Archived: Dr Saptarshi Saha Also known as Dr S Saha Surgery

Updated 22 June 2017

Dr Saptarshi Saha’s Surgery is also known as Darlaston Health Centre. The practice is located in Walsall, West Midlands and is situated in a multipurpose modern built NHS building, providing NHS services to the local community. Dr Saptarshi Saha’s practice is part of the Modality Partnership which is a GP partnership where partners own shares of the organisation. Modality Partnership provides one model of care across 25 different locations in Sandwell, Birmingham, Walsall and Hull.

Based on data available from Public Health England, the levels of deprivation in the area served by Dr Saptarshi Saha Surgery are below the national average, ranked at two out of 10, with 10 being the least deprived. (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial). The practice serves a higher than average patient population aged between zero to 39, and below average of patients aged between 40 and 85 plus.

The patient list is approximately 3,535 of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients; for example, childhood vaccination and immunisation scheme.

The surgery is situated on the ground floor of a multipurpose building shared with other health care providers. On-site parking is available with designated parking for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staffing comprises of one GP partner and one locum GP (both male), one advanced nurse practitioner, one health care assistant, one practice operations manager, four receptionists and two administrators.

The practice is open between 8.30am and 7.30pm on Mondays, 8.30am and 6:30pm on Tuesdays, Wednesdays and Fridays and between 8.30am to 12.30pm on Thursdays.

GP consulting hours are from 8.30am to 1pm and 4pm to 7.30pm on Mondays, 8.30am to 12.30pm and 2.30pm to 6pm on Tuesdays, Wednesdays and Fridays; and 8.30am to 12.30pm on Thursdays. Extended consulting hours are offered on Mondays until 7.30pm. The practice has opted out of providing cover to patients during the out of hours period. During this time services are provided by NHS 111. During the surgeries in-hours closure on Thursdays, sevices are covered by WALDOC (Walsall Doctors On Call).

The practice was previously inspected by CQC on the 3 October 2014 where we rated the practice overall as requires improvement. We then undertook a follow up inspection on 25 May 2016 to review in detail whether actions taken by the practice lead to improvements of the quality of care being provided.

During the May 2016 inspection, we found that the practice was required to make further improvements. Therefore we took enforcement action in relation to the practice not establishing systems for managing relevant patent safety alerts. Arrangements for responding to medical emergencies had not been established; there were areas where risks and staff training were not well managed. As a result we placed the practice into special measures.

This inspection was carried out to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was now meeting legal requirements.

Updated 22 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Saptarshi Saha also known as Darlaston Health Centre on 25 May 2016. The overall rating for the practice was inadequate and the practice was placed in to special measures for a period of six months. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Saptarshi Saha on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 11 April 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• The practice operated effective systems for reporting and recording significant events. Significant event logs showed that the practice had responded and learned from safety incidents.

• Effective system were in place to receive and act on alerts from the Medical and Healthcare products Regulatory Agency (MHRA) alerts.

• At our May 2016 inspection, some medicines required to respond to medical emergencies were not stored within the practice. During this inspection we found that the arrangements to respond to medical emergencies had been strengthened.
• The practice had clearly defined and embedded systems to minimise risks associated with legionella, fire and health & safety.

• Overall Quality Outcomes Framework (QOF) performance remained above local and national averages. Uptake of bowl cancer screening had increased since the May 2016 inspection.

• Clinical guidelines were cascaded to all the clinical team; staff had the skills and knowledge to deliver effective care and treatment. The practice used clinical audits in most areas to monitor quality improvements. However, audits of completed joint injections were not being carried out.

• The July 2016 national GP patient survey showed areas where patient satisfaction had either increased or declined since the previous inspection. The practice were aware of these results and took actions to improve patient satisfaction.
• Completed Care Quality Commission comment cards showed that patients felt they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Previously complaints were not being managed effectively. During this inspection the practice were able to clearly demonstrate improvements made to the quality of care as a result of complaints and concerns. New ways of working were established in response to survey results.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Staff felt supported by management. The practice had a number of policies and procedures to govern activity which staff had access to and held regular practice meetings. However, there were areas where oversight of some procedures were not carried out effectively such as managing uncollected prescriptions.
• The practice sought feedback from staff. The practice had an active patient participation group (PPG) and we saw measures in place in order to increase PPG membership and seek feedback from patients, which it acted on.

However, there were areas of practice where the provider should make improvements.

• Ensure staff are aware of practice policies and procedures and that these are adhered to and operated effectively.

• Establish an effective system for monitoring the overall stock of prescription stationery.

• Ensure clinical improvement initiatives are monitored to measure performance and quality improvements in all areas of need.

• Continue to consider ways of encouraging the uptake of national screening programmes such as bowel and breast cancer.

• Continue to review national GP patient survey results, internal patient feedback and explore effective ways to further improve patient satisfaction. Explore options to enable patients to be treated by a clinician of the same sex if and when requested.

• The practice should explore initiatives to improve engagement with patient groups where exception reporting is above local and national averages.

• Explore how to provide a service for patients who are unable to attend the practice.

• Ensure clinical performance initiatives are carried out to monitor quality improvements.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 June 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The percentage of patients diagnosed with diabetes who had a blood sugar reading which showed that the condition was being controlled appropriately was 84%, compared to the CCG average of 79% and national average of 78%. With a exception reporting rate of 10%, compared to CCG average of 10% and national average of 13%.
• Patients had access to a specialist diabetic nurse who attended the practice once a fortnight. There was a clear referral processes in place.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• The practice offered a range of services in-house to support the diagnosis and monitoring of patients with long term conditions including spirometry, phlebotomy, electrocardiogram (ECG) testing and followed recognised asthma pathways.
• All these patients had a named GP and there was a system to recall patients for 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.  

Updated 22 June 2017

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

• The practice was able to demonstrate systems 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.
• Staff we spoke with were able to describe how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.
• The practice’s uptake for the cervical screening programme was 84%, which was above the CCG average of 81% and national average of 82%.
• The practice provided support for premature babies and their families following discharge from hospital. GPs and practice nurse operated a weekly baby clinic where immunisations were given and GPs carried out health checks. Immunisation rates were relatively high standard childhood immunisations.
• The premises were suitable for children and babies. Appointments with GPs and nurses were available outside of school hours. Rooms were available for breast feeding and there were baby changing facilities.
• The practice worked with midwives, health visitors and school nurses where possible to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 22 June 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. For example, the practice had a dedicated phone line for at risk, frail and palliative care patients.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had a named lead that identified at an early stage older patients who might need specialist care, as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, patients were sign posted to Age UK.

Updated 22 June 2017

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

• The needs of these populations had been identified and the practice had adjusted some services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours were available with GPs and nurses.
• The practice was proactive in offering online services, telephone consultations; test results were available via a text messaging service.
• The practice offered travel vaccinations available on the NHS and staff sign posted patients to other services for travel vaccinations only available privately such as yellow fever centre (able to provide vaccination for a tropical virus disease transmitted by mosquitoes which affects the liver and kidneys).
• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.

Updated 22 June 2017

The practice is rated as requires improvement for providing effective and responsive care for people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.

• QOF data showed that 80% of patients diagnosed with dementia had their care plans reviewed in a face-to-face review in the preceding 12 months, compared to CCG and national average of 84%. Unverified data provided by the practice showed that 83% received a care plan and medicines review in the last 12 months.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs; data provided by the practice showed that 93% received a medicines review in the past 12 months.

• The percentage of patients diagnosed with mental health who had a comprehensive, agreed care plan documented in their record in the preceding 12 months was 95%, which was comparable to the CCG average of 92% and national average of 89%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia. A Community Psychiatric Nurse attended the practice fortnightly.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff we spoke with during the inspection had a good understanding of how to support patients with mental health needs and dementia.

Updated 22 June 2017

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 including homeless people, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability. Data provided by the practice showed that annual reviews were carried out.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, the practice provided a shared care service in partnership with the local addiction service for patients with opiate dependency allowing them to obtain their medicine at the surgery.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and outside normal working hours.
• The practice held a carers list. Carers had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Data provided by the practice showed that 2 % of the practice list were carers.