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MEADOWSIDE FAMILY HEALTH CENTRE

QUALITY ACCOUNTS 2010/2011

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MEADOWSIDE FAMILY HEALTH CENTRE QUALITY ACCOUNT

1. Who We Are - An Introduction to Meadowside Family Health Centre Page 3

2. Our Mission Statement Page 4

3. Senior Management Team Statement Page 5 Statement from Patient Participation Group

4. Priorities for Improvement Page 6

5. Statements of Assurance Page 9

6. The services we deliver Page 11

7. Statement from Solihull Primary Care Trust Page 18

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WHO WE ARE – An Introduction to Meadowside Family Health Centre Meadowside Family Health Centre is a six partner general Practice working under a PMS contract with Solihull Care Trust. The Practice list size is circa 8350. The team is made up of: G P Partners 6 Dr Martin Powis

Dr John Wilkinson Dr Carolyne Smith Dr Sheila Vanhouse Dr Liz Edwards Dr Mike Baker

Salaried GP 1 Dr Liz Neethling Registrar 1 Dr Ahmad Anwar Practice Nurses 3 Sr Jan Maclaurin

Sr Julie Chatwin Sr

Healthcare assistants 2 Mrs Jan Donovan Mrs Amanda O’Hara

Practice Manager 1 Mrs Vicki Baker Secretaries 2 Reception/Administrative staff 10 Patient Participation Group Chairman

8 Chair: Mr Jim Harris

Meadowside FHC is a training practice, and actively supports the education of medical students from Birmingham University Medical School and Warwick Medical School, as well as the continued training of qualified doctors as GP Registrars from the Birmingham Deanery. The Practice is housed in extended purpose-built accommodation encompassing 7 GP consulting rooms, 2 nurse treatment rooms, an isolation room, staff offices, a multi-purpose meeting room, and staff kitchen/rest room. There is a spacious waiting room for patients with Amscreen TV and electronic check-in desk. There is a lower height reception area for disabled access and a hearing loop is available. Notice boards are changed frequently to ensure content is up to date and appropriate. A car park is available for patients and staff.

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MEADOWSIDE FAMILY HEALTH CENTRE

MISSION STATEMENT

To be proactive in promoting health and well-being for patients of all ages and to provide high quality medical care with a holistic approach, by working together with other

agencies for the benefit of patients, whilst providing a safe and friendly working environment for staff.

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SENIOR PARTNER STATEMENT The Health Act 2009 puts a duty on all providers of NHS services to produce annual Quality Accounts to the public. For general Practice this will be a legal requirement from April 2012. The Meadowside Family Health Centre agreed to anticipate this with this first draft of Quality Accounts covering the 2010/11 year in review and planning head for 2011/12. The accounts focus on three areas:

• Patient Safety • Clinical effectiveness • Patient experience

The aim of the report is to look back at the services delivered during the previous 12 months, to identify areas for development focus, and to plan what the practice aims to achieve in the forthcoming 12 month period. It is our aim that this report provides the following:

• An overview of who we are and what we do • Assurance of the validity of the report covering 2010 – 2011 by the Senior management

Team • Recognition of areas for development in the forthcoming 12 months with appropriate plans • A review of services delivered in the preceding 12 months and the quality of that delivery

supported where possible with details of the measurement of quality This report has been produced after consultation with the Practice’s Patient Participation Group and after discussion with the Partners and Practice Team. I am confident that the data and information found in this report is an accurate representation of the services delivered by the Practice. We have endeavoured to make the report simple, relevant and accessible to all. Dr Martin D Powis Statement of Approval fro Patient Participation Group I have read in detail your proposed Quality Accounts and can only say that in my opinion it is a superbly written and detailed document. It is clearly laid out without any ambiguous or misleading statements and I feel that it is an excellent statement of facts for our Practice and I must compliment you for this proposed submission. On a personal note the PPG thanks you for our inclusion in this report. Jim Harris Chair of Meadowside PPG

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Part 2 – Priorities for Improvement and Statements of Assurance Priorities for Improvement Having completed the review of services and consultation with the Partners, staff and PPG, the following areas for development have been identified: Priority for Improvement 1

Domain: Patient Experience Clinical Effectiveness

Improve two-way communication with patients by

• Improving patient access to information • Facilitating easy and accessible methods for patients to provide feedback on current and

future services Action to be taken To explore the acquisition of a Touch Screen Patient Information service to provide:

• Information re services offered • Patient information re specific clinical areas • Signposting for appropriate alternative/additional services • Information re clinical governance i.e. how data is used, consent issues, access to

medical records Also to incorporate surveys/questionnaires to enable:

