Lockstown Practice

Updated 11 July 2017

Lockstown Practice is located in Walsall, West Midlands. The practice is situated in a multipurpose modern built Private Finance Initiative (PFI) owned building, providing NHS services to the local community. There are two sites that form Lockstown Practice; these consist of the main practice at Gomer Street and the branch site at Fisher Street. Lockstown practice is part of Walsall Alliance Federation which is a group of 31 practices in Walsall, covering a patient population of 125,000.

Based on data available from Public Health England, the levels of deprivation in the area served by Lockstown Practice are below the national average, ranked at three out of 10, with 10 being the least deprived. 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 practice serves a higher than average patient population aged between zero to four, 25 to 30, 50 to 60 and 70 to 85 plus.

The patient list is 7,880 of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The surgery is situated on the ground floor of a multipurpose building shared with other health care providers. On-site parking is available with designated parking for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair and push chairs.

The practice staffing comprises of two male GPs and a regular male GP locum, one female GP, one senior practice nurse, one nurse practitioner, one advanced nurse practitioner (independent & supplementary prescriber), two health care assistant (HCA), a practice manager and an assistant manager; and eight receptionists who worked across both locations. The practice is also an approved training practice and provided training to medical students. There were two female GP registrars (GPs on a registration course).

The practice is open between 7.30am and 6.30pm daily except for Wednesdays where the practice is open between 8am and 1pm. The Fisher street branch is closed on Wednesdays and Friday afternoons; during this time patients are directed to call the main branch at Gomer Street for medical advice.

GP consulting hours are from 7.30am to 12.30pm and 2pm to 6pm on Mondays, Tuesdays, Thursdays, Fridays and 7.30am to 12.30pm on Wednesdays. The practice has opted out of providing cover to patients in their out of hours period. During this time, services are provided by NHS 111. On Wednesdays from 1pm to 8am services are provided by WALDOC (Walsall doctors on call).

The practice was previously inspected by CQC on the 26 September 2016 where we rated the practice overall as requires improvement. This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Updated 11 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lockstown Practice on 26 September 2016. As part of the comprehensive inspection we also visited the branch practice at Fisher Street. The overall rating for the practice following the September 2016 inspection was requires improvement, the full comprehensive report can be found by selecting the ‘all reports’ link for Lockstown Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection carried out on 9 May 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 26 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The practice operated effective systems for reporting and recording significant events. Records showed that the practice had responded and learned from safety incidents.

• Effective systems were in place for receiving and acting on alerts from the Medical and Healthcare products Regulatory Agency (MHRA).

• At our September 2016 inspection, we found that risk had not been formally assessed in the absence of some emergency medicines and the management of high risk medicines was not effective. During this inspection we found the arrangements to respond to medical emergencies and management of high risk medicines had improved.
• Since the previous inspection the practice improved their systems to minimise risks associated with fire and improved their processeses to ensure patient information was kept secure at the Fisher Street branch practice.
• Data from the national GP patient survey showed patients rated the practice higher than others for some aspects’ of care. Completed comment cards we received aligned with these views. The practice took action in areas such as waiting times, to improve patient satisfaction.
• Further actions taken to identify carers since the previous inspection resulted in an increase in the practice carers list and carers were offered support where needed.
• Information about services and how to complain was available and easy to understand. There was evidence of improvements made to handling of complaints and concerns at the Fisher Street branch since the previous inspection.

• The practice had a number of policies and procedures to govern activity which staff had access to. Oversight of procedures had improved since the previous inspection. As a result, communication throughout the practice and the monitoring of training needs had improved. Processes had also been streamlined.

However, there were also areas of practice where the provider should continue make improvements. For example:

• Continue to ensure clinical performance initiatives are carried out to monitor quality improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 July 2017

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.

• Diabetes related performance had declined in some areas since the previous inspection; however, there were areas where exception reporting rates had improved. For example, the percentage of patients with diabetes, on the register whom had a blood sugar reading which showed the condition being controlled appropriately reduced from 79% to 69%, compared to CCG average of 79% and national average of 78%. Exception reporting also reduced from 25% to 19%, compared to CCG average of 10% and national average of 13%.

• Longer appointments and home visits were available when needed. There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• 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.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• The practice offered a range of services in-house to support the diagnosis and monitoring of patients with long term conditions including spirometry, phlebotomy and followed recognised asthma pathways.

Updated 11 July 2017

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

• The practice was able to demonstrate systems 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 accident and emergency (A&E) attendances.

• Immunisation rates remained relatively high for all standard childhood immunisations. Eight week baby checks were completed in one clinic run by the practice nurse and GP every Thursday morning. Patients who missed these appointments were closely monitored and referred to the Health Visiting Team following three missed appointments.

• The practice was accessible for pushchairs, had baby changing facilities and supported breast feeding.

• Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

• The practice’s uptake for the cervical screening programme remained above national and local averages. For example, 85%, compared to CCG average of 81% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice held a midwife clinic twice a week and work closely with the midwife to share necessary information about patients.

Updated 11 July 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. All patients had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• There was a dedicated practice nurse to do home visits for reviews and treatments such as ear syringing, spirometry and annual health checks

• GPs carried out nursing home ward rounds twice weekly where they also meet with community colleagues such as community matron, hospital admission avoidance nurse practitioner and the trained nurses at the nursing home.

• A dedicated phone number was issued to care homes for residents at risk of hospital admission.

• Hearing Tests for patients aged over 55 were available at Fisher Street Practice from an external service.

• The practice provided health promotion advice and literature which signposted patients to local community groups and charities such as Age UK.

• Data provided by the practice showed that patients aged over 75 who received a health check in the last three years had increased since the previous inspection from 80% to 86%.

• The practice was accessible to those with mobility difficulties.

Updated 11 July 2017

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.

• For accessibility, telephone consultation appointments were available with either a GP or Advanced Nurse Practitioner.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice offered yellow fever vaccinations (a vaccination for a tropical virus disease transmitted by mosquitoes which affects the liver and kidneys).

• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.

• Data from the national GP patient survey indicated that the practice satisfaction rates were above local and national average regarding phone access and comparable regarding opening times.

Updated 11 July 2017

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

• Nationally reported data for 2015/16 showed patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months had slightly increased from 84% to 85%, this was comparable to the local and national average.

• The percentage of patients diagnosed with mental health who had a comprehensive, agreed care plan documented in their record in the preceding 12 months remained at 100% which was above the local and national average. Exception reporting had declined from 16% to 0%, compared to CCG average of 5% and national average of 13%.

• 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 registered with Alzheimer’s society with a view of becoming dementia friends.

• The practice carried out advance care planning for patients with dementia.

• A Community Mental Health Nurse offered counselling services within the practice and staff told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia and there were a designated lead responsible for this population group.

Updated 11 July 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 including homeless people, travellers and those with a learning disability (LD).

• Longer appointments available for patients with a learning disability were available on Mondays at the main branch and Thursdays at Fisher Street.

• An alert system was used to identify patients at risk or with special requirements that needed additional support.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, they provided a shared care service in partnership with the local addiction service for patients with opiate dependency allowing them to obtain their medicine at the surgery.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff we spoke with 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 held a carers list. Carers had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Data provided by the practice showed that their carers list increased from 2% to 3% since the previous inspection.