Great Barr Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At the last inspection we found patients care and treatment was not provided in line with evidence based guidance and we identified significant concerns in the care of patients’ health conditions. At this inspection, we found patients with long term conditions needed improved monitoring, patients’ needs were not assessed, and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidelines and there was limited clinical leadership and oversight to ensure clinical tasks and referrals had been completed. Staff feedback demonstrated a clear divide between the leaders and staff in providing effective care to patients.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us the practice used codes and alerts on patients records to highlight any communication needs and any impairments. We found there were referral pathways in place to make sure that patients’ needs were addressed, however we were unable to gain assurances that these were used appropriately as we identified outstanding tasks which included referrals dating back to March 2024. Staff who were able to describe the process for coding of correspondence and care and treatment records for people. Staff we spoke to were aware of the workflow, however we found limited evidence to demonstrate how the practice provided further education and support to patients. We found that staff had the appropriate skills and training to carry out reviews where appropriate, but some staff reported being allocated patients that were outside of their competencies. This had been reported to the leadership team, however no action at the time of inspection had taken place. Staff told us due to patients being allocated to the wrong clinician was causing delays for patients in being seen.

The practice used codes and alerts on patients records to highlight any communication needs and any impairments, however we found these were not always used to identify patients who had clinical conditions. The practice had systems and processes in place to identify people’s needs and preferences during the registration process. We found that systems and processes to ensure the safe, care and treatment of patients needed strengthening to ensure clinicians were up to date with current evidence-based practice. During the remote clinical review we found 65 outstanding tasks and referrals that required action. We were unable to gain assurances that there was an effective system in place to ensure tasks, referrals and pathology results were actioned in a timely manner. For example: During the remote clinical review in May 2024, searches suggested there were 15 patients with a potential missed diagnosis of diabetes. A random review of 5 clinical records was completed which showed patients had not been reviewed, followed up or clinical codes had been added appropriately to their records.

Leaders told us they had systems in place which were in line with good practice standards and were ensuring care was consistently provided in line with guidance. However, we found that systems were inadequate to ensure effective monitoring of patients care and treatment. We found long term condition monitoring still required strengthening to ensure patients were monitored effectively. For example: Clinical searches suggested 15 patients had results which showed they had a new diagnosis of diabetes, but had not been coded appropriately and no action had been taken to inform the patients of their diagnosis or arranged for monitoring of their condition. Staff told us there was no formal supervision in place to monitor prescribing of medicines and they were not supported by leaders in delivering high quality care.

We found people with long-term conditions were not always offered a structured annual review to check their health and medicines needs were being met. The remote clinical searches that we undertook of the practice’s clinical records system showed the monitoring of people with some long-term conditions were not in line with National Institute for Health and Care Excellence (NICE) recommendations. For example: Clinical searches suggested that 31 patients with a diagnosis of hypothyroidism were not being monitored appropriately. We reviewed a random sample of 3 clinical records and found all patients were overdue monitoring, but medicines were still being prescribed without reviews having taken place. We found routine monitoring and management of people with asthma was not effective. For example: The clinical search suggested 40 patients with asthma had been prescribed oral steroids since 1 March 2024. We reviewed a random sample of 5 clinical records and found 2 patients had not received a full assessment, 3 patients were prescribed a dose of oral steroids that was lower than that recommended by NICE guidance and 4 out of the 5 patients were not followed up appropriately, with 3 patients overdue an annual asthma review.

Minutes of meetings were provided, these included safeguarding and clinical meetings, however we were unable to gain assurances that integrated care meetings with health care staff had been implemented to discuss the care and support needs of all patients. On reviewing the safeguarding minutes, we found no evidence to demonstrate that health visitors had been included in the meeting as part of strengthening safeguarding processes. We were provided with 2 sets of minutes from clinical meetings that had been held in February and March 2024. The minutes dated March 2024 confirmed that multi disciplinary meetings needed to be organised. At the time of the inspection in May 2024, we were not provided with evidence to confirm that these meetings had commenced. We found on speaking to a range of staff that were was a clear lack of communication within the practice with staff being unable to approach leaders and discuss people's care and treatment.

We were unable to gain assurances that there were effective systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care. We received no evidence to demonstrate regular meetings were held with multi-disciplinary teams to ensure care was co-ordinated effectively. Systems were in place to share information about patients electronically with other services. Since the partners return to practice in February 2024, evidence provided showed 2 clinical meetings had been held in February and March 2024 and 1 practice meeting had been held in March 2024, which the GP partners had not attended. We received no further evidence to demonstrate that the GP partners had held a meeting with staff since their return, this was confirmed by staff when speaking with them during the inspection in May 2024.

There were flags on patients records who were vulnerable and required ongoing monitoring, however the recall system needed strengthening to ensure all people with complex health needs and long term conditions were regularly reviewed and received support to manage their health needs. We found no evidence to demonstrate there was regular engagement with community services. We found outstanding and referrals that had not been actioned and a lack of clinical oversight to ensure systems were effective. The practice website detailed information and links for health promotion, health conditions and common health questions.

The GP patient survey demonstrated that 39% of patients said they have had enough support from local services or organisations in the last 12 months to help manage their long-term condition(s) which was below local and national averages.

We found that systems needed strengthening to ensure that that patients were being routinely monitored. We found during the remote clinical review had not received an annual review and were not being appropriately monitored to ensure their long term conditions were regularly reviewed.

We found that processes had not been strengthened and there were a lack of systems to recall and monitor patients with long term conditions and those who were prescribed high risk medicines and required regular monitoring. We found no evidence to demonstrate that the practice had a programme of targeted quality improvement and used information about care and treatment to make improvements.

We found the practice had not strengthened their systems sufficiently to ensure that those patients requiring medicine reviews and ongoing monitoring were actively being reviewed and recalled. There were limited systems in place to identify and manage patients who required monitoring. Our clinical searches showed potential misses for patients that required monitoring and reviewing to ensure they had received the appropriate care.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.