Archived: Great Barr Medical Centre

Updated 14 October 2016

Great Barr Group Practice is located in Great Barr, Birmingham an area of the West Midlands. There are two surgery locations that form the practice; these consist of the main practice at Walsall Road and the branch practice at Moreton Avenue. Systems and processes are shared across both sites. The practice will be moving to new premises in October 2016 where both sites will be combined.

The practice has a Personal Medical Services contract (PMS) with NHS England. A PMS contract are locally agreed contracts between NHS England and a GP practice. PMS contracts offer local flexibility by offering variation in the range of services which may be provided by the practice.

The practice also provides some enhanced services such as minor surgery, childhood vaccination and immunisation schemes. The practice is a training practice for doctors and currently has three GP trainees working across both sites. GP trainees are doctors that are completing the GP part of their medical training and work from 6 months to one year at a GP practice.

There are three GP partners (2 male, 1 female). The nursing team consists of one advanced nurse practitioner, one practice nurse and one health care assistant. The non-clinical team consists of a practice manager, administrative and reception staff.

Based on data available from Public Health England, the levels of deprivation in the area served by Great Barr Group Practice are above the national average ranked at six out of ten, with ten being the least deprived. The practice has a registered list size of approximately 9,000 patients and had a slightly older population than the national average.

The practice is open to patients between 8am and 6.30pm Monday to Friday. Extended hours appointments are available 6.30pm to 8.40pm Wednesday and 9am to 12.20pm Saturday. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. The practice had a messaging service for patients to remind them of their appointment times.

When the practice is closed, primary medical services are provided by Primecare, an out of hours service provider and NHS 111 service and information about this is available on the practice website.

Updated 14 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Great Barr Group Practice on 1 September 2016. Overall the practice is rated as Good. There are two surgery locations that form the practice; these consist of the main practice at Walsall Road and the branch practice at Moreton Avenue. Systems and processes are shared across both sites. During the inspection we visited the main site at Walsall Road. The practice will be moving to new premises in October 2016 where both sites will be combined.

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.
• The practice used innovative and proactive methods to improve patient outcomes, For example the practice nurse developed a checklist to follow when visiting housebound patients to ensure that both clinical and social needs were being met.
• Feedback from patients about their care was consistently positive.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• We saw that staff were friendly and helpful and treated patients with kindness and respect. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients could access appointments and services in a way and at a time that suited them. Patients were given the option of a preferred practice location and they could also access services across the two sites including cervical screening and phlebotomy.
• The practice worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs. For example the practice had commenced a rheumatology (DMARD) monitoring service for their patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• We observed the premises to be visibly clean and tidy. Some areas were showing signs of being worn, but the practice was moving to new premises in October 2016.
• Notices in the patient waiting room told patients how to access a number of support groups and organisations. There was also a language board, this explained how to book appointments in various languages.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result. The provider was aware of and complied with the requirements of the duty of candour.
• There was a clear leadership structure and staff felt they were supported by management and the GPs.
• Staff spoken with demonstrated a commitment to providing a high quality service to patients.

• The practice nurse had achieved the Queen’s award. The Queen's Nurse programme is designed for community nurses who want to develop their professional skills and promote the highest standards of patient care. From this award the nurse had introduced a checklist for housebound patients registered at the practice to review and monitor their care.

However there were areas of practice where the provider should make improvements:

• Continue to encourage patients with learning disabilities to attend their annual reviews.
• Review and strengthen current procedures for the filing of pathology results once actioned.

• Ensure effective communication where all staff groups have the opportunity to formally contribute to the running and development of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 October 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All these patients 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. We saw evidence that meetings were held on a monthly basis.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions. For example, a consultant led diabetes clinic was held every two months at both the main and branch site to review patients with complex diabetes.
• A rheumatology DMARD monitoring service has been commenced to support patients registered at the practice.

Updated 14 October 2016

• 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.
• 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, health visitors and school nurses. The midwife provided antenatal care every week at the practice.
• Childhood immunisation rates for under two year olds ranged from 87.8% to 97.7% compared to the CCG averages which ranged from 87.5% to 94.9%. Immunisation rates for five year olds were ranged from 83.6% to 95.5% compared to the CCG average of 87.1% to 94.4%.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice’s uptake for the cervical screening programme was 84% which was higher than the national average of 82%.

Updated 14 October 2016

• 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. The practice had 177 patients on the unplanned admissions register which represented 1.9% of the practice population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included blood tests and vaccinations for those patients who were housebound.
• The premises were accessible to patients with mobility difficulties.
• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice worked closely with multi-disciplinary teams so patients’ conditions could be safely managed in the community.
• Data provided by the practice showed that 86% of patients on the practice palliative care register had a face to face review in the past 12 months.
• The practice nurse had initiated a checklist to be used when visiting housebound patients to ensure that all medical and social needs were being met. There were 35 people on the housebound register.

Updated 14 October 2016

• 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 as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice offered a choice of extended hours to suit their working age population, with later evening appointments available one day a week and Saturday morning. Results from the national GP survey in July 2016 showed 73% of patients were satisfied with the surgery’s opening hours which was higher than the local average of 71% and slightly lower than the national average of 76%.

Updated 14 October 2016

• 74% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.
• 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.
• A counselling service commissioning by the CCG offered a weekly session at the branch surgery for patients.
• 94% of patients on the practice’s mental health register had had their care plans reviewed in the last 12 months, which was higher than the national average of 88%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 October 2016

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability, housebound and caring responsibilities and regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice offered longer appointments and annual health checks for people with a learning disability. Data provided by the practice showed that 52% of patients on the learning disability register had received their annual health checks. The practice sent appointment reminders to patients and was actively trying to reduce the number of patients who did not attend their health checks.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and held meetings with the district nurses and community teams every six weeks.
• 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 practice’s computer system alerted GPs if a patient was also a carer. There were 130 patients on the practices register for carers; this was 1.4% of the practice list.