Darlaston Family Practice

Updated 27 November 2017

Darlaston Family Practice is registered with the Care Quality Commission (CQC) as a partnership provider in Darlaston, West Midlands. The practice is part of the NHS Walsall Clinical Commissioning Group. 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 Darlaston Health Centre, Pinfold Street, Darlaston, Wednesbury, West Midlands, WS10 8SY.

The patient list is approximately 3,470 of various ages registered and cared for at the practice. The practice has a younger practice population than the national average. 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 (both male), and one male sessional GP (four sessions a week).
• A female practice nurse.
• A practice secretary and two reception / administration staff.

The practice is open between 9am and 1pm and 4pm and 6.30pm on Mondays, Tuesdays and Fridays, 9am and 5pm on Wednesdays, and 9am and 1pm on Thursdays. During the in hours periods when staff do not answer the telephones, the calls are answered by WALDOC, who will triage, advise and see patients as required. The practice offers pre-bookable appointments 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 and medical students 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.darlastonfamilypractice.nhs.uk.

Updated 27 November 2017

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (The practice was rated good at our previous inspection 10 October 2014)

The key questions are rated as:

Are services safe? – Good

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 Darlaston Family Practice on 1 November 2017. We carried out this inspection as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. The practice had reviewed correspondence from NHS England alerting all practices about the death of a child with sickle cell disease who died from sepsis, and identified learning points.
• We found a number of issues relating to monitoring of prescriptions, emergency medicines and oxygen. The practice rectified these issues during the inspection.
• The practice provided a holistic approach to assessing, planning and delivering care and treatment to patients. Patients with multiple long-term conditions were offered one annual review. The practice co-ordinated medicine reviews with the annual review of long term conditions. The practice maintained a register of housebound patients and carried out domiciliary visits for long-term reviews and ‘flu vaccinations.
• 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.
• The practice had introduced additional checks for patients with high blood pressure and carried out electrocardiograms (ECG a test to check the heart’s rhythm and electrical activity) every two years to identify potential heart problems.
• 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 participated in locally commissioned services, for example: bowel screening pilot and diabetes prevention programme. The practice nurse had trained to become a mentor for student nurses and the practice was awaiting accreditation to become a placement for student nurses.
• The practice was part of the Clinical Research Network and had participated in 11 research trials during the past two years.
• The GP partners were actively involved in the education and assessment of medical students and GP registrars. One partner was also involved in appraisals for GPs. One of the partners was the training programme director for the local deanery and lectured at the local university.

The areas where the provider should make improvements are:

• Complete a risk assessment to reflect guidance from The Control of Substances Hazardous to Health Regulations 2002 (COSHH) in relation to the storage or spillage of mercury.
• Share and discuss all significant events with the staff team to promote shared learning.
• Take a more proactive approach to identifying carers.
• Include details of how to escalate complaints in the response letter sent to complainants.  

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2015

The practice is rated as good for the population group of people with long term conditions. The practice had a good track record in the management of patients with long term condition. Patients with long term conditions received regular reviews to monitor their health and ensure their medicines were appropriate These were undertaken by clinical staff who maintained their skills, knowledge and received training in these areas. For those patients with the most complex needs the named GP worked with relevant health care professionals to deliver a multidisciplinary package of care. Where appropriate, the practice would refer patients to specialist health care professionals to help manage the patient’s health needs, for example health visitors and district nurses.

The practice participated in the unplanned admissions enhanced service, a scheme to avoid unplanned hospital admissions to hospital by focusing and coordinating care for the most vulnerable patients such as those with multiple conditions. There was a higher incidence of respiratory disease in the local area. Patients could request longer appointments if needed to manage their condition and there was a good range of information about various long term diseases and links to further support on the practice website.

Updated 19 March 2015

The practice is rated as good for the population group of families, children and young people. The practice population was younger than the national average and situated in one of the most deprived areas nationally. Staff had appropriate skills and training to help support this population group. One GP had specialist training in paediatrics including child health and the practice nurse had training to enable them to safely administer childhood immunisations.

There were systems in place for identifying and following-up children living in disadvantaged circumstances and those who were at risk of harm. The practice made use of information received to ensure that children at risk could be identified and followed up. All staff had received training in safeguarding children so that they had the knowledge and understanding to take action if they were concerned a child may be at risk of harm.

Appointments were available outside of school hours and the premises were suitable for children and babies with sufficient space for prams and buggies. We were provided with good examples of co-ordinated working with midwives and health visitors. Child health and immunisations clinics were arranged to coincide with the health visitor clinics. Immunisation rates were in line with the other practices in the Clinical Commissioning Group (CCG). With some childhood vaccines the practice was achieving a 100% uptake. Children who did not attend for their immunisations were followed up.

Flu vaccines for pregnant women were available at the same time as midwife clinics to avoid the need for multiple visits to the practice.

There was arrange of health information and promotion of health screening checks available on the practice website which reflected the needs for this age group.

Updated 19 March 2015

The practice is rated as good for the care of older people. The latest nationally reported data available to us showed outcomes for conditions commonly found amongst older people were in line with other practices locally. The practice offered proactive, personalised care to meet the needs of older people in its population. We saw there were care plans in place for older people with complex care needs and that these patients had a named GP to co-ordinate their care. The practice participated in the unplanned admissions enhanced service, a scheme to avoid unplanned hospital admissions to hospital by focusing and coordinating care for the most vulnerable patients. The aim is to effectively support them in their home. An enhanced service is a service that is provided above the standard general medical service contract.

The practice was proactive and could easily identify those who needed additional support to enable them receive the care and treatment they needed. The practice nurse was given protected time to visit housebound patients to review their health conditions and ensure they received their flu vaccinations. We saw evidence that older patients were offered memory testing to detect the onset of dementia.

The practice participated in multi-disciplinary working to ensure patients with complex needs or nearing the end of life received co-ordinated care. We saw evidence of discussions with families and patients at end of their life had taken place to ensure their needs and wishes were respected. We did not however see any clear protocols for the follow up and support of recently bereaved relatives.

All staff had received training in safeguarding vulnerable adults and had contact information to refer to should they suspect a person may be at risk of harm.

Updated 19 March 2015

The practice is rated as good for the population group of the working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified. The practice had adjusted the services it offered, where possible, to ensure these were accessible, flexible and offer continuity of care. For example patients could book and cancel appointments and request medication online via the practice website. Telephone consultations were also available for patients who found it difficult to attend the practice and did not need to be seen face to face.

Extended opening hours were not available at the practice and there was some feedback in comment cards from working age patients about the difficulty in accessing appointments. The practice opened until 6.30pm on three days each week.

The practice offered health checks for patients between the ages of 40 to 74 years. Cervical screening to help detect early changes which may need treatment.

The practice was making good progress with targets for blood pressure checks and recording the smoking status for patients in this age group helping to identify patients who may be at increased risk of developing health conditions. We saw that 90% of patients in the working age group had received a blood pressure check in the last year.

There was a range of health information and promotion of health screening checks available on the practice website which reflected the needs of this age group.

Updated 19 March 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). The practice held a mental health register and was able to demonstrate that patients on this register were receiving comprehensive annual physical health checks. We saw from data available that all patients on the dementia register at the practice had been reviewed in the last 12 months and that dementia screening was in place.

The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health. The practice hosted a weekly clinic with the community psychiatric nurse. This facilitated good links with the mental health services to help signpost patients to other services and discuss those patients who may require a mental health referral. One of the GP’s had undertaken additional training in substance misuse. Longer appointments were allocated to patients with poor mental health as it was recognised some patients needed more time to discuss their health needs.

Updated 19 March 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. The practice held registers of patients living in vulnerable circumstances, for example the practice had a register for patients with learning disabilities and had undertaken annual health checks for 95% of the patients on this register.

The practice offered longer appointments for people who needed them, and there was clear guidance to staff as to the patient groups who should be offered one, for example patients with learning disabilities. This was advertised in the practice so that patients were aware.

The practice was able to identify patients who were housebound or carers and used this information to ensure these patients received the care and treatment they needed in a patient centred way. For example patients with multiple health conditions had appointments coordinated.

Homeless patients could access healthcare at the practice. Staff gave us an example of when they had registered a patient with no fixed abode under their previous addresses. We did not see that there was a system in place to ensure correspondence was handled appropriately to minimise the risk of post being delivered incorrectly.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Information was regularly shared with other health care professionals and good working relationships were evident to ensure vulnerable patients were identified to receive the treatment, care and support they needed. Staff had access to information and contacts for reporting safeguarding concerns about vulnerable patients to the relevant agencies.