Letter from the Chief Inspector of General Practice

We previously inspected Lozells Medical Practice on 2 August 2016. As a result of our inspection visit the practice was rated as requires improvement overall, with requires improvement ratings for providing safe, responsive and well-led services. The practice was rated as good for providing effective and caring services. This was because we identified a regulatory breach under Regulation 12: Safe care and treatment. As a result, we identified areas where the provider must make improvement with regards to monitoring of prescribing and effectively managing risk in relation to emergency medicines. In addition, we identified some areas where the provider should make improvements such as improving patient satisfaction in relation to appointment access.

We carried out a focussed follow up inspection of Lozells Medical Practice on 16 November 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lozells Medical Practice on our website at www.cqc.org.uk.

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

• During our inspection we noted improved governance which complimented safe systems and processes, as well as effective risk management. We observed improved processes for managing safety alerts and with regards to the management of medicines.

• Prescribing was well monitored and there was an effective recall system in place for patients needing medicines reviews and we noted that this had been strengthened since our previous inspection in August 2016.

• The practices emergency medicines had been updated since our previous inspection in August 2016. The emergency medicines stock consisted of medicines recommended for general practice and the services they delivered.

• Members of the management team explained that access had been a key focus for improvement at the practice overall. To improve access the practice changed their opening times and in addition, was able to offer patient’s access to services up to 12 hours a day Monday to Saturday, through the My Healthcare HUB model as the practice was part of this federation.

• The practice recognised that patients were experiencing difficulties in accessing appointment by telephone and decided to change telephone provider for a better organised telephony system. A second telephone line had also been installed so that housebound patients and patients with complex needs could access the service through two direct access lines.

• We saw that the practices had carried out a satisfaction survey which demonstrated improvements to access over time. All survey respondents rated the practices opening hours as good, very good or excellent. In addition all respondents indicated that they were happy with telephone access. Results from the NHS Friends and Family Test (FFT) also highlighted improved satisfaction rates over time.

• The practice had focussed on identifying more carers in order to offer them support, the carers register had increased from 0.4% to 2% since our last inspection. The practice offered health reviews and flu vaccinations for anyone who was a carer. The practice displayed a range of supportive information for carers and there was information in place for carers to take away, we saw that carers were signposted to carer support services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lozells Medical Practice also known as Finch Road Primary Care Centre on 2 August 2016. Overall the practice is rated as requires improvement.

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. We saw evidence of annual meetings to review trends and where learning had been shared.
• Most risks to patients were assessed and well managed. However, some emergency medicines were not stocked in the practice, and the risk assessment provided by the practice did not demonstrate mitigating actions. 
• The practice received patient safety alerts and there was evidence that they were cascaded. However, there was no system to monitor that appropriate action had been taken.
• Not all patients had received a regular review of their medication.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients were positive about the levels of care received and staff delivering the care. However, some patients also said that they struggled to get through on the phone or get an appointment at times. The practice had implemented changes but was unable to demonstrate improvement.
• The practice was located in purpose built premises, 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 provider was aware of and complied with the requirements of the duty of candour.

• The practice had available an information leaflet with details of the services patients could access. However, this needed to be updated as some information was not current.

The areas where the provider must make improvement are:

• A risk assessment must be carried out which clearly identifies mitigating actions why some emergency medicines are not being stocked in the practice. The practice must review the system in place for the monitoring of some prescribed medicines to ensure it is effective and follows published guidance.

The areas where the provider should make improvement are:

• Review the system for monitoring that appropriate action had been taken in response to all relevant patient safety alerts.
• Continue to review and improve patient access to the services in regards to appointments and getting through on the phone.

• Systems or processes should be reviewed to ensure patients who are carers are identified so they can be offered appropriate support.

• The practice leaflet should be updated to contain the most current information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice