Archived: Blakenall Family Practice

Updated 19 June 2017

Blakenall Family Practice is located in the Walsall area of the West Midlands. The practice is situated in a multipurpose modern built NHS building, providing NHS services to the local community. Blakenall Family Practice is part of Phoenix Primary Care, which is a general medical service provider comprising of 12 GP practices operating in the Midlands, Bedfordshire and Herefordshire. Since the July 2016 inspection, Phoenix Primary Care merged with The Practice Group. The practice group works with the NHS to design and deliver innovative approaches to primary care across England.

Based on data available from Public Health England, the levels of deprivation (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by Blakenall Family Practice are below the national average, ranked at one out of 10, with 10 being the least deprived. The practice serves a higher than average population of patients from birth to 34, below average for patients aged 65 plus and comparable for patients aged 85 plus.

The patient list is 5,550 patients of various ages registered and cared for at the practice. Phoenix Primary Care Limited merged two practices in 2012 to form Blakenhall Family Practice. Phoenix Primary Care Limited board of directors runs the practice and service delivery is supported by a clinical and administration team. Services to patients are provided under an Alternative Primary Medical Services (APMS) contract with the Clinical Commissioning Group (CCG). APMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The practice 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 registered to deliver diagnostic and screening procedures, maternity and midwifery services and treatment of diseases, disorders or injury.

The practice is situated on the ground floor of a multipurpose building with a wide range of health care and community services. There is car parking available along with facilities for cyclists and patients who display a disabled blue badge. The practice has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staffing comprises of two male and two female salaried GPs, two advanced nurse practitioners; one independent nurse prescriber, one practice nurse and two health care assistants. There is a practice manager, a practice administrator and seven receptionists.

The practice is open between 8am and 6.30pm Tuesday to Friday and between 8am and 8pm on Mondays. Various GP consulting hours are available from 8.30am to 6.30pm Monday to Friday, extended hours provided on Mondays from 5pm to 7.30pm. The practice has opted out of providing cover to patients in their out of hours period. During this time, NHS 111 provides services.

Updated 19 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Blakenall family Practice on 4 July 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Blakenall Family Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 April 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 4 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good; however continues to be rated as requires improvement for providing responsive services.

Our key findings were as follows:

• At our July 2016 inspection, some medicines required to respond to medical emergencies were not stored within the practice and the provider had not assessed the risk posed by the absence of these. During this inspection we found that the arrangements to respond to medical emergencies had been strengthened.

• Results from the national GP patient survey published in July 2016 showed that patient satisfaction had slightly improved in some areas and declined in others since the July 2016 inspection. The practice was aware of this and taking action to improve patient satisfaction.

• Previously we saw the practice complaints process was not being followed effectively. As part of this inspection, we saw that oversight of the complaints process was more effective. As a result, the practice responded to complaints in a timely manner and improvements were made to the quality of care as a result of complaints and concerns.

• Arrangements for monitoring and improving quality and managing risk had improved since our previous inspection. For example, the practice established a programme of continuous clinical audits and oversight of risk was managed effectively.

• Data from the 2015/16 quality outcomes framework showed uptake of childhood immunisations was below local and national averages for vaccinations given to under two’s and five year olds. Staff we spoke with during this inspection explained that they actively contacted patients who failed to attend appointments.

• The practice no longer had set immunisation clinics and made clinic times more flexible for patients. Staff explained that the practice was also involved in a pilot with child health aimed at gathering central data of completed immunisations. As a result, 2016/17 QOF data showed immunisation uptake for under two’s and five year olds was above local and national averages.

• As part of the previous inspection data from the March 2015 national cancer intelligence network showed that uptake for breast and bowel screening was below local and national averages. When we carried out this inspection, we saw that uptake remained below local and national averages; however the practice were aware of this and continued to take actions to improve uptake. This included actively contacting patients to encourage uptake and arranging for testing kits to be sent out directly to patients.

In addition the provider should:

• Continue to review national GP patient survey results and internal patient feedback; and explore effective ways to improve patient satisfaction.

• Continue to consider effective ways of encouraging the uptake of national screening programmes such as bowel and breast cancer.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 November 2016

The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as requires improvement for safe, effective, caring, responsive and well-led. Therefore the issues identified as requiring improvement overall affected all patients including this population group.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the national average. For example, 83% had a specific blood glucose reading of 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) compared to the CCG and national average of 78%. Exception reporting rate was 28% compared to CCG average of 9% and national average of 12%.

• The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015), was 100%, compared to CCG average of 96% and national average of 94%. Exception reporting rate was 32% compared to CCG average of 22% and national average of 18%.

• Longer appointments and home visits were available when needed.

• Although staff we spoke to told us that these patients had, a named GP and a structured annual review to check that their health and medication needs were being met. Feedback from patients we spoke with on the day reported that access to a named GP and continuity of care was not always available.

Updated 10 November 2016

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for safe, effective, caring, responsive and well-led. Therefore the issues identified as requiring improvement overall affected all patients including this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and those who were at risk, for example, children and young people with a high number of A&E attendances. We saw positive examples of joint working with safeguarding teams.

• The practice held nurse-led baby immunisation and vaccination rates were relatively high for standard childhood immunisations with the exception of Infant Men C, which was 54%, compared to CCG average of 78%. Following the inspection the practice provided more recent unverified data, which showed that Infant Men C uptake increased to 87%.

• 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 for patients aged 25-64 in the preceding five years was 73%, which was below the CCG average of 81% and the national average of 82%. The practice provided data from 2015/16 which showed a 78% uptake rate, however as yet this data had not been verified or published.

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

Updated 10 November 2016

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for safe, effective, caring, responsive and well-led. Therefore the issues identified as requiring improvement overall affected all patients including this population group.

• 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, for example they offered weekly support to registered patients who resided in the local care home, home visits and urgent appointments was available for those with enhanced needs.

• Data provided by the practice showed that 99% of patients aged 75 plus have had their health needs reviewed in the past two years.

• Patient over the age of 75 years had a named GP, offered longer appointments if required and at a time to suit patient’s needs.

Updated 10 November 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as requires improvement for safe, effective, caring, responsive and well-led. Therefore the issues identified as requiring improvement overall affected all patients including this population group.

• 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 and flexible.

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

• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years. Data provided by the practice showed that 43% of patients in this age group had received a health check in the past 12 months. The practice offered extended clinic hours on Mondays from 5pm to 7.30pm.

Updated 10 November 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The provider was rated as requires improvement for safe, effective, caring, responsive and well-led. Therefore the issues identified as requiring improvement overall affected all patients including this population group.

• 73% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was below the national average of 84%. Following the inspection the practice provided unverified data for 2015/2016, which showed 82% had their care reviewed.

• Performance for patients with a mental health related disorder who have a comprehensive, agreed care plan documented in their record, in the preceding 12 months (01/04/2014 to 31/03/2015) was above the national average. For example, 93% compared to the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example, the GPs and advanced nurse practitioner carried out weekly visits to the local residential and nursing care homes. However, we saw that regular meetings were not always formal. The GP also held a list of patients unable to access the practice, which they visited upon request.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations, we also saw posters located in the reception area.

• 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.

Updated 10 November 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for safe, effective, caring, responsive and well-led. Therefore the issues identified as requiring improvement overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability (LD). The practice provided data, which showed that 63% of patients with a LD had a care plan, 94% had a medicine review and 63% had a face-to-face review in the last 12 months.

• 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, how to record safeguarding concerns and how to contact relevant agencies during and outside of normal working hours.

• 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 found that this supported patients more effectively and allowed the practice to manage any physical and psychological problems that may coexist with illicit substance misuse.

• The practice’s computer system alerted GPs if a patient was a carer, 2% of the practice list had been identified as a carer. Carers of patients registered with the practice had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Contact details for various avenues of support were provided during GP consultations and information were on display in the reception areas.