• Patient feedback on current services to ensure clinical effectiveness and inform development

• To seek patient opinion on the development of effective new services Monitoring – how and by whom

How will it be measured Reporting

Installation of Touch Screen VB Monitoring usage figures VB

Number of uses / completion of surveys

Quarterly review of activity and feedback received to be presented to Partners meeting and PPG

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Priority for Improvement 2

Domain: Patient Experience Clinical Effectiveness

Improve patient access to GP by telephone consultation Action to be taken To increase the number of telephone consultations undertaken by:

• Promoting the availability of telephone consultations via website and through reception team

• Enabling telephone consultations to be booked online

Monitoring – how and by whom

How will it be measured Reporting

Quarterly review of number of telephone consultations undertaken. VB

Increase in telephone consultations undertaken

Final review against baseline 2010/2011 figures to be undertaken at year end

Priority for Improvement 3

Patient Safety

Medication reviews to be regularly undertaken and recorded. Action to be taken

• All clinicians to ensure a medication review is undertaken and recorded in a timely manner – alerts will be available on the patient home page and are to be actioned.

• Repeat the audit of hospital discharge letters to ensure continuity of medication is appropriate

• To record in the patient record when a clinician decides it is not appropriate to prescribe a drug detailed on a hospital letter.

• To review medication in dementia patients to ensure appropriate prescribing of atypical antipsychotics.

Monitoring – how and by whom

How will it be measured Reporting

Medication reviews to be undertaken annually. Recall system to be utilised to facilitate monitoring by VB/admin

Outstanding review dates to be searched quarterly and actioned

PM to report to Partners, numbers undertaken and numbers outstanding

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Priority for Improvement 4

Clinical effectiveness Patient Safety

Improve services for patients with chronic lung disease Action to be taken

• To continue to support the nurse in training to complete her diploma qualification • To undertake a re-audit to quantify the progress made through our work with

POINTS/Quintiles • To plan a rolling programme for the forthcoming year to ensure all patients are reviewed

appropriately • To recruit an additional nurse with some experience and /or willing to train. • To establish specialised clinic sessions to deliver an improved services

Monitoring – how and by whom

How will it be measured Reporting

Regular monthly lists of patients to be reviewed to be monitored by VB/PP Monitoring through QOF reports VB

No of reviews undertaken and number of outstanding recalls. QOF reports

QOF outturn improvement Patient satisfaction survey Spring 2012

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Statements of Assurance Review of services During the period 1/4/10 to 31/3/11Meadowside FHC provided a NHS Services under a PMS contract Meadowside FHC has reviewed all the data available to them on the quality of care in this service. The income generated by the NHS services reviewed in 1/4/2010 to 31/3/2011 represents 100% of the total income generated from the provision of NHS Services by Meadowside FHC for the period 1/4/10 to 31/3/11 Participation in clinical audits During 2010/2011 Meadowside FHC did not take part in any clinical audits or confidential enquiries The reports of 11 local clinical audits were reviewed by the provider in 2010/2011 and Meadowside FHC intends to take the following actions to improve the quality of healthcare provided: MFHC has acted on the information gained by updating patient records and/or changing medication to increase clinical effectiveness/cost-effectiveness as appropriate. Participation in clinical research The number of patients receiving NHS services provided or sub-contracted by Meadwside FHC in 2010/2011 that were recruited during that period to participate in research approved by a research ethics committee 0. Goals agreed with commissioners Use of the CQUIN payment framework Meadowside FHC income in 2010/2011 was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework because Meadowside FHC does not use any of the NHS National Standard Contracts and is therefore not eligible to negotiate a CQUIN Scheme. What others say about the provider Statements from the CQC Meadowside FHC is not required to be register with the Care Quality Commission until April 2012. An application is in progress of development for that time. Data Quality Meadowside FHC will be taking the following actions to improve data quality:

• Data quality audits – using the E-audit tools available through PRIMIS/CHART NHS Number and General Medical Practice Code Validity Meadowside FHC did not submit records during 2010/2011 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

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Information Governance Toolkit attainment levels Meadowside FHC Information Governance Assessment Report score overall score for 2010/2011 was 89% and was graded Satisfactory. Clinical coding error rate Meadowside FHC was not subject to the Payment by Results clinical coding audit during 2010/2011 by the Audit Commission.

