Archived: Phoenix Family Care

Updated 8 December 2017

Phoenix Family Care is registered with the Care Quality Commission (CQC) as a partnership of three GPs and is situated in Coventry. 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 area is one of low deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 6,000 patients. The list size is decreasing and had been 6,500 in April 2014. The practice age distribution shows a higher percentage of elderly patients when compared to national and CCG averages. For example, 28% of the practice population is aged 65 years and over. This is higher than the CCG average of 15% and the national averages of 17%. The percentage of patients with a long-standing health condition is 52% which is lower than the local CCG average and the national average of 54%.

The practice is open between 8am and 6.30pm Monday to Friday (the practice has protected learning time every fourth Wednesday and remains open but telephones are switched to the out of hours provider). On week days, they provide a pre-bookable morning surgery between 8.30am and 11.50am, and in the afternoon between 3pm and 5pm. Patients can pre-book appointments up to eight weeks in advance for GPs and nurses. Extended hours appointments were available at the cluster practices within Coventry. The practice does not routinely provide GP appointments when the practice is closed but patients are directed to the GP out of hours service.

The practice team consisted of:

• One female and two male GP partners.
• A practice nurse
• Two practice managers
• A medical secretary
• A head receptionist and three supporting reception and administrative staff.

The practice has been through some significant changes in recent years. There was a merger with another nearby practice in April 2014 that increased the total number of registered patients from 5,300 to 6,500. There had been significant changes in staff. There were two consultant practice managers in post until a permanent practice manager had been appointed. The practice will be moving to new premises early in 2018 which are located centrally for their patient population.

The practice provides a number of specialist clinics and services. For example, long term condition management including asthma, diabetes and high blood pressure. It also offers services for child health developmental checks and immunisations and travel vaccinations. The practice hosted services from the practice that included counselling services and antenatal clinics.

The practice is a research ready practice and has taken part in a number of studies including research into the more appropriate time for treatment, and trials in treatment for gout.

Updated 8 December 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Phoenix Family Care on 14 November 2016. As a result of our inspection the practice was rated as inadequate in safe, requires improvement in effective, responsive and well-led with good in caring; with an overall rating for the practice of requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Phoenix Family Care on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 28 September and 10 October 2017, to confirm that the practice had carried out their plan to address the areas requiring improvement that we identified in our inspection in November 2016. This report covers our findings in relation to requirements and the improvements made since our last inspection.

We found the practice had carried out a detailed analysis of the previous inspection findings and taken action to address areas where improvements were needed. The practice had made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements and we saw a positive approach to performance and improvement throughout.

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 outcomes had been actioned.
• All appropriate recruitment checks had been carried out on staff prior to being employed by the practice. This included medical indemnity checks carried out on locum GPs employed, and the physical and mental health of newly appointed staff.
• Systems had been developed to monitor patients who took high risk medicines more effectively.
• An overarching training matrix and policy was in place to monitor that all staff were up to date with their training needs and received regular appraisals.
• Feedback from patients about their care was consistently positive and this was reflected in the National GP Patient Survey results published in July 2017.
• The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice offered extended opening hours on Monday and Wednesday between 6.30pm and 9.30pm and on Saturday and Sunday mornings.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This included appropriate arrangements for equipment and medicine that may be required to respond to a medical emergency.
• The practice had an internal process to manage complaints.
• There was a practice development plan that documented both their long and short-term priorities. This included actions they had taken in response to patient feedback about the difficulty in accessing appointments, and the plans for continued improvements.
• The practice had visible clinical and managerial leadership with audit arrangements in place to monitor quality.

There were areas where the provider should make improvements:

• The provider should continue to recall patients with diabetes to ensure that all patients were monitored and kept under review.
• The practice should continue to work towards improving access and measure the impact of changes to improve it.

At our previous inspection on 14 November 2016, we rated the practice as requires improvement for providing responsive services. Although the practice had taken action to address areas for improvement it was too soon for the outcome of these actions to demonstrate impact, such as improvements to telephone access. The practice is still rated as requires improvement for providing responsive services.

The practice was rated as good in safe, effective, caring and well-led with requires improvement in responsive. The overall rating for the practice is now good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 December 2017

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

• Nursing staff were supported by the GP in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The provider had reviewed 82% of patients on the asthma register in the preceding 12 months which was above the Clinical Commissioning Group (CCG) average of 79% and the national average of 77%. This was an increase of 26% on the previous year’s data.
• Performance for diabetes related indicators was generally below the Clinical Commissioning Group (CCG) and national averages. The practice was aware of the performance and had tasked reception staff with calling patients in to be reviewed.
• All these patients had a named GP. For those patients with the most complex needs the practice regularly worked with other health and social care professionals. Communication had been improved to include sharing information with the out of hours service about patients nearing the end of their life or if they had a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) plan in place.
• Reviews for all patients who had epilepsy had been completed to ensure they were prescribed medicines in keeping with current guidance.

Updated 8 December 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 provider told us they prioritised appointments for children.
• The practice’s uptake for the cervical screening programme of 76% was below the CCG and national averages of 82% for 2015/2016. Current data was not available at the time of this inspection.
• 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 and health visitors.
• The provider hosted a service that provided new mothers with post-natal checks and development checks for their babies.
• Data from NHS England for 2015/2016 showed that childhood immunisation rates for the vaccinations given were above the national average.

Updated 8 December 2017

The practice is rated as good for the care of older people.

• The practice offered personalised care to meet the needs of the older people in its population. All patients aged 75 and over had been written to and advised of their named GP.
• Patients’ needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity, promoting good health and ensuring patients had comprehensive written care plans.
• The provider had a structured approach to inviting patients aged 75 and over for annual health checks and planned to commence this in October 2017.
• Older patients who were at an increased risk of hospital admission were identified, had written care plan in place and reviewed with other healthcare professionals.
• The practice was responsive to the needs of older patients and offered home visits, urgent appointments and longer appointments for those with enhanced needs.
• Immunisations against flu, shingles and pneumococcal were offered to older patients.

Updated 8 December 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.
• Extended hours appointments were available at the cluster practices within Coventry.
• 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.
• All patients between the age of 40 and 74 years of age were offered NHS health checks through a service hosted by the practice but provided by the CCG.

Updated 8 December 2017

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, with a 2% exception reporting rate. This was an increase of 15% on the previous year. This was higher than the CCG average of 82% and the national average of 84%.
• 100% of patients with a diagnosis of depression had received a review after their diagnosis. Performance had improved on the previous year’s results (by19%) which were now above the CCG average of 85% and national average of 84%. Exception reporting was 4% lower than last year at 20%, which was lower than the CCG and the national average of 23%.
• 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.
• The practice provided a room for a weekly counsellor led clinic to support patients with poor mental health.

Updated 8 December 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. For example, the practice supported victims of domestic violence who took up temporary residence in a nearby refuge.
• The practice offered longer appointments for patients with a learning disability.
• 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.
• The GPs were trained in the assessment of deprivation of liberty safeguards (DOLS). These safeguards ensure that important decisions are made in people’s best interests.
• Staff had attended suicide risk training that informed them on how to identify the signs of a vulnerable patient and what action would be appropriate.