Archived: Primecare - Primary Care - Birmingham

Updated 26 March 2018

Primecare – Primary Care – Birmingham provides primary care medical services outside usual GP practice working hours (out-of-hours or OOH). The provider holds contracts to provide out-of-hours services with two Clinical Commissioning Groups (CCGs). These are Sandwell and West Birmingham CCG and Birmingham Cross City CCG. The population covered by these two CCGs is approximately 1.25 million people. The provider also contracts directly with a small number of GP practices who have retained contractual responsibility for providing their own out of hours provision for their patients.

The population is ethnically diverse. Just over half the population are white British and approximately one quarter are Asian or Asian British (who form the largest minority ethnic group). Data from Public Health England showed deprivation in the area served is higher than the national average.

Patients access the out-of-hours service via the NHS 111 telephone service or may contact Primecare – Birmingham directly if their usual GP service has subcontracted with Primecare - Birmingham to provide primary medical services when they are closed.

The main office for Primecare – Primary Care - Birmingham is at Crystal Court. This is where telephone calls are received and triaged. Patients who need to be seen by a clinician are seen as a home visit or are referred, by appointment, to one of the three primary care centres located in Birmingham and Sandwell. They include:

• Sandwell General Hospital, All Saints Way, B71 1RU
• Neptune Health Centre, Sedgley Road West, Tipton DY4 8PX
• Broadway Health Centre, Cope Street, Birmingham, B18 7BA

As part of our inspection we visited the main office and all three primary care centres.

Each primary care centre is open in the evening Monday to Friday, and all weekends and bank holidays. Home visits and telephone consultations take place throughout the whole out-of-hours period.

Staffing typically consists of a GP and a receptionist at each primary care centre; two GPs and two drivers for home visits and, at the call centre, a shift manager and between two and four call handlers and dispatchers.

The provider’s out-of-hours service is mostly GP-led. There are approximately 100 clinicians who contract with Primecare – Primary Care – Birmingham either on a sessional basis or through an agency. Approximately 45% of the GPs are regular locums. The provider also employs one Advance Nurse Practitioner.

The provider was previously inspected as a pilot site for the new CQC inspection methodology in March 2014 where we identified concerns relating to medicines management and the management of complaints. No ratings were given during the pilot inspections. The provider was re-inspected in April 2015 and rated requires improvement. At the inspection in April 2015 we identified a number of issues, including those relating to medicines management and local governance arrangements.

We carried out an announced comprehensive inspection on 28 March 2017 and 29 March 2017. The provider received an overall rating of inadequate and we issued a Notice of Proposal to cancel registration on 22 May 2017. This was as a result of finding that the provider had not made the necessary improvements and was not meeting relevant requirements in relation to good governance. A further focussed inspection took place on 17 August 2017 to follow up concerns identified in the Notice of Proposal which led the Notice of Proposal being withdrawn.

Updated 26 March 2018

We carried out an announced comprehensive inspection of Primecare – Primarycare – Birmingham on 28 March 2017 and 29 March 2017. The provider received an overall rating of inadequate and was placed into special measures. Following the inspection we issued a notice of proposal to cancel the regulated activities and registered manager at this location in relation to Regulation 17: Good governance. On 17 August 2017 we undertook a focused follow up inspection to confirm the provider was carrying out their plan to meet legal requirements in relation to breaches identified in the notice of proposal. You can read the full reports from the March 2017 and August 2017 inspections, by selecting the 'all reports' link for Primecare – Primary Care – Birmingham on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection, carried out on 17 and 18 January 2018. The purpose of the inspection was to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 28 and 29 March 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. At this inspection we found the provider had made adequate improvements.

This service is now rated as requires improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? – Requires Improvement

At this inspection we found:

• The provider had made significant improvements to address the breaches and improve the service delivered since our previous inspection in March 2017. The provider had put in place an action plan and turnaround team to support the local management to deliver the necessary improvements.

• The service had put in place systems to manage risk so that safety incidents were less likely to happen. For example, in relation to the premises, infection control, the management of medicines and safety alerts.

• There were improvements in reporting incidents and we saw evidence of learning being shared across the organisation. However, incident reports seen did not always clearly detail the action taken or which service they related to. Themes and trends were analysed at provider level to identify areas for improvement but did not distinguish between the different locations.

• The service routinely reviewed the effectiveness and appropriateness of the care it provided. Consultation audits were undertaken and areas of concern were followed up. We saw improvements in the sharing of evidence based guidance with clinical staff.

• The provider had improved the reporting of National Quality Requirements and we saw overall improved performance since our previous inspection. Staff told us there were systems for reviewing performance, however no documentation was maintained to demonstrate this and action taken in response to breaches.

• A programme of clinical audits had been identified and findings shared with clinical staff. However, none only one was a full cycle and did not demonstrate improvements made.

• The provider demonstrated effective joint working arrangements with key partners to develop co-ordinated care.

• Feedback collected by the provider and through CQC comment cards indicated that patients were treated with kindness, dignity and respect.

• Since our previous inspection in March 2017 the provider had made improvements to ensure patients received care and treatment from the service within an appropriate timescale for their needs. However, there was scope for further improvements such as the timeliness of less urgent home visits.

• There had been significant improvements in the provider’s governance arrangements. There was clearer leadership arrangements. Staff meetings had been instigated and most staff we spoke to felt valued and respected. However, there were some staff who did not feel well supported.

• The provider demonstrated a commitment to continuous learning and improvement. They had acted on the feedback from our previous inspection and were working closely with the CCG to develop integrated urgent care in the local area.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure effective systems and processes continue to be established to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Develop clear support systems for staff working in isolation during the out-of-hours period including formal opportunities to meet, discuss and raise issues relating to their role.

• Review systems for monitoring compliance against performance targets to support improvements in the timeliness of care and treatment patients received.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.