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PART 3

THE SERVICES WE DELIVER

Patient Experience of Services APPOINTMENT AVAILABILITY The Practice has provided extended opening hours on Monday evenings 6.30pm to 8pm and Saturday mornings from 8.30am to 10am. In order to try and meet demand, a proportion of GP appointments are available for booking up to 2 weeks in advance, a further proportion are available from 2 days in advance and a final quantity kept for on the day booking. These proportions are established by undertaking periodic audits of incoming telephone calls. Appointments offered in 2010/2011 Clinician Appointments

provided Did not attend Did not attend rate

Doctor

30249

1255

4.14%

Nurse/HCA

15891

1352

8.5%

Home visits - Doctor

2301

Home visits – Nurse/HCA

330

Telephone consultations

888 (1.92%)

Total face to face consultations were 48441 giving a consultation ratio of 5.8 (National ratio 5.3) What patients thought of the Practice appointment provision – taken from the 2010/2011patient survey results: Question

% response good

and above

% response fair

and above Satisfaction with availability of particular doctor 52 82 Satisfaction with availability of any doctor 69 92.5 Satisfaction with availability of a nurse 67.5 90 Satisfaction with phoning through to the practice 61 85 Satisfaction with phoning through to the doctor for advice 48 68 Satisfaction with phoning through to the nurse for advice 51 82 Summary of patient experience on contacting the surgery for an appointment taken from the audit conducted February 2011

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Telephone Audits Telephone audits are undertaken periodically to establish if the apportionment of appointment embargoes are in line with patient demand. The results of the most recent audit undertaken in February 2011 are below: Appt booked in time requested

Telephone consultation booked

Asked to phone back

Secured satisfactory alternative option

Unresolved calls

Total calls

398 7 85 29 0 520 77% 2% 16% 6% 0%

Requested Specified Doctor

Booked with specified Doctor

173 147 85% COMMUNITY EVENTS The Practice has undertaken several community events. In July 2010, working with another local practice, an event was held at the nearby Solihull Ice Rink with the main aim of raising awareness amongst the younger population of the Sexual Health Services available. Many other local organisations were invited and took part such as the Smoking Cessation Service, local Police regarding security, Healthy Eating, Chlamydia Screening service, Alcohol and Drug services. PPG INVOLVEMENT (Practice Participation Group) Meetings are held every other month at the practice in the evening in order that working patients can also be involved. The PPG are also active at various times of year within the practice, supporting seasonal flu vaccination clinics, assisting in promoting the patient survey and also with hands on help at community events. COMPLAINTS RETURN During the year under review, the practice has received 4 complaints which have been responded to and reviewed. Two related to the booking of appointments, 1 related to communication/attitude and 1 related to administration. All were resolved with the patients concerned. RECALL PROGRAMMES Patients are routinely called for the following:

• Diabetic reviews • Asthma reviews • COPD reviews / spirometry • Blood pressure reviews • Repeat blood glucose tolerance tests • Mental health reviews • Epilepsy reviews • Reviews for patients in residential nursing homes

ONLINE SERVICES Patients have access to online appointment booking, prescription ordering and submission of general queries. The % of patients registered for this service is currently 22% The % of appointments booked online for 2010/2011 was 5.82% 3558 prescription requests were received online in 2010/2011 58 patient enquiries were made online in 2010/2011

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GENERAL PRACTICE SERVICES Alongside daily general surgery session, the following services are routinely offered:

• Anti coagulation – clinics are held on Wednesday mornings and Friday afternoons, and if required, home visits are made to housebound patients. Patient survey undertaken in February in 2011 shows a 98% satisfaction with the clinic and 100% happy to attend at the surgery rather than the hospital for this service.

• Diabetic reviews – clinics are held on Monday afternoons and Wednesday mornings. Patients are routinely recalled twice-yearly for diabetic review

• Blood clinics – these are held on Tuesday, Wednesday and Thursday from 11.30am – 12.30pm on a drop-in basis, for the convenience of patients rather than attending the clinics in central Solihull

• Flu clinics – are held in the autumn on Saturday mornings and some late evenings in addition to normal surgery hours to minimise the impact on appointment availability

• Nursing services- include ECG, wound care/dressings, child immunisations, travel health (risk assessment and vaccination), ear irrigation, blood pressure checks, weight management, smoking cessation, asthma reviews and COPD/Spirometry reviews

• Minor operations – Clinics are held weekly on Monday mornings for procedures such as excisions/biopsies/cryotherapy

• Sexual health services – Safe & Well Clinic every Wednesday afternoon from 4pm for all ages incorporates STI screening, general sexual health advice, pre-pregnancy counselling, cytology

• Contraception services – Every Wednesday from 4pm alongside the Safe & Well Clinic. All contraceptive methods discussed. Guidance and further appointments offered for IUCD and Nexplanon fitting.

