Archived: Dr Prem Jhittay

Updated 9 September 2016

• Dr Prem Jhittay’s practice is located in Erdington, Birmingham and has approximately 3100 registered patients.
• The practice is led by one full-time male GP and has two part-time salaried female GPs. There is also a female practice nurse, a practice pharmacist, a phlebotomist (who also worked as a receptionist), a healthcare assistant, a practice manager and two receptionists at the practice.
• Dr Prem Jhittay’s practice is also a teaching and training practice and takes on both medical students and GP registrars periodically. There were two GP registrars at the practice at the time of the inspection.
• The practice has a General Medical Services (GMS) contract. A GMS contract is a contract between NHS England and general practices for delivering general medical services.
• The practice is open between 8.30am and 6pm Monday to Friday except for Thursday afternoons when the practice closes at 12pm. Appointments take place from 8.30am to 11.50am every morning and 3.30pm to 5.50pm daily (except on Thursdays). The practice offers extended hours on Wednesdays from 6pm to 7.30pm.In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are also available for people that need them.
• The practice has opted out of providing out-of-hours services to their own patients and this service is provided by Birmingham and District General Practitioner Emergency Rooms (BADGER) medical service. Patients are directed to this service on the practice answer phone message. BADGER cover was also provided between 8am and 8.30am.
• The practice is located in an area with high levels of social and economic deprivation.

Updated 9 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Prem Jhittay’s practice on 30 June 2016. Overall the practice is rated as good.

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

• Staff we spoke with understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. We saw evidence to demonstrate that learning was shared amongst staff.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.
• We saw evidence to demonstrate that the practice had carried out a comprehensive analysis of its patient population profile and developed targeted services and made changes to the way it delivered services as a consequence. For example by offering more in-house services such as diabetes care or 24 blood pressure monitoring.
• Risks to patients were assessed and well managed.
• Feedback from patients about their care was consistently positive. Patients we spoke with told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
• The practice offered standard appointments times of 20 minutes with the GP and 30 to 60 minutes with the nurse.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 September 2016

• Performance for diabetes related indicators for the practice was 84% which was comparable to the CCG average of 83% and a national average of 84%. The practice had set up a pre-diabetic register and identified patients at higher risk of developing diabetes in order to support and advise patients on changes to prevent diabetes developing.
• The percentage of patients with chronic obstructive pulmonary disease (COPD) who had a review undertaken in the preceding 12 months was 96% which was higher than the CCG average of 89% and a national average of 90%.
• 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.
• Patients attending for annual reviews were allocated extended appointment times of 45 minutes to allow full discussion of their long term condition.
• Patients at risk of hospital admission were identified as a priority and had care plans in place.

Updated 9 September 2016

• Same day appointments were available for children and those with serious medical conditions.
• Immunisation rates for childhood vaccinations were above CCG averages.
• The practice had a robust follow up strategy for children who were not brought to appointments for their immunisations and routine checks.
• The practice held weekly health visitor baby health clinics which ran alongside the practice nurse led immunisation clinics which accommodated 6-8 weeks checks and immunisations.
• Weekly antenatal clinics were held alongside vaccination clinics resulting in higher vaccination uptake rates in pregnant women.
• The practice’s uptake for the cervical screening programme was 86%, which was above the CCG average of 78% and the national average of 82%.
• Appointments were available outside of school hours.

Updated 9 September 2016

• 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 home visits and urgent appointments for those with enhanced needs.
• The leadership of the practice had engaged with this patient group to look at further options to improve services for them. For example, the practice had identified patients on practice registers that were housebound or over 65 years old who had not been seen at the practice for three years or more. Those identified were then visited and an assessment undertaken to determine any patient needs.
• A facility for online repeat prescriptions and appointments bookings was available.
• There were longer appointments available for older patients.
• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice. Patients were able to book telephone consultations with the GP.
• The practice had a level access and the consultation rooms were all located on the ground floor. A hearing loop was also available at the practice.
• There were disabled facilities available and the practice had a ramp at the entrance to the building to enable easy access for patients with mobility difficulties.
• There were marked parking bays for the disabled near the practice.

Updated 9 September 2016

• 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 offered extended hours on a Wednesday from 6pm to 7.30pm to accommodate working patients who could not attend during normal opening hours.
• Patients could book appointments or order repeat prescriptions online. Patients were also able to book telephone consultations with the GP.
• Text message reminders of appointment times were in place to try and reduce non-attendance rates.
• The healthcare assistant conducted the health checks and gave some advice on health promotion as well as making referrals to the health trainer where appropriate.

Updated 9 September 2016

• Performance for mental health related indicators was 88% which was comparable to the CCG average of 87% and a national average of 87%.
• The practice carried out advance care planning for patients with dementia. For example, the practice regularly screened patients identified as at risk of dementia and ensured prompt referral to appropriate services where applicable, to provide early interventions.
• A practice pharmacist provided further support and advice about the changing medicine needs of patients and to ensure effective medicine reviews.
• There were longer appointments available for patients with complex needs such as those with dementia, a learning disability and patients experiencing poor mental health.
• 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 good knowledge of the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005. We saw evidence that the GP had completed mental capacity training.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 9 September 2016

• The practice held a register of patients living in vulnerable circumstances and alerts were in place on the clinical patient record system.
• Patients on the learning disability register were all provided with ‘learning disability passports’ to take with them when accessing services such as hospital care. These learning disability passports set out details such as patient likes and dislikes as well as the medication or health needs.
• There were longer appointments available for patients with complex needs such as those with dementia or a learning disability. Where possible, these patients were also seen without a booked appointment.
• There was a lead staff member for safeguarding and we saw evidence to show that staff had received the relevant training.
• 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.
• Staff members we spoke with were able to demonstrate that they understood their responsibilities with regards to safeguarding.