Archived: Dr S Ahmed & Dr H Duffy

Updated 22 January 2015

Dr S Ahmed’s practice is currently a single handed practice following the departure of a partner in recent months. The practice has decided to merge with another practice in the same building which they already have close working relationships with. This will be completed in April 2015. They share a Patient Participation Group (PPG) and have implemented cross practice working to ensure staff and patients are familiar with staff from both practices.

The practice currently had one male GP and had access to four locum GPs from the neighbouring practice to meet the needs of the 5300 patients who were registered with the practice. This was supported by an advanced nurse practitioner, three practice nurses, a practice manager, a medicine manager and a reception and administration team who were all very familiar with their patients.

The practice do not provide an out-of-hours service to their own patients and patients are signposted to the local out-of-hours service when the surgery is closed at the weekends. The practice also used an acute visiting service from the local OOHs service for patients requiring immediate attention from a GP during surgery hours; this ensured patient’s needs were immediately addressed without having to wait for the GP to visit after his surgery.

The practice population groups are in line with or slightly below National averages with some group just above CCG averages. The largest population group within the practice the 14-18 age groups, with over 85 being the smallest group at 2.3%. Both figures are in line with CCG averages.

63.8% of patients have a long standing health condition and 0.5% of all patients are resident in nursing homes. 7.2% of all patients are unemployed at the practice which is in line with CCG but higher than National average. 15.5% of patients have carer responsibilities.

The practice is at fourth more deprived percentile. Information published by Public Health England rates the level of deprivation as four on a scale of one to ten. Level one represents the highest levels of deprivation and ten the lowest. Income deprivation affecting older people is higher in the practice than National average at 21% but below the CCQ average. Whilst the income deprivation affecting children is below both the CCG average and the national average at 21%..

Ethnic estimation is 3.0% non-white ethnic groups

Male life expectancy 74.9 years, with female 80.4 years.

Updated 22 January 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection on 12th November 2014. We spoke with patients, members of the Patient Participation Group (PPG), and staff including the management team.

The practice is rated as Good. A safe, caring, effective, responsive and well-led service is provided that meets the needs of the population it serves.

Our key findings were as follows:

• The service is safe.  All staff understand and fulfil their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal incidents are maximised to support improvement. 
• The service is effective. The practice is using proactive methods to improve patient outcomes and it links with other local providers to share best practice.
• The practice is caring. Patients told us they are treated with compassion, dignity and respect and they are involved in care and treatment decisions. Accessible information is provided to help patients understand the care available to them.
• The practice is responsive to patient’s needs. The practice implements suggestions for improvements and makes changes to the way it delivers services as a consequence of feedback directly from patients and from the Patient Participation Group (PPG). Patients told us they are fully dated with the planned merger of the practice and have been asked for their comments.
• The practice is well-led. They have a clear vision which has quality and safety as its top priority. A business plan is in place that includes detailed plans for the forthcoming merger with another practice. This plan is monitored and regularly reviewed by both practices, and discussed with all staff. Cross practice working is already in progress to ensure both patients and staff from both practices are familiar with each other. High standards are promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

• All the practice staff proactively followed up information received about vulnerable patients. .
• The approach of the practice in responding to and meeting the needs of different groups of people, including those in vulnerable circumstances or those with learning disabilities.
• The approach staff took to ensure patients were involved in the planning of their care and in decisions about their care / treatment using a variety of different methods appropriate to the person.
• The practice has close working relationships with the police and other protective agencies and was able to act quickly and address situations whilst maintaining the safety of the patient.
• The practice business plan for the future included a planned merger with another local GP practice; this was being handled in a sensitive, effective and open manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 January 2015

The practice is rated as good for the care of people with long term conditions.

Patients had as a minimum an annual review of their condition and their medication needs were checked at this time. When needed, longer appointments and home visits were available.

Patients at risk of being admitted to hospital due to their condition had a care plan in place, this was regularly reviewed by the GP and the multidisciplinary team involved in their care.

Patients who had been discharged from hospital with Do Not Attempt Resuscitation (DNAR) orders were visited as soon as practicable by the GP and the requests were discussed with patients and their family if the patient agreed in their home to ensure this was still their wish.

Updated 22 January 2015

The practice is rated as good for the care of families, children and young people.

Staff knew their patient population very well and we saw a system in place to identify children or parents at risk. We also saw an example where a patient at risk had been protected.

Children and young people were treated in an age appropriate way and their consent to treatment using appropriate methods was requested.

Childhood immunisations were carried out at the practice. Staff were able to promptly recognise signs of deteriorating health in young patients waiting in the practice and during the inspection we observed two young children being urgently transferred to the local A&E for immediate treatment. All staff were aware of the process to follow and promptly notified the GP and nurses of the need for immediate attention.

We were provided with good examples of joint working with professionals from other practices and health visitors. 

Updated 22 January 2015

The practice is rated as good for the care of older people.

Patients at the practice who were at risk of an unplanned hospital admission, of which there were 109, had a care plan in place. Housebound patients were routinely visited so they could be given information and advice to prevent hospital admissions.

The practice worked collaboratively as part of a multi-disciplinary team to take a holistic approach to caring for the over 65 age group. Regular meetings were held with other professional groups to discuss this group of patients and their needs.

 At the time of the inspection there was only one permanent GP at the practice and he was the named GP for all patients over 75 years of age.

Updated 22 January 2015

The practice is rated as good for the care of working age people (including those recently retired and students.

Appointments were offered until 8pm on Monday evening. Telephone calls to patients who were at work were made at times convenient to them.

NHS Health Checks were offered to all patients between the ages of 40 and 74. This was an opportunity to discuss any concerns the patients had and identify early signs of medical conditions.

Updated 22 January 2015

The practice was rated as outstanding for the population group of people experiencing poor mental health including people with dementia.

The practice had sign-posted patients experiencing poor mental health to various support groups, and they were proactive in helping patients address issues to improve all aspects of their health.

Home visits for patients suffering with dementia related conditions were carried out on a monthly basis to monitor and support patients and carers with the condition.

The practice worked closely with a local mental health rehabilitation centre and offered support to patients who resided here. Patients were offered longer appointments as required and were always seen on the day they requested appointment. The practice had a mobile telephone that was given specifically to patients who had a mental health need to ensure they could always access support from the practice.

Updated 22 January 2015

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable.

All the staff at the practice, including the receptionists, were proactive and innovative when following up information received about their patients, specifically those who were vulnerable. The staff knew all the practice patients well and were able to identify a person in crisis. Staff knew how to recognise signs of abuse in vulnerable adults and children. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies both in and out of hours.   Staff had extensive links with local organisations to assist them in providing effective and timely support as required.

The practice held a register of patients living in vulnerable circumstances including homeless people and those with learning disabilities (LD). The practice offered longer appointments for people with learning disabilities and carried out joint reviews with the patients, their families, carers and Community LD specialist team on a quarterly basis to address, adapt and monitor the care plans in place for this group of patients.

When vulnerable female patients attended for intimate examinations staff used pictorial processes to gain consent and inform the patient of the procedure. 

There was a local homeless shelter close to the practice and all patients at the shelter registered with the practice when they were first moved in. Patients continued their registration with the practice when they moved to a more permanent location unless they moved out of area.