Archived: New Invention Health Centre

Updated 17 November 2016

Dr Sinha, Rischie, Sinha, Shanker practice are the registered providers for New Invention Health Centre. They are registered for primary medical services with the Care Quality Commission (CQC) and have two registered locations, Pleck Health Centre and New Invention Health Centre.

We only inspected New Invention Health Centre on this inspection. The practice is based inside a converted house. The registered patient list size is approximately 6300 patients. The practice has an Alternative Provider Medical Services contract (APMS). An APMS contract allows practices to supply enhanced and additional primary medical services. The provider acquired the contract for New Invention Health Centre in April 2016 having been the ‘caretakers’ for the practice since April 2014.

The practice is open Mondays, Tuesdays, Wednesdays and Fridays from 8:30am to 6:30pm and telephone lines were available from 8am. Phone lines were diverted between 1pm and 2pm on these days to a contracted provider. The practice closed on alternate Tuesdays from 12pm until 2pm and Thursdays from 1pm. We have been advised by the practice that as of 1 October 2016 they will not be closing on Thursday afternoon. Extended opening hours are available on Mondays from 6.30pm to 8.15pm. When closed during normal working hours, the practice subcontracts with a local GP provider to provide access to primary medical services to its patients.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by an external out of hours service contracted by Walsall Clinical Commissioning Group (CCG).

There are four GP partners, (three male and one female) and two salaried GPs (one male and one female). The practice employs a pharmacist, two nurse prescribers (female), and a health care assistant (female) who also undertakes phlebotomy (the taking of blood). The non-clinical team consists of a business manager who works at both practices, a practice manager and reception and administration staff.

The practice is part of NHS Walsall Clinical Commissioning Group (CCG) which has 63 member practices. The CCG serves communities across the borough, covering a population of approximately 274,000 people.

Updated 17 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at New Invention Health Centre on 20 July 2016. Overall the practice is rated as Good. An inspection had been carried out on the 23 October 2014 and the provider was found to be in breach of legal requirements and was rated as Requires Improvement in the Safe domain. Following on from the October 2014 inspection, the practice wrote to us to say what they would do to meet the legal requirements. We undertook a focused inspection on 9 December 2015 to check that the practice had followed their plan and to confirm that they now met the legal requirements. We found that the action plan had not been completed. As a result, the practice was rated as inadequate in Safe, and warning notices were issued in relation to the outstanding actions. A follow up inspection was carried out on 3 June 2016 to review the actions the practice had taken in response to the warning notices and we found the practice had completed the actions identified.You can read all our inspection reports for this prcatice by selecting the 'all reports' link for New Invention Centre on our website at www.cqc.org.uk.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses and there was an effective system in place for reporting and recording significant events.
• The practice had strong, visible clinical and managerial leadership and staff felt supported by management.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had no information on display to encourage patients to identify themselves as carers and the practice did not actively identify carers or have information to advise carers of services and support available.
• The practice had made improvements to the building and room allocation to improve access for patients.
• Governance and risk management arrangements were in place and well managed. Opportunities for learning from incidents were shared with the staff.
• The practice was active in actioning identified areas for improvement of the building and infection control audits and we saw evidence of changes being made.
• Feedback from patients and staff suggested that the GP partners had made positive improvements and there was a sense of stability and continuity in care.
• The practice employed a pharmacist to ensure that patients’ medicines were reviewed on a regular basis and medicine audits and alerts were actioned accordingly.
• Patients said they were treated with compassion, dignity and respect and we staff were friendly and helpful and treated patients with kindness and respect.
• 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.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. We saw evidence that multidisciplinary team meetings took place every two months.

However there were areas of practice where the provider should make improvements:

• Ensure that patient records are appropriately coded so that staff are able to identify carers and develop a register of carers.
• Continue to review the registers for patients with learning disabilities to ensure appropriate reviews are in place.
• Review the impact on the accessibility of appointments and telephone access and seek patients’ views on the practice closing for patient appointments during normal working hours.
• Consider how to further engage with patients in the patient participation group to offer guidance and support, and encourage new members to join.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 November 2016

• Longer appointments and home visits were available when needed and patients who were housebound received reviews and vaccinations at home.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Patients with long term conditions had a structured annual review to check their health and medicines needs were being met.

• The practice was proactive in encouraging patients to attend reviews. For example, the practice had 412 patients on the diabetic register and 84% had received a flu vaccination during the past 12 months.
• A diabetes specialist nurse visited the practice every fortnight to review patients with complex diabetes.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 17 November 2016

• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. Childhood immunisation rates for under two year olds ranged from 94% to 100% and for five year olds from 81.8% to 100%.
• The practice’s uptake for the cervical screening programme was 79% which was slightly lower than the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The midwife provided antenatal care every week at the practice.

Updated 17 November 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice worked closely with multi-disciplinary teams so patient’s conditions could be safely managed in the community.
• The practice pharmacist carried out medicine reviews and held regular meetings with the GPs to discuss patients’ needs.

Updated 17 November 2016

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Extended surgery hours were offered on Monday evening from 6.30pm to 8.15pm for patients who worked and could not attend during normal surgery hours.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.

Updated 17 November 2016

• The practice had 45 patients on the dementia register and 64% had had their care reviewed in a face to face meeting in the last 12 months.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• A mental health therapist ran a clinic once a week to support patients.
• The practice was currently taking part in a mental health project with the support of a consultant psychiatrist. The project had 19 patients and looked at a group approach to managing the patients’ condition with co-ordinated care management plans.
• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice had 38 patients on their mental health register and 82% had had their care plans reviewed in the last 12 months.

Updated 17 November 2016

• The practice held a register of patients living in vulnerable circumstances including homeless people and patients with alcohol or drug dependency. The practice had nine patients on the vulnerable list and all had received a face to face review in the past 12 months.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and held meetings with the district nurses and community teams every two months.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice had 16 carers recorded on the carers register which represented 0.25% of the practice list. The practice had no information on display to encourage patients to identify themselves as carers or information to advise carers of services and support available.
• The practice offered longer appointments and annual health checks for people with a learning disability. Unverified data supplied by the practice showed there were 17 patients on the learning disability register and 82% patients had received their annual health checks. The practice told us they did send reminders to patients to encourage them to attend their appointments.