake for the immunisation of children aged five years old was below the local and national averages. The practice had a proactive process in place to manage this.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 72% which was lower than the local CCG average of 78% and England average of 82%.
• Appointments were available outside of school hours and urgent appointments were available for children.
• We saw positive examples of joint working with other professionals. The practice worked closely with the community midwives to discuss and facilitate the care of pregnant women.
• Meetings were held every three months with the health visitor to discuss babies and children identified as at risk and those on the child protection register.

Updated 28 December 2016

The practice is rated as good for effective, caring, responsive and well-led services overall and this gives an overall rating of good for the care of older people. The practice was rated as requires improvement for safe services. The concerns which led to these ratings in safe apply to everyone using the practice, including this population group.

• The practice offered personalised care to meet the needs of the older people in its population. Home visits and flexible appointments were available for older patients.
• The practice had 52 patients living in care homes. Weekly ward rounds were carried out at one of the homes to support the long term care of older patients.
• Patients aged 75 years plus were offered annual health checks, allocated a named GP and were included on the practice hospital admission avoidance register.
• The practice maintained a register of housebound older patients and older patients who required a home visit.

Updated 28 December 2016

The practice is rated as good for effective, caring, responsive and well-led services and this gives an overall rating of good for the care of working-age people (including those recently retired and students). The practice was rated as requires improvement for safe services. The concerns which led to these ratings in safe apply to everyone using the practice, including this population group.

• The practice offered telephone consultations specifically for workers.
• Extended hours appointments were available three days each week between the hours of 8am and 8pm.
• The practice offered online services which included making online appointment requests.
• Patients were sent telephone texts to remind them about their appointment and to send test results.
• Patients were signposted to a full range of health promotion and screening that reflects the needs for this age group.

Updated 28 December 2016

The practice is rated as good for effective, caring, responsive and well-led services and this gives an overall rating of good for the care of people experiencing poor mental health (including people with dementia). The concerns which led to these ratings in safe apply to everyone using the practice, including this population group.

• The practice worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia.
• A quiet room located away from the main waiting area was available to be used by patients who were anxious and appointments were made available at quieter times of the day.
• The practice maintained a register of 34 patients diagnosed with dementia. The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 68%, which was lower than the local CCG average of 82% and England average of 84%. The practice had plans in place to improve this and current QOF data for 2015/16 showed a significant increase to 86%.
• The practice held a register of patients who experienced poor mental health. Clinical data for the year 2014/15 showed that 82% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This was lower than the local CCG and England averages of 88%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Counselling clinic sessions were held at the practice with an experienced mental health counsellor based in the community.

Updated 28 December 2016

The practice is rated as good for effective, caring, responsive and well-led services and this gives an overall rating of good for the care of people whose circumstances may make them vulnerable. The practice was rated as requires improvement for safe services. The concerns which led to these ratings in safe apply to everyone using the practice, including this population group.

• The practice held a register of patients with a learning disability and offered this group of patients longer appointments.
• The practice was alerted to other patients whose circumstances may make them vulnerable or may present a risk to ensure that they were registered with the practice if appropriate.
• The practice had identified that approximately 1% of its patients misused substances that could cause them harm. The practice maintained a register to monitor their care and worked alongside other community organisations to support this group of patients.
• The practice had told vulnerable patients about how to access various support groups and voluntary organisations.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had a designated member of staff who attended safeguarding meetings.