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Dr Usman Akbar Good Also known as The Family Practice

Inspection Summary


Overall summary & rating

Good

Updated 17 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Usman Akbar also known as The Family Practice on 19 July 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The practice worked closely with two other practices in the area and outcomes and learning from complaints and significant events were shared appropriately between the practices at joint team meetings.

  • We saw evidence of “competition” between three collaborating practices which helped incentivise staff to ensure that patient needs were prioritised for example; we saw that flu vaccination targets were met.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. We saw that development and learning was prioritised by the practice and staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment during consultations with their GP. Satisfaction rates for consultations with nursing staff was lower than the national average but comparable to other practices in the area.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with on the day said it was difficult to make an appointment with their preferred GP. Urgent appointments were available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. However, the practice shared with us that they faced a number of challenges with the building.
  • There was a clear leadership structure and staff felt supported by management. Staff told us that they would feel confident to raise any concerns with the lead GP or practice manager.
  • The practice sought feedback from patients and the Patient Participation Group (PPG), which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

The practice offered a level two diabetes clinic where patients could be commenced on insulin therapy without having to attend the hospital. (Insulin is a drug used for diabetics which keeps blood sugar levels from getting too high or too low). This combined clinic could offer a multi-disciplinary service, including the input of a specialist dietician, a podiatrist and the lead GP who had specialist knowledge in this area. By offering these services closer to the patients’ home the practice could also reduce the burden on hospital services. In an area of high deprivation where travel costs could be prohibitive for some patients, services were planned to meet patient needs.

Patients at the practice could be difficult to engage due to their cultural diversity and understanding of health services. However, the percentage of women who had undergone a cervical screening test was 88% which was higher than the Clinical Commissioning Group (CCG) average of 77% and the national average of 82%. Patients would be contacted by the nurse who would explain the importance of this test in a culturally sensitive manner and in the patients' own language where appropriate.

The areas where the provider should make improvements are:

The service should continue to review the access to appointments and review the necessity of making changes to the telephone systems.

The practice should continue to review the results of patient satisfaction surveys in order to meet the needs of the patient population in the future taking into account improvements to the accessibility of services and clinicians.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Learning was widely shared with the staff team and across the collaborating BD8 group of practices. (BD8 refers to the postcode). Staff we spoke with were aware of and knowledgeable regarding incidents and outcomes. We saw that action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. We saw evidence that the practice would meet with patients to address any concerns. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. We saw evidence of multidisciplinary discussions at team meetings, where vulnerable children, adults and families were discussed.
  • Risks to patients were assessed and well managed.
  • The BD8 collaboration enabled the practice to maintain appropriate staffing levels and adopt a flexible approach to meeting patients’ needs. During a recent power failure the practice was able to use their links to other surgeries and clinicians to ensure continuity of care for their patients.

Effective

Good

Updated 17 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. Results showed that rates for breast and cervical screening were above CCG and national averages. There were clear arrangements in place to recall patients for reviews and follow up appointments.
  • Staff assessed needs and delivered care in line with current evidence based guidance, we saw evidence that guidelines were followed and shared with the staff team.
  • The practice participated in CCG initiatives such as Bradford Beating Diabetes and could offer specialist support to patients requiring help with insulin management. This reduced the need for patients to attend the local hospital.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. The practice held joint protected learning afternoons every three months, where meetings, discussions and training would take place. Staff were encouraged to remain up to date with their training and attend additional learning and development events which would improve patient care.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked effectively and collaboratively with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice continued to attempt to reduce the number of patients who did not attend for appointments by ringing patients the day before their appointment to remind them of their consultation. They would also send an SMS text message on the day.

Caring

Good

Updated 17 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with averages for the CCG for providing caring services, but rates were below national averages. For example, patients said nursing staff did not always treat them with care and concern or involve them in decisions about their care and treatment. However, patients told us that they were treated with care and concern by the GP and that they would recommend the practice to someone who had just moved to the local area.
  • Patients said they were treated with compassion, dignity and respect and their privacy was maintained during consultations.
  • Staff told us that if families had experienced bereavement, their usual GP contacted them. In recognition of religious and cultural observances, the GP would respond quickly, in order to provide the necessary death certification to enable prompt burial in line with families’ wishes. Where patients were nearing the end of life, the GP would give the family their personal mobile number so that they could be contacted quickly.
  • Information for patients about the services available was easy to understand and accessible. We saw evidence that new patient leaflets were available in numerous different languages and staff responded to patients in their preferred language where possible.
  • We were told that the multi-lingual Health Care Assistant (HCA) would conduct visits to newly registered Eastern European families to explain the benefits of attending review appointments, health assessments and childhood immunisations.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 17 August 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice liaised closely with the CCG and took part in CCG initiatives such as the Bradford Beating Diabetes programme.
  • Patients said they did not always find it easy to make an appointment with a named GP but urgent appointments were available the same day.
  • The practice held an extended hours clinic on a Monday until 7.30pm. Patients could also be seen at the two other collaborating practices until 7.30pm on a Tuesday and a Wednesday.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. The practice website could be translated into 80 different languages, including those relevant to the patient population.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. The practice held a healthy living event attended by multiple voluntary and care organisations following suggestions made by the PPG. This was evaluated as very successful by the patients who attended.
  • A PPG member told us that the practice were excellent at making timely referrals to secondary care. We were also told that for patients who struggled to understand referral letters, the practice would help them to choose where their treatment was undertaken and arrange this.
  • Information about how to complain was easy to understand and evidence showed the practice responded quickly to issues raised. We did not observe any displayed information informing patients how to make a complaint. However, the practice told us of high levels of deprivation and low levels of literacy within the population. In response to patient complaints we saw evidence that the practice would document the complaint and meet personally with the patient to resolve any issues.
  • Learning from complaints was shared with other practices, staff and stakeholders.
  • We were told that young children would always be seen on the day regardless of whether appointments were available or not.
  • The practice had identified numerous issues with the building including malfunctioning doors and inappropriate heating. We saw email evidence that the practice manager reported these issues regularly and attempted to have them resolved. The practice had taken legal advice regarding the environmental issues.

