Archived: Drs Bilas & Thomas

Updated 20 July 2017

Drs Bilas & Thomas are registered with the Care Quality Commission (CQC) as a two GP partnership. The practice is located in Wolverhampton. The practice is a single story building. There is level access to the building but doors to the building are not automated. Patients who experience mobility difficulties and/or use a wheelchair are asked to ring a bell at the entrance; this alerts staff to patients who require support to enter the premises. All areas within the practice are accessible by patients who use a wheelchair or parents with a pushchair.

The practice team consists of two GP partners, both male. One of the GP partners is currently on long term absence. Cover is provided by regular locums to ensure consistency for patients. A regular female locum undertakes a weekly session at the practice. The GPs are supported by a practice nurse and a healthcare assistant who both work part time. Clinical staff are supported by a practice manager, deputy practice manager, a medical secretary, an administrator, six reception staff, a scanning clerk and two domestic staff. In total there are 17 staff employed either full or part time hours to meet the needs of patients. The practice also provides training placement opportunities for student nurses.

The practice is open every week day between 9am and 12pm and from 4pm to 6.45pm Monday, Tuesday, Wednesday and Friday. The practice is closed from 12pm on Thursday. Appointments are available from 9am to 11am each weekday and from 4pm to 6pm on Monday, Tuesday, Wednesday and Friday. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service, provided by Vocare, via the NHS 111 service.

The practice has a General Medical Services contract with NHS England to provide medical services to approximately 3876 patients. It provides Directed Enhanced Services, such as the childhood immunisations, minor surgery and asthma and diabetic reviews. The practice has a slightly higher proportion of patients aged 45 to 59 and a higher proportion of patients, mainly female aged 75 to 85 when compared to the practice average across England. The income deprivation affecting children of 25% was higher than the national average of 20%. The level of income deprivation affecting older people was also higher than the national average (23% compared to 16%).

Updated 20 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Drs Bilas & Thomas on 20 June 2016. After the comprehensive inspection, the practice was rated as requires improvement for providing safe services.

We issued a requirement notice in relation to:

• Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Safe care and treatment.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drs Bilas & Thomas on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified at our previous inspection on 20 June 2016. This report covers our findings in relation to those requirements.

Our key findings were as follows:

• The recording of significant events had been reviewed and were sufficiently detailed to show that concerns identified about patients were appropriately followed up to prevent further occurrences and ensure improvements made were appropriate.
• The practice had reviewed its systems and procedures to ensure the safe management of medicines.
• Records were available to confirm that a full legionella risk assessment had been carried out.
• The practice’s complaint handling procedures had been reviewed to ensure that the appropriate management of verbal complaints was included. Staff were made aware of the procedure to follow.
• The practice chaperone practices had been reviewed to ensure that all staff were aware of the correct procedure to follow when carrying out the role.
• Staff had received training to ensure that they were aware of the requirements of the Mental Capacity Act (MCA) 2005 and their responsibilities under the act as it relates to their role.

There was one area where the provider should make improvements:

• Ensure that a risk assessment is completed to determine whether there is a need for a second thermometer to confirm the accuracy of the temperature of the fridge used to store medicines.

At this inspection we found that the practice had addressed all the concerns raised and is now rated as good for providing safe services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 September 2016

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

• The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice Quality and Outcomes Framework (QOF) for the care of patients with long-term conditions was similar to or higher than the local and national average. For example the practice performance for diabetes related clinical indicators was higher than the local Clinical Commissioning Group and England average (94% compared to the local average of 82% and England average of 89%).
• Longer appointments were available when needed and home visits made to patients who were housebound.
• The named GP and practice nurse worked with relevant healthcare professionals to deliver a multidisciplinary package of care to patients with complex needs.

Updated 23 September 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 did not attend hospital appointments.
• Immunisation rates for standard childhood immunisations were similar to or higher than the local CCG immunisation rates.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered some contraceptive services and in the absence of a female GP offered female patients the choice of referral to local family planning services. Patients were referred locally for specialised contraceptive services.
• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the national average of 82%.

Updated 23 September 2016

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.
• The practice offered home visits to older people who were housebound only.
• Flexible appointments were available for older patients.
• All patients aged 75 plus were offered a health check including blood tests.
• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

Updated 23 September 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 did not offer extended opening hours and the appointment telephone line was not easily accessible to patients who worked during the day.
• 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.
• University students were offered the options of re-registering with the practice as a temporary resident or as a patient in immediate need of treatment.

Updated 23 September 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia.
• The practice held a register of patients who experienced poor mental health. Clinical data for the year 2014/15 showed that 67% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This was much lower than the national average of 88%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Counselling clinic sessions were held at the practice with an experienced mental health counsellor based in the community.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 75%, which was lower than the national average of 84%.
• The practice maintained a register of patients diagnosed with dementia.

Updated 23 September 2016

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

• The practice held a register of patients with a learning disability and had plans in place to ensure annual health checks were carried out for these patients.
• The practice had a low prevalence of patients living in vulnerable circumstances, when identified the practice assisted and supported these patients on an individual basis.
• Staff had been trained 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.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.