Great Barr Medical Centre

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• 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

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. Patients with long term conditions needed improved monitoring, patients’ needs were not assessed appropriately and by staff who had not completed the relevant training or had the competencies to carry out clinical reviews. We were unable to gain assurances on speaking with the clinical team that there was clinical supervision in place to ensure staff were supported within their role.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The National Patient Survey results demonstrated that 91% of people felt their needs were met during their last general practice appointment which was in line with local averages and national averages. However, the shortfalls we identified in relation to this could impact people’s care. You can find more details of our concerns in the evidence category findings.

Leaders and staff told us the practice used codes and alerts on clinical records to highlight any communication needs and any impairments. Staff we spoke with on the day of the onsite assessment reported they had been reviewed by colleagues with the experience to review their abilities in carrying out clinical assessments, however on reviewing these competency checklists we found them to be inadequate and signed off by staff who did not have the appropriate experience to confirm the competencies of other staff at the practice.

We found there was a lack of systems and processes in place to ensure the safe, care and treatment of people. We found the monitoring of long term conditions was inadequate with staff not having the appropriate qualifications carrying out the reviews. There was a lack of consistency in working practices amongst clinicians that was not always within current evidence-based practice. During the remote clinical review, we found medicines management did not always reflect current and relevant best practice and people's care needs were not always reviewed.

During the clinical review we carried out as part of this assessment we identified shortfalls which could impact people’s care. You can find more details of our concerns in the evidence category findings.

Leaders told us they had systems in place, however we found that systems did not always ensure effective monitoring of people's care and treatment. We found long term condition monitoring required strengthening to ensure people were monitored effectively. For example: Clinical searches identified 3 people who had a missed diagnosis of diabetes, which had not been coded appropriately and no action had been taken to inform people of their diagnosis or arrangements in place for monitoring of their condition.

Further clinical searches showed 118 people with diabetes who had a blood sugar glucose level (HbA1c) of 75 and above. We sampled a 5 clinical records and found 1 person had not had a diabetic review since 2016 and another person since 2020. The records we sampled showed 3 people had not had been reviewed or had had their medication adjusted when their blood tests showed raised glucose levels.

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 10 people with a diagnosis of hypothyroidism were not being monitored appropriately. We sampled 5 clinical records and found they were overdue monitoring, but medicines were still being prescribed without reviews having taken place. We found that there was no effective approach to delivering and monitoring care.

We found inconsistencies in assessing people's immediate and ongoing needs including their clinical needs and their mental and physical wellbeing and we were provided with limited assurance that people presenting with symptoms which could indicate serious illness were followed up in a timely and appropriate way.

During the clinical review we carried out as part of this assessment we identified shortfalls which could impact people’s care. You can find more details of our concerns in the evidence category findings.

We were unable to gain assurances that there were regular integrated care meetings with community health care staff as part of the primary care network to discuss the care and support needs of all people. The provider was unable to provide evidence that they had established meetings with the health visitor as part of strengthening their safeguarding processes.

Staff told us that they had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support; and they had enough information to plan and refer people and receive subsequent results and information following referral.

We were unable to gain assurances that the practice had effective systems in place to ensure the care and treatment of patients was co-ordinated with other teams to ensure continuity of care.

We were provided with the minutes of a safeguarding meeting, however the minutes provided no evidence to demonstrate if safeguarding concerns were shared with health visitors or other teams as required. We were unable to gain assurances that palliative patients were reviewed regularly and we were provided with no evidence of regular staff meetings to ensure all staff were kept up to date with guidance and best practice.

The primary care network (PCN) helped to support the practice by providing links to pharmacists and social prescribers. Systems were in place to share information about patients electronically with other services.

The National Patient Survey results demonstrated that 52% of patients say they had enough support from local services or organisations in the last 12 months to help manage their long-term conditions or illnesses which was below local and national averages. We identified shortfalls that could impact on people's care. You can find more details of our concerns in the evidence category findings.

Due to difficulties in the lack of systems and processes we found some delays in carrying out annual reviews and were not fully assured that the practice was identifying people who may need extra support and directed them to relevant services. This included people at risk of developing a long-term condition and carers. We were not assured that people had access to appropriate health assessments and checks.

There were alerts on clinical records to show 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 a lack of clinical oversight to ensure systems were effective and regularly monitored to ensure people were supported to live healthier lives where possible. The practice website detailed information and links for health promotion, health conditions and common health questions.

During the clinical review we carried out as part of this assessment we identified shortfalls which could impact people’s care. You can find more details of our concerns in the evidence category findings.

Staff told us that they had reviewed their systems to ensure that that people were being routinely monitored. As part of this assessment we carried out a clinical review and found some annual reviews had not been routinely carried out for those with a long-term condition. We found some staff had not completed the relevant training to complete annual reviews and the clinical leaders had not identified there was a clear lack of understanding and competencies in their staff and had taken action to ensure the safety of people.

People that we had previously identified at the assessment in May 2024 who we found were high risk and needed to be reviewed, still had not been reviewed or monitored to ensure they were receiving the appropriate care and treatment.

We found that processes required action as there was a lack of systems to recall and monitor patients with long term conditions and those who were prescribed high risk medicines. We found limited evidence to demonstrate that the practice had a programme of targeted quality improvement and monitoring and used information about care and treatment to make improvements.

We found inconsistent approaches to monitoring peoples care and treatment and found during the remote clinical review not all people had received an annual review and were not being appropriately monitored to ensure their high-risk medicines and long-term conditions were regularly reviewed. For example, we found patients were identified who had a potential missed diagnosis of diabetes. People with hypothyroidism did not routinely have regular thyroid function tests. People with asthma who had been prescribed 2 or more doses of steroid medication in 12 months were not provided with the correct dose of steroids.

We found the practice systems were not sufficient to ensure that those 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 systems were ineffective to ensure people were safely monitored. The overall trend for child immunisation was below 90% for all of the 5 indicators and cervical screening was significantly below the 80% target.

We saw evidence that consent was obtained, so people understood their rights around consent to the care and treatment they were offered. The GP survey demonstrated that 93% of patients were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment.

Staff were able to tell us the process they followed when obtaining consent. For example, when carrying out examinations and minor surgery procedures. All staff had completed training on mental capacity and understood legislation when considering consent and decision making.

We found that there was a DNACPR policy in place. We found that Clinicians understood the requirements of legislation and guidance when considering consent and decision making and saw that consent was documented.