We carried out an announced focused inspection at Handsworth Medical Practice on 25 April 2019. At this inspection we followed up on breaches of regulations identified at a previous inspection on 1 May 2018.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

At the last inspection in May 2018 we rated the practice as requires improvement for providing safe services because:

• The practice had not assessed health and safety risks.
• Systems to monitor infection prevention and control (IPC) standards were not in place and the IPC policy and procedure required further development.
• A programme of redecoration and repair was required at the branch site.
• Systems were not adequate to ensure the safe storage of vaccines.
• Systems were not adequate to ensure blank prescription forms were stored securely.

At this inspection, we found that the provider had satisfactorily addressed these areas.

We have rated this practice as good overall.

We rated the practice as good for providing safe because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

We reviewed areas where we recommended the practice should improve from the May 2018 inspection and found the practice had acted on these recommendations. For example:

• They had improved the prominence of the display of CQC ratings on the practice website.
• They had reviewed appraisal arrangements and developed a schedule of annual appraisals for 2019.
• They had completed two, one cycle, audits to monitor the quality of care provided but a plan for continued clinical audit was not in place.

At the April 2019 inspection we also discussed data we had reviewed which showed the practice was below local and England averages.

For example:

National GP survey data, January to March 2018.

We noted patient satisfaction with telephone access was significantly below average at 30% compared to the England average of 70%. The practice told us in response to the data they had changed the telephone system in December 2018 to enable them to monitor incoming calls and response times. The system also provided a queuing system for patients and additional staff to answer the phones had been provided at busy times. The practice was in the process of surveying patients to check the effectiveness of the changes made. We have asked them to share the results with CQC. We also spoke to four patients about access. Two people told us they had noticed improvements in the past few months and one thought there had been no improvement.

Quality outcome framework (QOF) data. (QOF is a system intended to improve the quality of general practice and reward good practice.)

We noted data for 2017/18 for the percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months was 76% which was below the clinical commissioning group (CCG) and England averages of 89%. We saw this was slightly improved from the 2016/17 data of 74%. At the last inspection in May 2018 the practice had put measures in place to try to further improve the outcomes for patients in this area including birth month recalls for reviews and dedicated administration staff to monitor attendance for review. At this inspection the practice provided unverified data for 2018/19 which showed more significant improvements had been achieved.

We noted significant improvements in 2017/18 QOF data for the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months which was 91% compared to 2016/17 achievement of 50%. Unverified data for 2018/19 showed continued improvement in this area.

The areas where the provider should make improvements are:

• Consider development of a schedule of clinical audit to improve the monitoring of the quality of the care provided.

• Review effectiveness of improvements relating to telephone access for patients.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Good overall. (Previous inspection March 2016 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive at Handsworth Medical Practice on 1 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice did not have clear systems to manage risk as risk assessments had not been completed for health and safety matters other than fire safety. The practice had recognised this shortfall and was in the process of completing these.

• When incidents related to safety did happen, the practice learned from them and improved their processes.

• There was little evidence that the practice had reviewed the effectiveness and appropriateness of the care it provided and activity in this area was not planned.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The majority of patients found the appointment system easy to use and most patients reported that they were able to access care when they needed it.

• Learning and improvement was encouraged at all levels of the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

• Display the CQC rating on the practice website in a prominent positon.

• Review and increase the frequency of checks of the emergency equipment to meet the Resuscitation Council guidance.

• Review and improve the protocol to support the management of incoming post and criteria for sharing information with clinicians.

• Review and improve appraisal arrangements for clinical staff so all staff receive an annual appraisal.

• Review and improve the monitoring of the quality of the care provided.

• Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Handsworth Medical Practice and the branch site at Fitzalan Road on 3 March 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed with the exception of the temperature recording of the medical fridges.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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. However, patients told us they found it difficult to make an appointment with a GP.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The registered provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice had linked with local schools and a local organisation for young carer’s to actively encourage young carer’s to come forward and register this on their medical record. This would alert practice staff to try to be flexible when booking appointments and signposting to appropriate support services could be offered as well as an invitation to an annual health check at the practice.

The areas where the provider should make improvements are:

• The practice should follow its own policy and recommended Public Health England guidelines regarding monitoring and recording of medical fridge temperatures.

• The practice should make secure the clinical waste storage containers at the branch site.

• The practice should review its appointment system to ensure patients can make an appointment with a GP in a timely manner.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice