Duncan Street Primary Care Partnership

Updated 10 February 2017

Duncan Street Primary Care Partnership is registered with the Care Quality Commission (CQC) as a partnership. The practice is located in an inner city area of Wolverhampton and has good transport links for patients travelling by public transport. Parking is available for patients travelling by car. The practice is a two storey 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 two GP partners (one male, one female) and four salaried GPs all female. The GPs are currently supported by a nurse practitioner, two practice nurses and a healthcare assistant. Clinical staff are supported by a practice manager, reception manager, three administration and six reception staff. In total there are 22 staff employed either full or part time hours to meet the needs of patients. The practice also use regular 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 and provides advanced training for GP registrars who have not been able to complete their training in the three-year training period.

The practice is accessible by phone between 8am and 6.30pm and open from 8.30am to 6pm Monday to Friday. Appointments to see a GP are available from 9am to 11.30am and 2pm to 6pm. Patients are able to book appointments with the practice nurses between 8.30am and 12.30pm and 2pm to 6pm. This 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 Vocare via the NHS 111 service.

The practice has a Primary Medical Services contract with NHS England to provide medical services to approximately 9,452 patients. It provides Directed Enhanced Services, such as childhood vaccinations and immunisations, facilitating the timely diagnosis and support for patients with dementia and the care of patients with a learning disability. The practice has a higher Asian population of 38% in comparison to other local practices. 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 30% 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 10 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Duncan Street Primary Care Partnership on 1 September 2016. Overall, the practice is rated as good with requires improvement in providing a safe service.

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. Learning was shared with staff and reported to external agencies when required.
• Required recruitment checks had been made before staff were employed to work at the practice.
• Effective systems were in place to mitigate risks to patients who took high risk medicines.
• A training matrix and policy was in place to monitor that all staff were up to date with their training needs and received regular appraisals.
• Patients said they found it difficult to get through to the practice by telephone. The practice had put systems in place to address this. Urgent appointments were available the same day with the on call GP.
• Feedback from patients about their care was consistently positive.
• The practice engaged with the local community to support the self-management of patients with long-term conditions. For example, the practice invited patients to take part in educational and lifestyle sessions held at a local temple.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively managed, reviewed and responded to complaints and made improvements based on the outcome.
• The practice had a strong culture for education and learning.
• The practice had visible clinical and managerial leadership.
• Governance and audit arrangements were comprehensive and effective.

There were areas of practice where the provider should make improvements:

• Continue pro-actively identifying carers and establishing what support they need.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 February 2017

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

• Nursing staff had lead roles and were supported by the GPs in the management of patients with a chronic disease and those at risk of hospital admission were identified as a priority.
• The GPs and practice nurses worked with relevant health care professionals to deliver a multidisciplinary package of care to patients with complex needs.
• The practice Quality and Outcomes Framework (QOF) score for the care of patients with long-term conditions was similar to the local and national averages. However the practice performance for diabetes related clinical indicators overall was lower than the local Clinical Commissioning Group and England average. The practice had a proactive approach to improve the management of patients with diabetes. For example, patients who did not attend appointments were invited to take part in educational and lifestyle sessions held at a local temple to support them to manage their diabetes.

Updated 10 February 2017

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.
• The practice held regular clinical meetings where children at risk, child welfare concerns and safeguarding issues were discussed to ensure awareness and vigilance.
• The practice uptake for the immunisation of children overall was similar to the local and national averages.
• The practice’s uptake for the cervical screening programme was 74% which was lower than the local Clinical Commissioning Group (CCG) average of 78% and the England average of 82%. The practice had a proactive process in place to manage this.
• Protected daily appointments were available for children of all ages. Appointments were available outside of school hours and urgent appointments were available for children.

Updated 10 February 2017

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Older patients at higher risk of hospital admission had written advanced care plans.
• The practice had a register of frail and vulnerable older patients and these were discussed at regular multidisciplinary meetings with other health and social care professionals.

Updated 10 February 2017

The practice is rated as good 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 as well as a full range of health promotion and screening that reflected the needs of this age group.
• All patients between the age of 40 and 74 years of age were offered NHS health checks and healthy living advice.

Updated 10 February 2017

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

• Eighty one per cent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was slightly below the local CCG average of 86% and national average of 84%.
• The percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 80%. This was lower than the local CCG and national averages of 88%.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 February 2017

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.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with external health and social care professionals, to provide effective care to patients nearing the end of their lives and other vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.