We carried out an announced comprehensive inspection of Midlands Medical Partnership -Birmingham North East (MMP) (also referred to as Erdington Medical Centre in this report) on 8 November 2018 and its 10 branches during the months of November and December 2018 as part of our primary care at scale inspection testing programme.

The practice was previously inspected in October 2016 and was rated Outstanding overall, with Outstanding ratings in Effective and Well-led and Good ratings in Safe, Caring and Responsive.

During our inspection in November and December 2018 we inspected Erdington Medical Centre and the ten associated branches, including any centralised functions.

The branches included in the inspection were:

• All Saints Medical Centre, 2a Vicarage Road, Kings Heath, Birmingham, B14 7RA
• Broadmeadow Health Centre, Keynell Covert, Kings Norton , Birmingham, B30 3QT
• Dudley Park Medical Centre, 28 Dudley Park Road, Acocks Green, Birmingham, B27 6QR
• Eaton Wood Medical Centre, 1128 Tyburn Road, Erdington, Birmingham, B24 0SY
• High Street Surgery, 26 High Street, Erdington, Birmingham, B23 6RN
• Jockey Road Medical Centre, 519 Jockey Rd, Sutton Coldfield B73 5DF
• Kingsmount Medical Centre, 444 Kingstanding Rd, Birmingham B44 9SA
• Mere Green Surgery, 2nd Floor Carlton House, Mere Green Road, Sutton Coldfield, B75 5BS
• Old Priory Medical Centre, The Old Priory Surgery, 319 Vicarage Rd, Birmingham, B14 7NN
• Stratford House Surgery, Stratford House Surgery, 578 Stratford Road, Sparkhill , Birmingham, B11 4AN

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.

We have rated this practice as Good overall and Good for all population groups.

We rated the practice as requires improvement for providing safe services because:

• Not all systems and policies the provider had implemented to keep patients and staff safe and protected from harm were effective or well embedded at all branches.

We rated the practice as good for providing effective, caring, responsive and well-led services because:

• MMP had developed an effective system to monitor performance at Erdington Medical Centre and the ten associated branches.
• We saw evidence of improved outcomes for patients following audits.
• The practice had developed specific resources for carers including a carers pack. The practice had held a carers event and patients and carers had access to dementia drop in sessions run by the Alzheimer’s Society held at one of the branches each month.
• Each branch was aware of its local populations needs and organised and delivered services to meet those needs.
• The provider had implemented extended access on evening and weekends at two hub sites. Initial feedback we viewed from patients and staff was positive about the new service.
• The provider was taking action to improve telephone access and appointment availability.
• The provider was involved in leading on projects to help improve the health of patients accessing services in the Birmingham and Solihull Clinical Commissioning Group (BSOL CCG).

We saw areas of outstanding practice including:

• MMP had developed its own clinical templates. These were based on best practice and ensured all clinical staff were using the latest guidelines and ensured the best outcomes for patients. This included patients with long term conditions.
• The provider had identified their screening rates for bowel screening were low, and worked with Cancer Research UK to combine bowel cancer screening with the flu vaccination program. Data from the provider showed they had increased screening at the time of our inspection.
• The provider used a central target team (CTT) to manage performance and coordinate patient care. The team worked closely with each branch to identify areas they needed to improve on. We saw that this had resulted in additional clinics, mobilisation of staff and walk in appointments for screening accessible to all patients across the organisation. We saw significant improvements in the numbers of patients attending for childhood immunisations and cervical screening and an increased uptake on long term condition reviews.

The areas where the provider should make improvements are:

• The provider should continue to monitor and improve its system for identifying carers, including young carers to further advise and support and to be responsive to individual needs.
• The provider should consider a formal program of clinical supervision for all nursing staff.
• The provider should continue gaining feedback from patients and staff to ensure a consistent experience across all branches and continue to ensure opening and appointment times across all branches including extended access are clear and accessible to patients.
• The provider should continue to review processes for assessing, mitigating and monitoring risk.

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

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 Midlands Medical Practice (MMP) – Birmingham North East, Erdington Medical Centre on 18 and 19 October 2016. Erdington Medical Centre is located in Erdington, Birmingham.It has four branch surgeries at Jockey Road Medical Centre,Eaton Wood Medical Centre, Kingsmount Medical Centre and High Street Surgery.

Erdington Medical Centre is one of four registered providers within the Midlands Medical Partnership (MMP) group of practices. The four registered providers include four locations with an additional six branches.The other registered providers in the group are: Dudley Park Medical Centre, serving Birmingham South east surgeries; Mere Green Surgery serving Sutton Coldfield and Old Priory Surgery in Kingsheath, covering Birmingham south with two branch surgeries. All four registered locations were visited by the inspection team including all six branches.All of the practices share one practice list and have a central management team with shared policies, procedures and governance arrangements. We have produced four reports to reflect the four provider/location registrations; however due to the structure of the practice much of the detail included in the reports will be replicated.

Overall the practice is rated as outstanding.

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

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). In response to patient feedback a central telephone hub was created with support from the PPG. This had improved telephone access to all 11 MMP practices with call abandonment rates reduced by up to 90% and demonstrated improved patient satisfaction. Feedback from patients about their care was consistently positive.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The organisation actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

These are the outstanding features:

• Staff had been trained to identify and support patients at risk of domestic violence. Over a six month period referral rates to services providing specialist support increased six-fold and staff told us patients said they felt supported and listened to.
• An event in August 2016 for all of the practice staff focussed on reporting of significant events. As a result all practice staff were aware of their responsibility in responding to risks. They were discussed weekly at practice meetings and there was a strong emphasis on learning. The events were analysed, actions agreed and learning points shared.
• There was evidence of quality improvement including clinical audits. There had been 25 clinical audits undertaken in the last two years across MMP with the learning shared across all practices. These were completed audits where the improvements made were implemented and monitored. Findings were used by the practice to improve services.
• Staff offered kind and compassionate care. For example a dementia drop in service had been established in conjunction with the Alzheimer’s Society which ran monthly. Patients and their carers were free to drop in without appointment to access support and advice.
• MMP’s ethos was “Taking Care” which was applied at all levels to both patients and staff. The management group had set objectives to achieve consistently exceptional care, to demonstrate leadership in service redesign and promote patient engagement and empowerment.
• A comprehensive understanding of the performance of the practice was maintained through the elected management board. Performance was managed centrally and managers could examine achievement and compliance at each location and cross-organisationally. We saw individual practice dashboards which were discussed with staff to motivate them to seek further improvement.
• Staff said they felt respected, valued and supported. For example,an employee of the month scheme motivated staff to perform well and all members of staff could identify opportunities to improve the service delivered through the staff forum.

The provider should:

• Continue to identify and support carers in order to be responsive to individual needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice