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Archived: Dr Imran Haq Good Also known as Firs Surgery

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 4 October 2017

Letter from the Chief Inspector of General Practice

We previously carried out three announced comprehensive inspections and a focused inspection at Dr Imran Haq’s practice. Following an inspection in February and March 2015 the practice was rated inadequate overall and placed into special measures. Subsequent inspections in November 2015, February 2016 and July 2016 showed continuous improvement and the practice was rated as good overall in July 2016. The full comprehensive reports for these inspections can be found by selecting the ‘all reports’ link for Dr Imran Haq on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 September 2017 to confirm that the improvements made leading to the good rating in July 2016 had been sustained. The overall rating of good has been maintained.

Our key findings were as follows:

  • Improvements leading to the good rating in July 2016 had been sustained and the practice continued to make improvements for example, in relation to the quality outcomes framework.
  • Patient outcome data was mostly in line with local and national averages. However, performance was lower for childhood immunisations for under two year olds and uptake of bowel screening.
  • The practice’s list size had recently increased by approximately 350 patients following the closure of a nearby practice. The practice was in the process of assessing what impact this was having and whether action was needed to increase staffing.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety. These included safeguarding, medicines management and recruitment processes.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed high levels of patient satisfaction with the service. Patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Patients found it easy to make an appointment and access the service. Same day urgent appointments were available if needed. There was continuity of care.
  • Information about services and how to complain was available.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure with strong managerial support. Staff felt supported and worked well as a team.
  • Future direction and working with other local practices was currently in negotiation to identify areas for improving efficiency.
  • The practice sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Review and continue take action to improve the uptake of national screening programmes for bowel cancer and childhood immunisations for under two year olds.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 October 2016

  • There was an effective system in place for reporting and recording significant events.
  • Outcomes and learning to improve safety in the practice had been shared with staff and were discussed at practice meetings. Information was disseminated to all staff.
  • When there were unintended or unexpected safety incidents, people received reasonable support, information, and a verbal apology where appropriate. They were also told about any actions to improve processes to prevent the same thing happening again.
  • There had been improvements made to the safeguarding process. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. There was a lead member of staff for safeguarding children and vulnerable adults.
  • Risks to patients were assessed, embedded and well managed.

Effective

Good

Updated 6 October 2016

  • Unpublished and unverified data available from the practice for 2015/16 showed that significant improvements had been made in areas where the practice had been identified as an outlier for QOF (or other national) clinical targets.
  • There was evidence that audits were driving improvement in performance to improve patient outcomes such as in reducing antibiotic or hypnotics prescribing rates.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. Since the last inspection, patient records now contained sufficient documentation and the electronic patient system was being effectively utilised.
  • Care plans for mental health and learning disabilities were in place. Patients in the 2% of the most complex needs had their care plans updated since the last inspection to provide more concise and relevant information.

Caring

Good

Updated 6 October 2016

  • Results from the latest national GP patient survey published July 2016 were varied. Patients rated the practice near or above average for its satisfaction scores in most areas. However, results for consultations with the GP were lower than the local and national averages in some aspects.
  • We noted that as a result the GP had attended courses on more effective patient consultations. Some improvement was seen in patient satisfaction rates compared to the previous national patient survey published in January 2016.
  • We found that information for patients about the services available was easy to understand and accessible.
  • We found that since the last inspection, more support and information was being provided for carers.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 6 October 2016

  • There was evidence that the practice had more comprehensively reviewed the needs of its local population since the last inspection and had engaged with the Clinical Commissioning Group to secure improvements to services where these were identified.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available in the patient waiting areas. No formal written complaints had been received by the practice.

Well-led

Good

Updated 4 October 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The practice performed in line with local and national averages in relation to the patient outcomes and patient satisfaction with the service. Although uptake of childhood immunisations for under two year olds and bowel screening were areas for improvement.

  • The practice had sustained improvement seen at our last inspection in July 2016.
  • The provider was aware of the requirements of the duty of candour.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice sought feedback from staff and patients.
Checks on specific services

People with long term conditions

Good

Updated 6 October 2016

  • Longer appointments and home visits were available when needed.
  • Patients had a structured annual review to check that their health and care needs were being met.
  • Performance for diabetes related indicators for the practice was 77% which was slightly below the CCG average of 83% and a national average of 84%. Data available from the practice for 2015/16 showed that therehad been an improvement with the practice performance now at 80%. However, this was not published and verified data.
  • For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice had care plans in place for 2% of patients with the most complex needs. We saw that since the last inspection, these care plans had been updated and refined.
  • There was a large variation in the percentage of patients with hypertension having regular blood pressure tests which was below the national average. The practice average of 73% compared to a national average of 84%. Unpublished and unverified data available from the practice showed that therehad been significant improvement for the year 2015/2016.

Families, children and young people

Good

Updated 6 October 2016

  • Same day appointments were available for children and those with serious medical conditions.
  • Immunisation rates for childhood vaccinations were in line CCG averages.
  • The practice’s uptake for the cervical screening programme was 66% which was below the CCG average of 78% and the national average of 82%. However, we saw evidence to demonstrate that the most recent uptake rates had significantly improved through the implementation of various strategies.
  • Appointments were available outside of school hours and the premises were suitable for children and babies and baby changing facilities were available.
  • We saw positive examples of joint working with district nurses and health visitors
  • Gaps previously found in the understanding of when a safeguarding referral may be appropriate had been fully addressed by the practice.

Older people

Good

Updated 6 October 2016

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Longer appointments were also available for older people when needed.
  • There were disabled facilities and translation services available.
  • The practice had a level access to the front entrance.
  • Online appointments were available as well as online repeat prescriptions.
  • Older patients who were in the top 2% of complex needs had a completed care plan to support their needs.

Working age people (including those recently retired and students)

Good

Updated 6 October 2016

  • The practice offered extended hours on Thursdays from 6pm to 8pm for working patients who could not attend during normal opening hours.
  • Patients could book appointments or order repeat prescriptions online.
  • Patients were able to book telephone consultations with the GP.
  • The practice offered a full range of health promotion and screening that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 October 2016

  • Performance for mental health related indicators was 94% which was above the CCG average of 87% and a national average of 87%.
  • The percentage of patients with physical and/or mental health conditions whose notes recorded smoking status in the preceding 12 months was 86% for the practice compared to CCG and national averages of 94%. Unpublished and unverified data available from the practice showed that there were had been an improvement for the year 2015/2016. We saw that care plans were also now in place for these patients.
  • The practice maintained a mental health register on the clinical system.
  • Staff had received training on how to care for people with mental health needs.
  • The practice had informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The GP we spoke with had knowledge of the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 6 October 2016

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability or suffering from poor mental health and alerts were in place on the clinical patient record system.
  • Translation services were available.
  • The practice offered longer appointments for patient requiring an interpreter or for those with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Since the last inspection, patients with learning disability or poor mental health now had a care plan in place to further support this.
  • The practice had policies that were accessible to all staff which outlined who to contact for further guidance if they had concerns about a patient’s welfare.
  • There was a lead staff member for safeguarding and we saw evidence to show that staff had received the relevant training.
  • Staff members we spoke with, including the GP, were able to demonstrate that they understood their responsibilities with regards to safeguarding.