• National screening programmes – The Practice partakes in the National Screening programmes for cytology, mammogram, Chlamydia screening

• Mental health – Access to CBT/counselling services. The Practice hosts members of the IAPT service to provide a local service to our patients and those of other local practices. This increases the opportunity of appointment times by utilising various venues.

• Learning disabilities – annual reviews are held for all patients with a registered learning disability. The Practice Manager meets with a representative of the Learning Disabilities at least twice a year to review the list and ensure any movement is appropriately responded to.

• NHS Health checks are undertaken for all those aged between 40 and 74. Invitations are issued in accordance with the risk stratification undertaken. Patients are also advised that they can self refer to this service if they are in the appropriate age group.

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Patient Safety & Clinical effectiveness of services QOF Clinical Achievement As at 31.3.11 The chart below shows the Practice achievement in QOF clinical areas for 2010/2011:

Item Points Clinical 685.0 / 694 Asthma 45 / 45 Atrial Fibrillation 27 / 27 COPD 25.6 / 30 Cancer 11 / 11 Cardiovascular Disease Primary Prevention 12.3 / 13 Chronic Kidney Disease 36.7 / 38 Coronary Heart Disease 86.4 / 87 Dementia 20 / 20 Depression 52.1 / 53 Diabetes 99.4 / 100 Epilepsy 15 / 15 Heart Failure 29 / 29 Hypertension 81 / 81 Hypothyroidism 7 / 7 Learning Disabilities 4 / 4 Mental Health 38.7 / 39 Obesity 8 / 8 Palliative care 3 / 3 Smoking 60 / 60 Stroke And Transient Ischaemic Attacks (TIA) 23.8 / 24 Organisational 92.5 / 94 Medicines (not submitted) 15 / 15 Records 77.5 / 79 Patient survey results The patient survey gives an indication of the perceived clinical effectiveness of consultations as shown below: Question

% response good

and above

% response fair

and above Satisfaction with continuity of care 68 94 Satisfaction with Doctor’s questioning 96 99 Satisfaction with nurse’s questioning 95 98 Satisfaction with how well doctor listens 96 99 Satisfaction with how well nurse listens 97 99 Satisfaction with how well doctor puts patient at ease 95 99 Satisfaction with how well nurse puts patient at ease 98 99 Satisfaction with how much doctor involves patient 94 99 Satisfaction with how much nurse involves patient 95.5 99 Satisfaction with doctor’s explanations 93 99 Satisfaction with nurse’s explanations 98 99 Satisfaction with time doctor spends 92 99 Satisfaction with time nurse spends 96 99 Satisfaction with doctor’s patience 95 99

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Satisfaction with nurse’s patience 98 99 Satisfaction with doctor’s caring and concern 96 99 Satisfaction with nurse’s caring and concern 97.5 99 After seeing the doctor today do you feel more able to understand your problem/illness?

Yes

85

After seeing the doctor today do you feel more able to cope with your problem?

Yes

83

After seeing the doctor today do you feel more able to keep healthy?

Yes

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Anticoagulation Clinics The practice takes part in quarterly NEQAS surveys to ensure accuracy of readings and the latest result from February 2011 survey is shown.

The practice also reviews data reported from INR software, a summary of which is below: Number of patients / tests 1/4/10 to 31/3/11 was 154 patients and 1756 test Variance report 1/4/10 to 31/3/11

Within 0.5 Within 0.75 INR above 5 INR above 8 >1 INR unit below Target

Number 1196 1422 13 0 71

Percentage 68% 81% 1% 0% 4%

Adverse events report 1/4/10 to 31/3/11 There were 7 minor adverse events recorded. All made a full recovery with observation only and did not involve admission Cardio Vascular Disease Checks (NHS Health checks) Since the launch of this service in November 2010 the Practice has undertaken 104 reviews. Of those 20 patients were referred on for Lifestyle interventions and 21 were started on specific treatments. This is therefore proving to be a clinically effective service. Infection control audit The annual Infection Control Audit was undertaken in February by Solihull Care Trust Infection Control team and the Practice received a 96% compliance rating. An action plan has been developed to address areas that did not reach 100% compliance, although some of these are beyond immediate control or have been deemed acceptable risk i.e. carpets in GP consulting rooms.

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Minor Operations The following figures show a breakdown of the minor surgical procedures carried out during the last 12 months. The incidence of wound infection was zero.

