Archived: Dr G Horton's Practice

Updated 7 September 2016

Dr Horton’s Practice is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

Dr Horton’s Practice is registered with the Care Quality Commission to provide primary medical services. The practice has a general medical service (GMS) contract with NHS England. Under the GMS contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care.

The practice is located in purpose built accommodation with parking available. Based on data available from Public Health England, the area served is among the most deprived areas in the country (within the highest 10%). The practice has a registered list size of approximately 11,000 patients and had a slightly younger population than the national average.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available usually between 8.30am and 11.30pm and between 2pm and 6.30pm Monday to Friday.

The practice provided extended opening hours on a Monday evening between 6.30pm and 8.30pm.

When the practice is closed primary medical services are provided by an out-of-hours provider (BADGER).

The practice currently has five GP partners (4 male and 1 female) and one salaried GP (female). Other practice staff consist of an advanced nurse practitioner, three practice nurses and a healthcare assistant and a team of administrative staff which includes a practice manager who supports the daily running of the practice.

The practice has not previously been inspected by CQC.

Updated 7 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr G Horton's Practice on 07 July 2016. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• The practice premises were exceptional, had received a nationally recognised sustainability award, supported excellent infection control standards and was designed to meet the varied need of the practice population.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Despite the challenges of high levels of deprivation the practice performed well in relation to patient outcome indicators compared to other practices locally and nationally.
• Feedback from patients about their care was consistently positive.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients said they found it easy to obtain an appointment with urgent appointments available the same day. Getting through on the phone was the main issue raised.
• 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 sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Consider whole staff meetings in which all staff groups have the opportunity to formally contribute to the running and development of the practice.
• Review and implement ways in which the identification of carers might be improved so that they may receive support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 September 2016

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• All these patients had a named GP and at a minimum a structured annual review to check their health and medicines needs were being met.
• Diabetes reviews were based on individual needs rather than set timescales.
• For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Given the levels of deprivation the practice performed exceptionally well compared to CCG and national averages in relation to patient outcomes for many long term conditions and had lower exception reporting rates. Overall performance for diabetes related indicators (2014/15) was 97% which was higher than the CCG average and national average of 89%.
• Longer appointments and home visits were available when needed.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions for example insulin initiation, electrocardiographs (ECGs), ambulatory blood pressure monitoring and spirometry. Phlebotomy services were available daily on a sit and wait basis to avoid the need for patients to attend the practice twice. Anticoagulation services were also hosted on-site.

Updated 7 September 2016

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

• There were systems in place 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 A&E attendances.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. The premises were well adapted for those with young children and included a purpose built room for breast feeding and baby changing facilities. This was large enough to easily accommodate pushchairs and included comfy chairs and space for other children to move about.
• Given the high levels of deprivation in the area the practice’s immunisation rates were higher than CCG averages for the most of standard childhood immunisations.
• Appointments were available outside of school hours and children were able to obtain same day appointments.
• Health visitors and midwives were very positive about the joint working arrangements with the practice and support to meet patient needs.

Updated 7 September 2016

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. Care plans were in place for those at risk of unplanned admissions.
• Systems were also in place to review the needs of those who had an unexpected hospital admission.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included health checks for those over 65 years who were housebound.
• The premises were accessible to patients with mobility difficulties. A large porch provided space for parking mobility scooters and a practice wheelchair was available for those who might need it.
• Various services were hosted by the practice which would benefit this population group such as hearing and anticoagulation clinics.
• The practice provided flu and shingles vaccinations to relevant patients. Data for 2015 showed uptake of flu vaccinations in patients over 65 years was similar to other practices within the local clinical network. Although the practice was able to show year on year improvements in the uptake of shingles vaccinations.
• The practice regularly met with hospice and district nurses to discuss and plan the care of those with end of life care needs.
• The practice received positive feedback from care homes in which patients of the practice were registered.
• The practice was participating in a pilot project which is running between July 2016 and July 2017 targeting support for frail and socially isolated patients.

Updated 7 September 2016

The practice is rated as good for 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.
• The practice offered online services for appointments and prescriptions. Text messaging was also used to remind patients of appointments and for ease of cancelling appointments no longer required.
• The practice provided a wealth of health promotion information which was available on the television screen in the waiting area. The partners had full control over what was screened on the televisions which enabled them to keep information updated and topical without commercial influences. The patient participation group also supported improvements in the delivery of information to patients and regularly refreshed the information displayed.
• Extended opening hours were available on a Monday evening between 6.30pm and 8.30pm to support those with work commitments that could not attend during the day. Patients were able to book during with either a GP or nurse.
• A variety of services were provided to this group of patients including sexual health and contraception, travel vaccinations available on the NHS, smoking cessation services and NHS health checks.
• Given the practice was located in the 10% most deprived areas they performed well in relation to uptake of national screening programmes and actively promoted attendance. Uptake for breast screening was above CCG and national averages and for bowel screening in line with CCG and national averages. They were also participating in screening for abdominal aortic aneurysms.

Updated 7 September 2016

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

• 83% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 82% and national average of 84%.
• 98% of patients with poor mental health had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This was higher than the CCG average of 89% and national average 88%.
• The practice had lower rates of exception reporting than both the CCG and national average for mental health and dementia indicators. Generally, low exception reporting means more patients receive treatment.
• The practice held six monthly meetings with the psychiatrist and community psychiatric nurse to discuss the care of those with poor mental health.
• The practice carried out advance care planning for patients with dementia.
• The practice hosted adult and adolescent counselling services for those with mental conditions such as anxiety and depression.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing issues relating to poor mental health.

Updated 7 September 2016

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 including those with a learning disability, patients who were housebound and those with caring responsibilities.
• The practice offered longer appointments for patients who needed them for example, those with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Information for patients to access various support groups and voluntary organisations was available.
• 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.
• There was a dedicated nurse who undertook heath reviews for patients with a learning disability who received support from the learning disability team. During 2015/2016 the practice had reviewed 62% of patients registered with a learning disability.
• Patients on the learning disability registered also received patient passports which enabled them to record important information including likes and dislikes should they move between services.
• Patients with no fixed address were able to register with the practice using the practice address and we saw evidence that this had been done sensitively.
• We saw evidence of thanks given to the practice from patients in vulnerable circumstances for the support from the practice including patients made homeless and patients with a learning disability.