Archived: Your Health Partnership Also known as Carters Green Medical Centre

Updated 12 April 2017

Carters Green Medical Centre is part of Your Health Partnership (YHP), a GP led partnership that consists of four practices including Regis Medical Centre, Oakham Surgery and Whiteheath Medical Centre. The outlets (practices), based in Sandwell in the West Midlands, provide services for approximately 46,000 patients. Carters Green Health Centre provides services for approximately 10,600 patients.

Carters Green Medical Centre is located on the High Street in West Bromwich . It is an older building with plans to expand in a new location. The majority of consultations are conducted on the ground floor although three of the treatment/consultation rooms accessed by patients are reached via steep staircases. There is easy access to the building and facilities for disabled patients are provided. There is limited car parking on site for patients. After an extensive patient and public engagement campaign there are plans to relocate the practice to the Sandwell Hospital site and YHP are awaiting final approval.

The practice holds a General Medical Services (GMS) contract with NHS England and forms part of NHS Sandwell and West Birmingham Clinical Commissioning Group (CCG). The staff group, policies, systems and procedures are generally managed across the corporate partnership (Your Health Partnership).

There are seven GPs working at the practice, three GPs are partners and four salaried GPs. One salaried GP is currently on maternity leave. One of the GP partners is male and two are female, two of the salaried GPs are male and two are female. There are also three GP registrars based at the practice. The practice uses locum GPs regularly as YHP has been unable to recruit sufficient permanent medical staff. There are four female practice nurses, one of whom is currently on maternity leave. Two of the practice nurses are full time and two practice nurses are part time. Advanced nurse practitioners (ANP) held specific clinics at several sites and were part of the corporate partnership. There is a full time female health care assistant (HCA).

The practice has an ethnically diverse population - a mixture of long-established families from south Asia and the Caribbean, recent immigrants from the middle East and Africa, and a significant number of patients from eastern Europe. Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to ten, with level one representing the highest level of deprivation.

There is an outlet supervisor who oversees the daily business and management of the practice, and a team of administrative staff. The telephony and patient service teams are also based on the top floor of the premises.

The practice opening times are 8am until 6.30pm Monday to Friday. There is an extended hour’s surgery on Mondays from 6.30-9pm and Wednesdays 7.30-8am. Appointments are available from 8am to 6.30pm Mondays to Fridays and 6.30-9pm on Mondays and 7.30-8am on Wednesdays.

Patients requiring a GP outside of normal working hours are advised to call the 111 service and there is a walk-in centre a short distance away.

This is a teaching practice for doctors training to be GPs.

Updated 12 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Carters Green Medical Centre on 29th November 2016. The practice is part of Your Health Partnership (YHP) a four practice group operating with centralised management and governance. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows;

• Risks to patients were assessed and well managed.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about the services were provided and how to complain was available and easy to understand. The practice website informed patients of the complaints process and the services available. There was a facility to translate the website into a variety of languages.

• Improvements were made to the quality of care as a result of complaints and concerns.

• The practice had good facilities and was well equipped to treat patients and meet their needs. However the size and design of the building limited the number of consulting rooms available and access to consulting rooms on the first floor was difficult for patients with mobility problems.

• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. Patients said appointments had become easier to access in the last six months.
• The provider was aware of and complied with the requirements of the duty of candour.

• All patients who reported or sought help from other providers after an episode of attempted or actual self-harm were contacted by telephone or offered a face to face appointment within one week to discuss ongoing care by a GP.

• The practice kept a register of patients with coeliac disease and offered them an annual review.

The provider should make improvements as follows:

• Continue to encourage attendance for cancer screening programmes.

• Continue to monitor and ensure improvement to patient feedback regarding access, for example patient perception and access options available

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 April 2017

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

• The practice was part of corporate partnership YHP and nurses delivered specialised clinics in diabetes, heart disease, chronic obstructive pulmonary disease, asthma, anticoagulation and dementia across all of the practices.
• Performance for diabetes related indicators was better than or comparable with the local and national average. For example the percentage of patients with diabetes, on the register, in whom the last blood pressure reading was 140/80 mmHg or less in the period April 2015 to March 2016 was 91%. The clinical commissioning group (CCG) average was 91% and national average 91%.
• YHP employed a diabetes specialist nurse who ran a dedicated weekly clinic. There was an ongoing diabetes skills development programme for other practice nurses.
• Longer appointments and home visits were available when needed.

• YHP had developed a Year of Care plan of proactive care for patients with long-term conditions based on their complexity. All these patients had a named GP and a structured annual review to check their health. Detailed policy and management flow-charts were available to staff on the computer system. Patients were invited to have the relevant blood tests in advance and given a one-stop extended appointment with the practice nurse with a plan agreed for the follow up period. The GP reviewed medicines and authorised repeat prescription medicines for the following year.
• The health care assistant undertook telephone screening with some groups of patients for example those with hypothyroidism. Any abnormalities were then flagged to a GP or nurse for action.
• Clinicians were encouraged to complete an annual medicines review for patients on repeat medicines using a dedicated system. This was subject to an ongoing audit.
• Patients were encouraged to access healthy lifestyle support via the local health support website. Patients could also be referred to the local smoking cessation and health trainer services.
• Patients taking warfarin were offered the opportunity to be monitored in a weekly nurse-led clinic. Monitoring of patients taking anti-rheumatic drugs took place via the centralised patient-services team.
• The practice kept a register of patients with coeliac disease and offered them an annual review. The review was established in 2013 following a Royal College of General Practitioners award-winning audit by a former GP trainee.

Updated 12 April 2017

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

• There were comprehensive 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 & Emergency attendances and those who did not attend secondary care appointments.
• All new mothers and their babies were invited to a postnatal and baby check when infants were 8 weeks old. This was a 30 minute appointment with a GP.

• Same day appointments were available for families either face to face or by telephone. Appointments were available so that school children could be seen outside of school hours. The premises were suitable for children and babies.
• Immunisation rates were relatively high for all standard childhood immunisation programmes achieving from 73% to 94% in 2015/16, the same as the clinical commissioning group (CCG). These were provided both at immunisation clinics and by appointment.
• Saturday influenza clinics were offered at another YHP practice to enable improved access and uptake of the influenza vaccination.
• The practice provided sexual health services and cervical screening and staff signposted patients to the local sexual health clinics and for family planning.
• We saw that 87% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to a CCG average of 79% and a national average of 81 %.

Updated 12 April 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. Each patient over 75 years had a named doctor who saw them for appointments and followed up on test results which older patients told us they found very valuable.

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

• Practice staff visited a number of care homes in the area to provide ward rounds, confer with staff and managers and provide advice on medicines management.

• There were patients on the Avoiding Unplanned Admissions register all of whom had a care plan.

• The practice offered influenza, pneumococcal and shingles vaccinations to patients.

• Multidisciplinary team meetings were held on a monthly basis, where patients were selected and reviewed along with palliative care patients. The health care professionals who attended included palliative care nurses, district nurses, community matrons and Sandwell ICARES (including the community falls team). Your Health Partnership (YHP) had worked with the local hospital trust to secure a dedicated team of district nurses for the registered population which enhanced continuity of care. The district nurses also ran a dedicated clinic at Rowley Hospital for patients from the YHP group of practices.

• Patients who may be at risk of falls were assessed using a standardised template and were referred to the community falls prevention team.

• YHP employed an advanced nurse practitioner to provide acute and planned care for the predominantly elderly housebound population.

• The practice referred patients to a number of voluntary sector organisations for assessment and support of patients’ social needs. For example, Kaleidoscope provided links to a befriending service, ‘walk from home’ enablement programme, lifestyle packages, falls prevention programmes, day trips, good neighbouring, social enterprise development training, IT and health training and information and guidance services. Kaleidoscope attended the practice during the dedicated influenza vaccination weekend clinics to promote their services to patients.

Updated 12 April 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. This included surgeries from 8am each day, on Monday evenings (6.30-9pm), Wednesday mornings (7.30-8am), and Saturday mornings as a joint clinic with the three other YHP practices. There were also daily pre-booked and same day telephone consultations.
• The practice was proactive in offering online services including appointments, repeat prescriptions and viewing their medical records.
• Health checks were available for patients aged between 40-74years.
• Where appropriate patients were able to request MED3 Fit for Work notes by telephone. If an assessment was needed then the duty GP contacted the patient, otherwise the note was issued for collection within an agreed period.
• Students were offered vaccinations as part of the national immunisation programme. Where students required information for health or study enrolment purposes staff provided this quickly through an outlet support team who handled such requests.

Updated 12 April 2017

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

• Annual enhanced reviews with the healthcare assistant and a named GP were offered to check physical and mental health, review chronic disease control, arrange appropriate screening and agree a care plan. The electronically-generated care plan included individualised mental and physical health goals.

• We saw that 87% of patients with schizophrenia, bipolar affective disorder and other psychoses, 94% had a comprehensive, agreed care plan documented in the record in the preceding 12 months. This compared with a clinical commissioning group (CCG) average of 90% and a national average of 89%.

• Of patients with mental health conditions, 92% had their alcohol consumption recorded in the preceding 12 months. This compared with the CCG average of 93% and the national average of 89%.

• The practice used an in-house template to encourage a standardised approach to patients presenting with depression or anxiety. Clinicians were encouraged to review all patients with a new diagnosis within 2 weeks after diagnosis.

• Clinicians referred to the local wellbeing team who provided guided self-help support, group support and access to face to face talking therapies. This included signposting to the ‘Books on Prescription’ scheme pioneered by one YHP partner. Patients could borrow books which provided information and advice about their condition.

• Patients requiring the input of the specialist mental health teams were referred to the local ‘Single Point of Access’ team.

• All patients who reported or sought help from other providers after an episode of attempted or actual self-harm were contacted by telephone or offered a face to face appointment within one week to discuss ongoing care by a GP.

Updated 12 April 2017

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

• We saw posters in the reception areas signposting patients to other services for example HIV testing, sexual health clinics and NOMAD services. (NOMAD provided housing and support to help people to maintain their tenancies or those at risk of losing their home.)

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• Carters Green Medical Centre participated in the enhanced service for patients with learning disabilities. This involved a nurse-led annual review for adults and a GP review for patients under 16.
• The practice regularly worked with other health care professionals, including hospice staff, palliative care nurses and district nurses in the case management of vulnerable patients. This included multidisciplinary integrated care meetings to ensure patients received safe, effective and responsive care.
• Staff were involved in planning do not attempt cardiopulmonary resuscitation (DNA CPR) forms (where an advance decision not to resuscitate is made) in accordance with the YHP group protocol. All decisions involved discussion with a GP.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. The practice had a named safeguarding lead and a deputy lead. The practice had a domestic violence prevention pathway available on the computer system. There were posters around the practice and in patient toilets about the local support service for women experiencing domestic violence.
• The practice’s computer system alerted GPs if a patient was a carer. The practice had identified 181 patients as carers (2% of the practice list). A carer’s information board was maintained in the waiting room. All carers were offered a health check, the influenza vaccination and were signposted to relevant support services. YHP was currently establishing a network of carer’s champions in each practice to support this work.Regular reviews of the practice register of carers were undertaken to monitor for any changes in patient circumstances.
• The practice had an ethnically diverse population. An audit in 2015 revealed that 5% of consultations took place in the presence of a professional interpreter. An unquantified but significant number also relied on informal interpreters bought by patients. Patients requiring an interpreter were encouraged to make advance appointments.