Report Results: Minor Surgery Audit Procedure Patient

Count Item Count

Percentage of the total

Injection of carpal tunnel 12 17 4.0 % Minor surgery done -aspiration 2 2 0.7 % Minor surgery done - incision 1 1 0.3 % Minor surgery done - excision 142 153 46.9 % Minor surgery done - injection 154 221 50.8 % Golfer's elbow injection 4 4 1.3 % Tennis elbow injection 12 16 4.0 % Injection of knee joint 78 106 25.7 % Injection for plantar fasciitis 7 7 2.3 % Injection for tenosynovitis of finger 6 8 2.0 % LARCS (Long acting reversible contraceptive services) During the preceeding 12 month period the following fitting/removal of LARCS have been undertaken.

A survey of patients who had received an Implanon was undertaken to test the quality of the service delivered. The return was 24%. Results are shown below: Have you had an implant fitted?

100% yes

Where was the implant fitted? Surgery 82% Family Planning Clinic 18%

Do you feel all options were discussed before fitting?

82% yes

How did you find the fitting? V painful 0% Painful 0% Uncomfortable 36% Not painful 64%

Do you still have an implant fitted?

Yes 82% No 18%

Would you recommend this method?

Yes 91% No 9%

Has your cycle settled down after the fitting?

Yes 64% No 36%

Overall how satisfied are you with this method?

Very satisfied 45% Satisfied 45% Not very satisfied 0% Dissatisfied 9%

Chronic Obstructive Pulmonary Disease With a change of nursing staff the Practice was left without a qualified COPD nurse and was aware that this would put a real strain on the service we deliver to patients. To minimise the impact of this, the Practice worked with an organisation called POINTS through GSK who have undertaken an audit and risk stratification and have worked with the nurse currently undergoing the diploma course to maximise the reviews undertaken and the learning achieved.

Name Count Implanon fitting 45 Implanon removal 18 IUCD Fitting 44 IUCD removal 28

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The Practice will continue to support the nurse in completing her diploma and are looking to recruit a further experienced nurse. This is an area for continued development for the forthcoming year. Prescribing audits The Practice has undertaken several prescribing audits with the help of the Practice Prescribing Support Pharmacist and these have resulted in ensuring ongoing effective and appropriate clinical prescribing. The practice has also been able to make several switches to more cost-effective drugs and a leaflet was produced to inform patients why this work is undertaken and explain the difference between branded and generic drugs (“Why change my medicine? Are generics really as good as their originals?”) An audit of medication advised by hospital discharge letter was undertaken during the year and showed an anomaly rate of 24%. This was repeated following discussion and the anomaly rate was reduced to 4%. This audit is still being followed through as there are some concerns regarding the basis and process of audit and this will therefore feature as part of the developments for the forthcoming year. Significant events A Significant event is any event from which a learning point can be drawn. This can be positive as well as negative. The Practice has a robust process for reporting, reviewing and learning from significant events where appropriate. All reports are written up by clinician/staff involved and passed to the Practice Manager who will arrange review at the next practice meeting (or earlier if appropriate). All events are available on the practice intranet under the education pages in order that they can be revisited and used as learning aids. During the last 12 month period, the practice reported on 9 events, 4 of which were in response to actions taken by other agencies that had impacted or had the potential to impact our service. There were no RIDDOR reportable events Research initiatives The practice has previously been involved in national research initiatives through the MRCP, however none have been undertaken in the last 12 months. We are currently considering taking part in the Active Women Study: Exercise & menopausal symptoms.

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Statement from Solihull Primary Care Trust Quality accounts are not yet mandated for primary medical services. Solihull Primary Care Trust is therefore pleased to be able to provide a supporting statement for Meadowside Family Health Centre ‘dry-run’ quality account, which covers the period 1st April 2010 – 31st March 2011. It is pleasing to note that Meadowside Family Health Centre has to date implemented a number of initiatives to improve and enhance patient experience, patient safety and clinical effectiveness. Primary medical services have a busy year ahead with the requirement to register with the Care Quality Commissions ‘essential standards of quality and safety’. The PCT will continue to support the practice in any future challenges and is committed to working together to ensure the achievement of the intended 2011/2012 quality initiatives detailed within this document. In addition this account has identified that the participation of clinical audit (both at a national and a local level) could be further strengthened and the practice will be supported in this. This will be a key priority for the PCT over 2011/12. In our assurance role the information contained within this account is in our view a reasonable interpretation of the data however it must be recognised that Solihull PCT is not able to corroborate the accuracy of all data within this quality account. It remains a key priority of Solihull PCT to ensure high quality, safe and effective primary medical services are available for the population of Solihull. The continued implementation of the 2011/2012 quality initiatives detailed in the quality account provided by Meadowside Family Health Centre will drive forward this priority. E•N•D