Sky Blue Medical Group

Updated 8 March 2017

Green Lane Medical Centre is part of the Sky Blue Medical Group, located in Finham, a mainly residential part of the city of Coventry, in the West Midlands. It has seven GP partners (three males and four females) and a salaried GP operating from a purpose built building in Finham. There is also a branch surgery, Harnall Lane Medical Centre within the Group which was not included as part of this inspection. Green Lane Medical Centre provides primary medical services to patients in an urban area and has a larger number of patients between the ages of five to 18 years (approximately 15.4% to 19.5%) compared to the England average (approximately 11.4% to 14.8%) and lower numbers of patients aged 75 plus (5.4%) compared to the England average (7.6%).

The GPs are supported by a practice manager, a nurse practitioner, five practice nurses and administrative and reception staff who divide their time working across the Green Lane Medical Centre and the Harnall Lane Medical Centre. There were 17,494 patients registered with the practice at the time of the inspection in November 2015.

The practice has a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Surgery times are:

• Monday from 8.30am to 5.30pm
• Tuesday from 7.30am to 8pm
• Wednesday from 8.30am to 5.30pm
• Thursdays from 8.30am to 1pm
• Friday from 8am to 5.30pm.

The practice is closed at weekends. The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances. Information on the out-of-hours service is provided to patients and is available on the practice’s website and in the patient practice leaflet.

Extended hours appointments are available from 7.30am to 8.30am and 5.30pm to 8pm every Tuesday and 8am to 8.30am on most Friday mornings each week.

Home visits are also available for patients who are too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book appointments. Booking of appointments can also be made up to four weeks in advance.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for maternity care and family planning. Sky Blue Medical Group also provides minor surgery clinics for treatment such as the removal of skin lesions and ingrowing toe nails.

Sky Blue Medical Group is an approved training practice for doctors who wish to be become GPs. A trainee GP is a qualified doctor who is training to become a GP through a period of working and training in a practice. Only approved training practices can employ trainee GPs and the practice must have at least one approved GP trainer.

Updated 8 March 2017

Letter from the Chief Inspector of General Practice

We had carried out an announced comprehensive inspection of Sky Blue Medical Group on 19 November 2015. As a result of our inspection the practice was rated as good overall but required improvement for providing safe services.

During the last inspection we identified a breach of regulation around safe care and treatment. As a result we identified areas the provider must improve:

• Implement a suitable system for the management and stock control of all prescriptions.
• Establish a process to ensure appropriate checks were carried out on locum GPs recruited by an agency to work at the practice.

We also identified further areas the provider should improve:

• Training records should accurately reflect the current status for all staff.
• All staff who chaperone should be suitably trained for the role and that all required security checks had been carried out in line with the provider’s own policy.

Following the inspection the practice sent us an action plan detailing the actions they were going to take to improve.

We carried out a focused desk-based review of Sky Blue Medical Group on 16 February 2017 to check that the provider had made improvements in line with our recommendations and to ensure regulations were now being met. This report only covers our findings in relation to those requirements. The full comprehensive report for the November 2015 inspection can be found by selecting the ‘all reports’ link for Sky Blue Medical Group on our website at www.cqc.org.uk.

The practice is now rated as good for the provision of safe services.

As part of our focused desk-based review the management team provided evidence to demonstrate that:

• A suitable system for the management and stock control of all prescriptions had been established and was fully embedded.

• A process had been implemented that ensured appropriate checks were carried out for locum GPs recruited by an agency to work at the practice.

• Training records had been updated and maintained so they accurately reflected the training completed and planned for all staff.
• Staff had received appropriate chaperone training and all required security checks for staff undertaking chaperone duties had been carried out in line with the provider’s own policy. The management team provided evidence to demonstrate that appropriate checks with the Disclosure and Barring Service (DBS) had been completed for relevant staff. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

We were satisfied that the practice had made the required improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 February 2016

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

• GPs and the practice nurses 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 that their health and medicine needs were being met.
• For those patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The quality monitoring data (QOF) for 2014/2015 showed that the percentage of patients with hypertension (high blood pressure) having regular blood pressure tests was 85.96% which was higher than the national average of 83.11%.

Updated 18 February 2016

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 accident and emergency (A&E) attendances.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Childhood immunisation rates were higher than the local Clinical Commissioning Group (CCG) averages.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw good examples of joint working with midwives and health visitors.

Updated 18 February 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs such as patients with dementia and those needing end of life care.
• The practice maintained a register of all patients in need of palliative care and offered home visits and rapid access appointments for those patients with complex healthcare needs.

• Flu vaccination rates for the over 65s were 78.71% which was higher than the national average of 73.24%. The rates for those groups considered to be at risk were 64.22% which was higher than the national average of 52.29%.

Updated 18 February 2016

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.
• The practice was proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group. The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions.
• The practice offered extended hours on Tuesdays so that patients could access appointments around their working hours.

Updated 18 February 2016

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

• The proportion of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was 83.61% which was in line with the national average of 83.82%.
• Patients with mental health concerns such as schizophrenia, bipolar affective disorder and other psychoses with agreed care plans in place were 91.2% which was higher than the national average of 86.04%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• It carried out advance care planning for patients with dementia.
• The practice had advised patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 18 February 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and mental health concerns.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
• It advised vulnerable patients about how to access various support groups and voluntary organisations.
• Staff told us they had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm, although we were unable to see records to confirm this. 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.
• Alerts were placed on these patients’ records so that staff were aware they might need to be prioritised for appointments and offered additional attention such as longer appointments. Longer appointments were available and annual health checks were carried out for patients with a learning disability.