This practice is rated as Requires improvement overall. (Previous rating 11 January 2017 – Good)

The key questions at this inspection are rated as:

Are services safe? – Requires Improvement

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

We previously carried out an announced comprehensive inspection at The Acocks Green Medical Centre on 11 January 2017 as part of our inspection programme. We carried out an unannounced focused inspection on 31 May 2018 in response to concerns received. The full comprehensive report on the 11 January 2017 inspection and the unannounced focused report on the 31 May 2018 inspection can be found by selecting the ‘all reports’ link for The Acocks Green Medical Centre on our website at .

At this inspection we found:

• There were areas where risk was not being assessed or managed effectively. For example, health and safety risk assessment did not identify all risks, the fire risk assessment had not been reviewed since June 2016 and risk assessments to cover the full range of substance hazardous to health had not been carried out.
• Clinical waste was not appropriately labelled in a way which enabled the waste to be classified correctly so that it was managed appropriately upon collection.
• In the absence of some suggested emergency medicines the practice did not carry out a risk assessment to mitigate risks.
• The practice did not operate an effective staff immunisation programme and were unable to demonstrate how they mitigated risks to staff who had direct contact with clinical specimens’.
• The practice had clear systems to manage safety incidents so that they were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines. Staff were aware of the practice Quality Outcome Framework results and were taking action to improve areas where performance was below local and national averages.
• National GP patient survey results showed that patients felt involved in their care and treatment, staff were caring and patients felt listened to. Survey results showed that patients were treated with compassion, kindness, dignity and respect.
• Completed Care Quality Commission comment cards showed that patients did not always find the appointment system easy to use and reported that they were not always able to access care when they needed it. National survey results were below local and national average regarding access. Staff were aware of this and took action to improve patient access.
• There was a focus on continuous learning and improvement.
• The practice demonstrated a clear understanding of the practice population group and created referral pathways to community support groups. For example, the practice was a Armed Forces Veteran friendly accredited practice. Veterans were identified and signposted to services which offered them as well as their families support.
• The leadership, governance and culture were used to drive and improve the delivery of its service. All staff were involved in the development of the practice. However, we found some gaps in the practice governance arrangements. For example, there was no written protocol for Patient Specific Directives, there was a lack of effective monitoring systems in place for the safety of the service, some risks had not been mitigated and some protocols had not been reviewed.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Take action to increase the number of health checks carried out for patients on the practice learning disability register.
• Continue taking action to improve the uptake of national screening programmes.
• Take action to ensure privacy and dignity is maintained at all times.
• Continue taking action to improve patient satisfaction.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

We carried out an unannounced focused inspection on 31 May 2018 in response to information regarding the lack of GP appointments and clinical cover. On the day of our inspection, the principal GP was on leave; a locum GP was covering the morning clinic and the practice closed during the afternoon for staff training. The practice is a three GP partnership, at the time of our inspection, staff explained one partner had physical day to day presence at the practice. During this inspection, CQC only reviewed areas where concerns had been reported.

A full comprehensive inspection of The Acocks Green Medical Centre was undertaken on 11 January 2017. The full report is available on CQC website.

At this inspection we found:

• National GP survey results published July 2017 showed that patients found the appointment system easy to use; however, satisfaction regarding timely access to care were below local and national averages.
• Staff were aware of low patient satisfaction in areas such as appointment access and were taking action to improve patient satisfaction.
• Although, the practice had arrangements with Birmingham and District General Practitioner Emergency Rooms (BADGER) medical services to enable access to medical care during Wednesdays and Thursday afternoons; the practice website and leaflet did not provide clarity regarding the availability of GP appointments at the practice during Thursday afternoon.
• Staff we spoke with were clear regarding their responsibilities, roles and systems of accountability to support governance and management within the practice. For example, complaints and concerns were managed and responded too in a timely manner.

The areas where the provider should make improvements are:

• Continue to carry out actions to improve patient satisfaction in areas where survey results were below local and national areas.
• Continue exploring ways to increase clinical capacity through appropriate recruitment and monitoring of staffing levels.
• During the implementation of the new file sharing platform, ensure staff have access to practice documents such as records of complaints and minutes from practice meetings.
• Ensure practice leaflets and details on the practice website provide clarity on GP appointment times.

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 The Acocks Green Medical Centre on 4 May 2016. Following that inspection the overall rating for the practice was requires improvement. The full comprehensive report for the May 2016 inspection can be found by selecting the ‘all reports’ link for The Acocks Green Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken to follow up progress made by the practice since the inspection on 4 May 2016. It was an announced comprehensive inspection on 11 January 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had been proactive in responding to the findings of the previous CQC inspection to improve the service delivered. We found significant improvements had been made since the inspection in May 2016.
• 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.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patient outcomes were mostly in line with CCG and national averages with the exception of diabetes and cervical screening.
• 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 able to obtain appointments when needed with urgent appointments available the same day. The appointment system had been reviewed leading to an increase in available appointments.
• 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 provider was aware of and complied with the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Continue to improve the uptake of cervical screening and identify how uptake of national screening programmes for breast and bowel cancer may be improved.
• Review systems to improve outcomes for patients with diabetes.
• Review registration with CQC to ensure it is current and correct.

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 The Acocks Green Medical Practice on 4 May 2016. Overall the practice is rated requires improvement.

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. There was an effective system in place for reporting and recording significant events.
• Some risks to patients had been assessed and were well managed however, this did not include those relating to staffing, recruitment checks and prescription safety.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Systems to ensure staff had the skills, knowledge and experience to deliver effective care and treatment were not sufficiently robust.
• 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.
• Most patients said they were able to make an appointment with urgent appointments available the same day. However, some patients told us they found it difficult to make appointments by telephone and there was a long wait for the next available routine appointment with a GP.
• The practice was accessible and well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from patients and had acted on this but meetings were infrequent.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure that the recruitment process includes all necessary pre-employment checks for staff.
• Establish systems to ensure staff receive appropriate support, supervision and training relevant to their roles and responsibilities.
• Ensure robust management of risks in relation to staffing, prescription handling and business continuity in the event of disruption to the service.

The areas where the provider should make improvement are:

• Review processes to try and encourage greater uptake of cervical screening for relevant patients.
• Ensure patients are aware that there is an alternative entrance for patients who use a wheelchair.
• Develop systems for recording verbal and informal complaints in order to identify themes and trends and to support learning.
• Ensure carers at the practice can be easily identified so that they can be appropriately supported and their needs accommodated and identify processes to support those who are recently bereaved.
• The practice should review access to appointments and identify how this may be improved.
• Review processes for scanning patient information so that it is available on the patient record in a timely manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice