Archived: Dr Harminderjeet Surdhar Also known as Fiveways Health Centre

Updated 3 September 2015

Dr Harminderjeet Surdhar’s Medical Practice is located in the Fiveways Health Centre and in the NHS Sandwell and West Birmingham Clinical Commissioning Group (CCG). The practice provides primary medical services to approximately 4,100 patients in the local community under a general medical services (GMS) contract. We reviewed the most recent data available to us from Public Health England which showed that the practice is located in one of most deprived areas in the country. The population served is younger than the national average.

The lead GP at the Dr Surdhar’s Medical Practice is male, and a female locum GP also works regularly at this practice. A practice manager, practice nurse (female), health care assistant (female) and five administrative staff also work at the practice.

The practice opening times are from 8.30am to 6.30pm on Tuesday and Friday and from 8am to 6.30pm on Thursday. Extended opening hours are provided from 8am until 7.30pm on Mondays and the practice is closed from 1pm onwards on a Wednesday afternoon.

The practice manager told us that when the practice was closed on a Wednesday afternoon, general medical service cover was provided by Badger, an out of hours provider. Primecare also provide out of hours cover when the surgery is closed in the evening. Primecare are the out of hours service contracted by the CCG.

We previously inspected the Dr Surdhar’s Medical practice on 4 August 2014 and found that improvements were required in some areas generally relating to governance arrangements, particularly relating to assessing and monitoring the quality of service provision and effective systems to manage risk. Other areas requiring attention were incident reporting, emergency equipment, mental capacity act, management of prescriptions, infection control, alert systems on patient records, review of policies and procedures, staff appraisal and complaints. These areas were reviewed as part of this comprehensive inspection.

Updated 3 September 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Harminderjeet Surdhar’s Practice, Fiveways Health Centre on 24 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health. It required improvement for providing safe services.

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

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff including any locum GPs or nursing staff who work at the practice.
• Ensure that sufficient numbers of staff are on duty including cover arrangements when practice nurse or health care assistants are on leave.

In addition the provider should:

• Ensure that the GP completes the necessary training to obtain a level 3 qualification in the safeguarding of vulnerable adults.
• Implement systems to ensure that staff are aware that the vaccine fridge should not be unplugged.
• Implement systems to ensure clinical waste is stored securely and not accessible to patients or other visitors to the practice.
• Ensure that all portable electrical appliances are routinely tested and display stickers indicating the last testing date.

• Ensure that systems are in place to ensure staff receive updates regarding best practice and clinical guidelines
• Implement a system for logging, investigating and acting upon verbal complaints received at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 September 2015

The practice is rated as good for the care of people with long-term conditions. The practice nurse took the lead role in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

87% of medicine reviews undertaken for patients with a long term condition on four or more medicines. Medicine reviews were undertaken within 72 hours of discharge from hospital for patients in this population group. The practice participates in Quality and Outcome Framework (QOF) which involved reviewing and monitoring patients with long term conditions/chronic diseases. Records seen demonstrated that the practice was a high QOF achiever.

The GP followed up patients who had been discharged from hospital who resided in a care home and the community matron visited patients in the community and provided feedback to the GP. Care plans were seen for those patients receiving end of life care.

Updated 3 September 2015

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, for example, children and young people who had a high number of accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Children under the age of five were offered a same day appointment when required. Child health surveillance checks were offered for new born babies. Quarterly meetings were held with the health visitors to address any safeguarding issues.

We saw that the practice promoted chlamydia screening for the young population.

Updated 3 September 2015

The practice is rated as good for the care of older people. Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. Vaccination programmes were available, for example influenza and shingles. The practice was in line with national averages in all patient categories for influenza vaccination uptake. Patients at higher risk of admission to hospital were identified and offered care plans and review under the unplanned admissions enhanced service. A local enhanced service had been introduced to identify patients aged over 75 years who were at higher risk of admission or clinical deterioration but did not fall under the unplanned admission enhanced service. The practice held a register of housebound patients to ensure reviews were booked for home visits. Multi-disciplinary team meetings were held every month and representatives from the practice clinical team, community matrons, district nurses and case manager’s team attended.

Elderly patients with long term conditions had care plans in place and regular reviews took place. Hospital and accident and emergency (A&E) attendance was monitored to enable the GP to make contact following discharge to ensure that there has been no change to health needs.

The GP attended a local care home twice per week which helped to ensure that patients received consistent care from a named GP. We were told that when required, end of life care planning was completed according to the patient’s wishes.

Updated 3 September 2015

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 reflected the needs for this age group. A health check including cardiovascular risk assessment was available for patients aged between 40-74 years and 75% of patients in this group had undertaken this health check.

Extended opening hours were provided one evening per week and the practice was open at 8am two mornings per week. Telephone consultations were available for those patients who were unable to access the practice during normal working hours.

The practice provided well man and well women clinics and recorded the smoking status of patients during routine consultations.

Updated 3 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 89% of people experiencing poor mental health had received an annual physical health check. Same day appointments were offered to patients to prevent any deterioration in mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Some staff had received training on how to care for people with mental health needs and dementia.

Patients newly diagnosed with dementia would be referred to services such as a memory clinic and given details of external support agencies.

Updated 3 September 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances and applied appropriate read codes to patient records. For example children with a protection plan or vulnerable adults. Details of those vulnerable patients were recorded on a board in the office for administrative staff to see. The process of putting a flag on these patients’ records had commenced. This flag would be used to alert staff that these patients may have additional needs. Longer appointments were offered for patients with a learning disability and for those with drug and alcohol addiction. A substance misuse clinic was held at the practice twice per week.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.

There were no homeless patients registered at the practice. However, we were told that homeless patients were able to register with the practice and the contact telephone number and next of kin details (where possible) would be obtained to enable contact with the patient the patient for health needs review. Patients would also be informed of the Health Exchange service where homeless people and rough sleepers could access primary medical services without an appointment. Staff monitored vulnerable adults or children who attended the accident and emergency department (A&E) frequently or who missed appointments. This information was brought to the GP’s attention who arranged appointments or worked with other health care professionals to ensure vulnerable patients’ health needs were being met.