Monkspath
Surgery
(M89028)
QUALITY ACCOUNT
2011/12
Monkspath Surgery chose to produce its first quality
account for 2010/11 in advance of the proposed
introduction of accounts into primary care for 2011/12.
The Government have since decided to delay introducing
quality accounts for General Practices
“in light of the proposed changes affecting primary care,
including changes to the commissioning of primary care
services, primary care professionals taking a new lead role
in commissioning, and the registration of primary care
providers with CQC”.
We do not know when accounts will become mandatory
but have chosen to produce an account for 2011/12 with
an update on our first account.
Monkspath Surgery
Quality Account 2011/12
Contents:
Page 3
Part 1 - Statement by senior partner
Pages 4 -7
Part 2 - Priorities for Improvement
Statement relating to quality of NHS Services
provided
Pages 8 -12
Part 3 - Review of Quality Performance
Page 13
Appendix
2
Part 1.
Statement by Senior Partner
Monkspath Surgery continues striving to provide efficient, effective, high
quality, and timely primary care services to the whole practice population.
The primary health care team work together to improve the health and well
being of our patients. We continually review our procedures and practice to
seek ongoing quality improvement.
The Health Act 2009 requires all providers of NHS services to produce quality
accounts. Quality accounts are being introduced in a phased approach and
whilst the introduction of quality accounts into primary care providers (which
includes GP practices) has now been delayed from its planned 2011/12 we
have chosen to produce an update to our account this year.
This quality account is an annual report for the public, which attempts to
explain the quality of the services we currently provide and our plans for
quality improvement for the coming year.
During 2011-12 we feel that we have provided a good quality service and
overall we are happy with our performance. Our achievements in the quality
and outcomes framework have improved since the previous year from 957 to
982 points and we are pleased with this achievement. We continue to review
our access for patients and recognise that the waiting time for a routine
appointment is still longer than we, and our patients, would like. We have
conducted an extensive patient survey and have a plan in place to try to
address some of the areas that we scored less well in. We plan to undertake
some refurbishment works to the surgery in 2012-13 which we hope will
improve our patients’ experience.
We are aware of the new challenges which we will face in the coming years
under the Health and Social Care Bill which will give GPs in Consortia much
more responsibility for spending the healthcare budget. We hope to embrace
the opportunities which will be presented to improve the quality of primary
care.
We hope that everyone who reads this report finds it informative and
interesting. The information contained in this quality account is, to the best of
my knowledge, accurate.
Signed:
Dr S L Green
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Part 2 – Priorities for Improvement
2012-13
Due to the delay in introducing quality accounts for primary care, we have
decided to largely continue the same focus in our quality account for 2012-13,
but have updated our priorities in line with new information and
developments during 2011-12.
As a practice, we feel we have a culture of review, reflection and seeking
quality improvement. We have always embraced new technology and
opportunities and have been proud to be recognised as a forward thinking
practice. We have taken advantage of our independence to ‘trial’ new ideas in
our search for new and improved ways of working. Often triggers for local
change are unplanned, however we can identify and focus on particular areas
where we feel we can improve in the coming year. The impact of the Health
and Social Care Bill will be significant and although it is not yet fully known
how this will affect our future plans, we have taken account of this in some of
our priorities.
Our priorities for quality improvement for 2012-13 are:
Patient Safety
 Clinical Assessment Team Meetings
The surgery has in place a clinical assessment team who arrange appropriate
appointments for patients with more urgent matters. We understand how
important it is to patients to be able to speak to or see a clinician for advice at
the earliest opportunity. We plan to have regular meetings with all clinicians
who are part of the clinical assessment team to review the processes we have
in place for managing patients’ needs and to ensure a consistent approach.
Meetings will be minuted and any actions followed up. The benefit of the
meetings will be monitored by patient questionnaires on the service and by
feedback from the clinical assessment team.
 Journal club meetings
Meetings will be planned for all available doctors to attend, usually monthly,
to discuss topical clinical issues. Subject matters may include NICE (National
Institute for Health and Clinical Excellence) guidance; prescribing and audits.
The meetings will be led by a named GP before open discussion. The
meetings will help to inform practice and keep doctors up to date with any
new guidelines and services. Journal club meetings will improve clinical
communication and feedback on the benefits will be given by doctors at
meetings and appraisals. It is expected that doctors will attend at least 4
journal club meetings each year.
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Clinical Effectiveness
 Referral Review
The importance of effective referrals for outpatient services is widely reported
and forms part of the ‘Improving Quality and Productivity in the NHS’
indicators. GPs are being asked to review their referrals with the aim of
eliminating any unnecessary referrals and to ensure that they use primary
care pathways wherever possible. The practice will continue to audit referrals;
review data on the specialities with the highest referral rates and costs; and
operate a system of peer (colleague) referral and review to ensure the most
effective use of NHS resources. The practice will monitor the success of
referral review through statistics on referral rates and comparison with
previous years; and the use of primary care pathways.
 Review of patients’ use of accident and emergency departments
Through the review of discharge letters, doctors will identify patients whose
clinical condition could possibly have been dealt with in primary care. The
practice will write to these patients with information about the primary care
services available, focusing on when the surgery is closed. In line with
national guidance, the practice will review all A&E attendances for patients
aged 15 and under and over 65 and will advise patients of primary care
services for future reference. The practice will also arrange displays to advise
patients of the primary care services available in the local area.
Data is available to the practice from Sirius (the South Solihull GP Consortium)
showing the numbers and cost of patients attending A&E each month. The
report is usually provided on a monthly basis and looking back over the
previous 15 months, allowing month on month comparison with the previous
year, which will account for seasonal variations. The data will be used to
assess improved knowledge of primary care services.
5
Patient experience:
 Access to appointments
In 2011-12 the practice invested in access to online appointment booking for
patients and the use of this service continues to grow. Statistics are available
on the numbers of patients registered for the service and the numbers of
appointments that have been booked and cancelled online.
The online booking service is provided by the clinical system supplier and
enhancements are planned. The practice will arrange training for the
enhancements to ensure maximum use of the service and the widest access
to appointment booking for patients.
The practice will continue to monitor the numbers of patients registered for
the service and their use of online bookings and cancellations
 Increase patient involvement
In 2011-12 the practice developed a ‘virtual’ patient reference group, with
whom communication was via email. The group offered valuable feedback,
notably in relation to the patient survey and plans to address areas within the
survey that the practice scored less well in.
It is hoped that the group will continue to engage with the practice in 201213.
 Refurbishment of patient facing rooms and common areas in the
surgery
In 2012-13 the practice hopes to engage in refurbishment works in the
surgery to modernise and improve patient facing areas. We hope that the
planned works will improve patients’ experience and meet new regulations
and recommendations for infection control.
6
Quality Account Statements:
The Quality Account toolkit details a number of statements that are
mandatory requirements for inclusion. Many of these statements are not
applicable to GP practices. In order to ensure this Quality Account remains
user friendly to our readers we have listed all non-applicable mandatory
statements in the appendix following advice from Solihull Primary Care Trust.
Care Quality Commission
The practice was not required to be registered with the Care Quality
Commission (CQC) during 2011/12. However, the practice will be complying
with the appropriate timescales for primary care organisations to register with
the Care Quality Commission by April 2013. The practice has not participated
in any special reviews or investigations by the QC during 2011/12.
Information Governance
Monkspath Surgery’s Information Governance Assessment Report score
overall for 2011-12 was 97% and was graded green.
Participation in Clinical Research
Participation in clinical research demonstrates Monkspath Surgery’s
commitment to improving the quality of care we offer and to making our
contribution to wider health improvement. Our clinical staff
stay abreast of the latest possible treatment possibilities and active
participation in research leads to successful patient outcomes.
During 2011-12 we have taken part in a number of research studies,
coordinated by The Health Improvement Network (THIN) and the Clinical
Practice Research Datalink (CPRD). All invitations to take part in research are
reviewed by Dr Stokes, the practice lead, and discussed at partnership
meetings where appropriate. All patients who are invited to take part are
contacted by the surgery and anonymised details forwarded to THIN and
CPRD as appropriate. In 2011-12 the studies that we have been involved with
include:
 Cardiovascular disease in patients with psoriasis
 Atrial fibrillation outcome assessments
 Stroke
 Hypertension
 Saxagliptin
 Uterine Fibroids
 Endometrial Ablation
 Psoriatic Arthritis
 Glaucoma
 Cataracts
 Sudden Cardiac Death
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PART 3 – Review of Quality Performance
2011-12
Introduction
In writing our quality account we have used the opportunity to review our
services across the 3 domains of quality - patient safety; clinical effectiveness;
and patient experience. We hope that the areas we have focused on for
review are interesting and relevant to our readers. In our first quality account,
we reflected on many areas, but in this second year, we have focussed on the
specific areas, as set in our first account.