Well-led

Good

Updated 17 August 2016

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

  • The practice had a clear vision and strategy to deliver patient focused high quality care. Staff were clear about the priorities of the practice and this was discussed and reviewed in meetings.
  • There was a clear leadership structure and staff felt supported to develop and improve their skills by the GP and practice manager. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active and patients from the BD8 group held regular joint meetings which were attended by GPs.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 17 August 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Nursing staff were encouraged to develop competencies and skills to lead in the management of long term conditions.
  • Patients diagnosed with diabetes were offered longer, 40 minute appointments, so that they could discuss every aspect of their condition.
  • The practice offered a level two diabetes clinic where patients could be commenced on insulin therapy without having to attend the hospital. This innovative combined clinic could offer a multi-disciplinary service, including the input of a specialist dietician, a podiatrist and a lead GP with specialist knowledge. By offering these services closer to the patients’ home the practice could also reduce the burden on hospital services.
  • Outcomes for diabetes related indicators were comparable to other practices. For example the percentage of patients on the register who had a flu immunisation in the preceding 12 months was 98% compared to the CCG average of 96% and the national average of 94%. For some indicator results, the practice were slightly lower than national averages.
  • Patients could access Spirometry testing at the practice, this is a test of how well you can breathe and can help in the diagnosis of different lung diseases such as chronic obstructive pulmonary disease (COPD).
  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 17 August 2016

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

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Vulnerable children, young people and vulnerable family groups were discussed and reviewed in a multidisciplinary meeting every month.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Children could be seen by the nurse outside of school hours until 6pm in the evening and the premises were suitable for children and babies.
  • Patients at the practice could take advantage of the pharmacy first scheme. This allows people who receive free prescriptions to go straight to their pharmacist to receive treatment without needing to visit their GP first to get a prescription.
  • The percentage of women who had undergone a cervical screening test was 88% which was higher than the CCG average of 77% and the national average of 82%.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. The practice offered joint eight week baby checks where mothers and babies could be seen at the same time.

Older people

Good

Updated 17 August 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered urgent appointments for those with enhanced needs.
  • The practice offered home visits for older people and this was supported by a home visits protocol.
  • Flu vaccinations were offered to older patients in their own homes by the practice nurse. The uptake for vaccinations in patients over 65 years old was 87%.

Working age people (including those recently retired and students)

Good

Updated 17 August 2016

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

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • The practice would contact patients by telephone the day before they were due to attend the surgery and send an SMS text message to remind them of their appointment on the day.
  • Telephone consultations were available for patients who could not attend the surgery.
  • The practice offered an extended hours clinic until 7.30pm on a Monday. Patients could also access a GP at the two other BD8 group surgeries until 7.30pm on a Tuesday and Wednesday.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The GP patient survey showed that 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was slightly lower than the CCG and national average of 84%.
  • Data showed that 100% of patients with a mental health issue had their smoking status recorded in their notes in the preceding 12 months, but only 75% of patients had an agreed and documented care plan.
  • The practice nurse would opportunistically complete a short memory assessment with older patients and refer them to the GP if concerns were noted.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency when they may have been experiencing poor mental health.
  • 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 17 August 2016

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

  • The practice were aware of patients living in vulnerable circumstances including homeless people, travellers, carers and those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability, long term conditions or those who required an interpreter.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. The collaboration between the three practices enabled complex and vulnerable cases to be discussed confidentially and reviewed by clinicians with additional specialist knowledge in their monthly meetings.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Patients were able to access a benefits advisor at the surgery one morning per week.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. All the staff we spoke with on the day of inspection were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
  • High numbers of patients at the practice did not speak English as their first language and so were at risk of experiencing health inequalities. The diverse staff team were able to converse with patients in multiple languages and assist their access to health care.