Archived: Lichfield Street Surgery

Updated 6 April 2016

Lichfield Street Surgery opened in Walsall in 1930 and is part of a group practice with two other sites in the local area. The practice provides primary medical services to approximately 8,000 patients in the local community. The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some directed enhanced services such as minor surgery, childhood vaccination and immunisation schemes. The practice also runs an anti-coagulation clinic for both the practice patients and people In the local community.

There are 4 GP partners (3 male, 1 female) and 4 salaried GPs (2 male, 2 female). During the last 12 months the group practice has been successful in recruiting three new GPs and two new GP partners. The practice is a teaching practice for the University of Birmingham Medical School and a Nurse Training Practice for the University of Wolverhampton. The practice offers training for medical students in their final (fifth year) year and first to fourth year medical students come to the practice at various times during the year. At the time of the inspection there was one trainee GP. The senior nurse practitioner is a qualified teacher of nursing and takes on this lead role. The GPs are supported by two advanced nurse practitioner (ANP), two practice nurses, one health care assistant and a phlebotomist. The non-clinical team consists of administrative and reception staff, a locality manager and a new practice manager will be commencing in March 2016. There is a nominated team leader for the nursing, reception and secretarial teams.

The practice serves a higher than average population of those aged 65 years and above. The population is 65% White British (2011 Census data). The area served has higher deprivation compared to England as a whole and ranked at three out of 10, with 10 being the least deprived.

The practice is open to patients between 7am and 6.30pm Monday to Friday. Emergency appointments are available daily. A telephone consultation service is also available for those who need urgent advice. Home visits are available to those patients who are unable to attend the surgery. The out of hours service is provided by Primecare and NHS 111 service and information about this is available on the practice website and telephone line.

Updated 6 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lichfield Street Surgery on 3 February 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.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment and had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients said they found it easy to make an appointment with a named GP and that 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 and complied with the requirements of the Duty of Candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 April 2016

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice ran an anti-coagulation clinic service on a weekly basis for their patients and the local population and a specialist diabetic nurse and heart failure team ran regular clinics at the practice. Longer appointments and home visits were available when needed. All patients with a long-term condition had a named GP and 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. Patients were encouraged to engage with the Expert Patients Programme. This is a self-management programme for people living with long-term conditions which supports them by increasing their confidence, improving their quality of life and helping them manage their condition more effectively.

Updated 6 April 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. Immunisation rates were high for all standard childhood immunisations. 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 82% which was in line with the national average of 82%. Appointments were available outside of school hours and urgent appointments were allocated each day for children. The premises were suitable for children and babies. The practice held nurse-led baby immunisation clinics weekly and vaccination targets were in line with the national averages. We saw positive examples of joint working with midwives and health visitors and the midwife ran an ante natal clinic on a weekly basis.

Updated 6 April 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, this included enhanced services for dementia and end of life care. The practice was responsive to the needs of older people, and offered home visits and urgent appointments when required and patients over 75 years of age were offered an annual face to face review with a GP and all patients had a named GP. The practice worked closely with district nurses and the community matron and used the Integrated Care Team for conditions that could be safely managed in the community including cellulitis and DVT. The practice actively promoted the national Aortic Aneurysm Screening Programme and hosted the service in the practice.

Updated 6 April 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 was proactive in offering online services such as appointment booking and repeat prescriptions services and telephone consultations, as well as a full range of health promotion and screening that reflects the needs for this age group. It provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years. It offered an appointment reminder text messaging service and appointment times were offered early each morning. The practice provided an electronic prescribing service (EPS) which enables GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 6 April 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). There were 70 patients on the dementia register and 44 had had their care plans agreed in a in the last 12 months. The community psychiatric nurse held clinics twice a week at the practice for continuity of care and support to patients. The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact. We saw that there were 141 patients on the mental health register and 102 had had care plans agreed. Patients experiencing poor mental health were signposted to various support groups and voluntary organisations. Staff had a good understanding of how to support patients with mental health needs and dementia and had held a dementia awareness day with guest speakers to offer patients detailed information. The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Updated 6 April 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. We saw that there were 35 patients on the learning disability register and the practice had carried out 14 annual health checks for patients on the register. The practice held a register of carers, and had a carers corner in the waiting room which had information and advice about local support groups and services. There was a system in place to identify patients with a known disability. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and provided shared care for patients with opiate dependency allowing them to obtain their opiate prescribing at the surgery.

It had told vulnerable patients about how to access various support groups and voluntary organisations and there was a system in place to identify patients who required additional support and extra time during appointments. Staff had received safeguarding training and 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 were examples of how the practice had responded to the needs of vulnerable patients; for example the practice supplied hearing aid batteries for the local community.