Patient Safety
 Clinical Assessment Team Meetings
We have held meetings throughout 2010-11 with the team, which have
reviewed the systems in place; how individuals operate the clinical
assessment and availability of appointments. Minutes have been written and
shared with other team members to try to ensure a consistent approach.
Patient questionnaires have been sent to patients accessing this service every
2 months. The latest set of data showed the following results:
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 Journal club meetings
Meetings have been arranged to discuss topical clinical issues.
In 2011-12, subject matters have included oncology, prescribing, the use of
zinc in the common cold, licensing of herbal remedies, nutritional
supplements, HPV warts and verrucae, and ovarian cancer.
The meetings have been well received by clinical staff, who have attended a
number of sessions. Due to new teaching commitments of the co-ordinating
GP in 2011-12, there was a period of time without any journal club meetings.
It is anticipated that meetings will be more regular in 2012-13.
9
Clinical Effectiveness
 Referral Review
The practice has audited referrals, focussing on ENT and dermatology. All
potential referrals have been peer reviewed and we have been able to redirect some patients to in house services and community services which have
speeded up the patient’s appointment and prevented a secondary care
attendance.
The practice has also had meetings to discuss referral patterns and to
compare these with other local practices to look for any outlying data. In
general, the practice has a lower than average referral rate amongst Solihull
practices which we hope reflects good management of patients by GPs where
appropriate, and appropriate referrals to secondary care. Data provided by
Solihull Health has also shown that the practice has engaged with the new
‘care closer to home’ pathways which were introduced for ENT and
cardiology.
 Review of patients’ use of accident and emergency departments
Through the review of discharge letters, doctors have identified patients
whose clinical condition they felt could possibly have been dealt with in
primary care. After review of the patient’s records to try to ensure selfreferral, the practice has written to these patients with questionnaires asking
about their experience at A&E and to ascertain their knowledge of other
primary care services.
The data for those questionnaires which were returned show attendance at
A&E on the following days. Over 70% of attendances took place when the
surgery was closed.
10
Patients responding to the questionnaire had a good awareness of the walk in
centre and of the surgery triage system but only just over half were aware of
the services offered by Badger.
The practice will be altering their approach to A&E attendances and patient
education in this area in 2012-13.
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Patient experience:
 Access to appointments
In 2011-12 the practice invested in access to online appointment booking for
patients and the use of this service continues to grow. Statistics are available
on the numbers of patients registered for the service and the numbers of
appointments that have been booked and cancelled online.
The practice currently has 395 active users of this service and recent searches
show that approximately 40 appointments are being booked on line each
month and 10 cancelled. It is anticipated that increased use of online
bookings has also reduced telephone calls to the surgery, and hopefully
improved telephone access for other callers.
 Increase patient involvement
In 2011-12 the practice developed a ‘virtual’ patient reference group, with
whom communication was via email. The group offered valuable feedback,
notably in relation to the patient survey and plans to address areas within the
survey that the practice scored less well in.
The practice were really pleased with the engagement with the group and
hope to continue this in 2012-13.
12
Appendix
The Quality Account toolkit details a number of statements that are
mandatory requirements for inclusion. Many of these statements are not
applicable to GP practices. In order to ensure this Quality Account remains
user friendly to our readers we have listed all non-applicable mandatory
statements here. This was undertaken following advice from Solihull Primary
Care Trust.

Use of the CQUIN payment framework
Monkspath Surgery income in 2011/12 was not conditional on achieving
quality improvement and innovation goals through the Commissioning for
Quality and Innovation payment because the provider does not use any of the
NHS standrard contracts that are eligible to negotiate a CQUIN payment.

NHS number and General Medical Practice Code Validity
Monkspath Surgery did not submit records during 2011/12 to the secondary
uses service for inclusion in the Hospital Episode Statistics which are included
in the latest published data (this is a secondary care requirement).
 Clinical Coding Error Rate
Monkspath Surgery was not subject to a Payment by Results clinical coding
audit during 2011/12 by the Audit Commission
 Participation in Clinical Audits
The national clinical audits and national confidential enquiries that Monkspath
Surgery was eligible to participate in during 2011-12 are nil (this is a
secondary care requirement)
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