Archived: IH Medical Practice

Updated 31 March 2015

Drs Pahwa and Pahwa are registered for primary medical services with the Care Quality Commission (CQC). The registered location is Bilston Health Centre and a branch surgery is located at Goldthorn Medical Centre. Patients were able to visit either site. During this inspection we only visited Bilston Health Centre.

The registered patient list size is approximately 3900 patients. The practice is open Monday to Friday 8am until 6.30pm. It closes at 1pm on Thursdays. On a Thursday afternoon an answerphone message directs patients to the Primecare service who provide cover during this time. Extended opening hours are available between 6.30pm and 7.30pm on a Tuesday at Goldthorn Medical Centre and Wednesday at Bilston Health Centre.

Staffing at the practice consists of two GPs who work across the two practice sites (one male and one female). A practice nurse who works three hours per week at the main practice and six reception staff at each site (three at each practice site).

The practice has a General Medical Service contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as for example, chronic disease management and end of life care.

The practice is part of NHS Wolverhampton CCG Clinical Commissioning Group (CCG). The CCG serves communities across the borough, covering a population of approximately 261,000 people registered with 50 practices. A CCG is an NHS organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

We reviewed the most recent data available to us from Public Health England which showed that the practice age distribution of patients at the practice was similar to the national average. The income deprivation score was higher than the England average.

The practice had opted out of providing out-of-hours services to their own patients. This service was provided by an external out of hour’s service (Primecare).

Updated 31 March 2015

Letter from the Chief Inspector of General Practice

We completed a comprehensive inspection at Drs Pahwa and Pahwa Surgery on 27 November 2014. The provider also operates a branch surgery (Goldthorn Medical Centre) but we did not inspect the branch surgery as part of our visit. The overall rating for the practice is requires improvement. We found the practice required improvement in providing a service that is safe, effective, caring, responsive and well-led.

Our key findings were as follows:

• Systems in place were not robust to ensure patients received a safe service. Staff lacked an understanding of risk management to keep patients safe.

• There was some evidence of clinical audits, significant event analysis and best practice guidance in place. However, the practice was unable to show how it effectively used information and audits to drive improvements in patient outcomes.

• Services provided did not always demonstrate a responsive service. Patients did not always find it easy to access appointments including urgent appointments.

• Complaints processes did not ensure patients concerns were adequately addressed.

• The governance arrangements were not clearly defined to ensure effective management of risks and performance.

There were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure that robust systems to identify, monitor and manage risks to patients and others who use the service are put in place to protect patients from unsafe care. This includes risks relating to (but not exclusively) the premises, staffing, staff training, fire safety, records and prescriptions, potential emergencies.

• Identify patients who are most at risk due to complexity of their disease or multiple co-morbidities so that their comprehensive care needs can be identified, planned and managed.

• Ensure staff undertaking chaperoning duties have an understanding of their role and responsibilities.

• Ensure that all appropriate equipment at the practice has been tested for electrical safety, calibrated and serviced regularly.

• Ensure appropriate recruitment checks are undertaken to protect patients from the risk of unsuitable staff.

• Review its processes for handling and managing complaints and ensure they are fully investigated as far as practicable. Patients should be made aware of the process for escalating complaints. Information from complaints should be used to support learning and service improvement.

In addition the provider should:

• Maintain accurate training records for staff and ensure that the learning needs of staff are identified to enable them to do their job effectively and where appropriate plans implemented to ensure those learning needs are met.

• Ensure staff are aware of processes to support all patients whose first language is not English so that they can access the healthcare they need.

• Improve information available to patients so that they can access support services relevant to their needs.

• Review the appointment system and identify how it may be improved. This should include raising awareness of the online booking system and informing patients as to how they can access it.

• Ensure the whistle blowing policy supports staff to report concerns appropriately. Staff should be made aware as to where they can report concerns if they do not feel able to within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2015

The practice is rated as requires improvement for the population group of people with long term conditions. The GPs and practice nurse undertook annual reviews of patients with long term conditions. National data available showed the practice to be in line with other practices in the CCG area for the care of patients with long term conditions. The exception being diabetes in which the practice was an outlier and performing worse than other practices in the CCG area and nationally. There were no action plans in place to improve performance and outcomes for diabetic patients. Patients with deteriorating health were referred to secondary care but some patients described access to appointments including emergency appointments as difficult in order to get the healthcare support they needed. Home visits were available for patients who were unable to attend the practice . The practice did not actively offer longer appointments but told us they were not strict about appointment times.

The rating for people with long term conditions is requires improvement. This is because the provider was rated as requires improvement for safety, effective, caring, responsive and well-led. The concerns which led to those ratings apply to everyone using the practice, including this population group.

Updated 31 March 2015

The practice is rated as requires improvement for population group of families, children and young people. Systems were in place for identifying children living in disadvantaged circumstances and who were at risk. However, there were no specific systems for following up patients such as children and young people who had a high number of A&E attendances or did not attend for immunisations. Immunisation rates for the standard childhood immunisations was mixed. For example Meningitis C immunisations were worse than the CCG average.

Children with deteriorating health were referred to secondary care but some patients described access to appointments including emergency appointments as difficult in order to get the healthcare support they needed. Emergency processes were in place for pregnant women who had a sudden deterioration in health through the midwife. Appointments were available outside of school hours and the main practice premises seen were accessible for pushchairs.

Baby checks were undertaken at the practice and one GP had specialist training in sexual health which enabled them to provide additional family planning services to patients. A male and female partner meant patients were able to be seen by a GP with the gender of their choice.

The rating for families, children and young people is requires improvement. This is because the provider was rated as requires improvement for safety, effective, caring, responsive and well-led. The concerns which led to those ratings apply to everyone using the practice, including this population group.

Updated 31 March 2015

The practice is rated as requires improvement for the care of older people. Nationally reported data showed that the practice outcomes for conditions commonly found in older people were mixed. Dementia diagnosis rates for the practice were lower than the national average but we were told that they were in the processes of identifying patients in order to develop appropriate plans of care for this group of patients. Although vaccination coverage for those over 65 years was in line with other practices in the CCG area. Coverage in the CCG was still below the England average and below the optimum protective target set by the World Health Organisation (WHO).

The practice had opted to offer the new enhanced service to follow up patients discharged from hospital. Enhanced services are services which require an enhanced level of service provision above what is normally required under the core GP contract. At the time of our inspection the GP told us that they were reviewing records and provided examples of follow up reviews undertaken as part of this. We saw examples of care plans that had been put in place for patients over the age of 65 years and those at the end of life. Patients who were housebound were able to receive home visits. The practice did not actively offer longer appointments but told us they were not strict about appointment times.

The rating for older people is requires improvement. This is because the provider was rated as requires improvement for safety, effective, caring, responsive and well-led. The concerns which led to those ratings apply to everyone using the practice, including this population group.

Updated 31 March 2015

The practice is rated as requires improvement for the population group of the working-age people (including those recently retired and students). The practice patient age profile is similar to the national average and consists mainly of patients who are of working age. Services were available that reflected the needs of patients in this age group. The practice opened extended hours on two evenings each week until 7.30pm to accommodate the needs of working age patients. On-line booking for appointments had been introduced to make it easier for patients to book appointments. However there was very little information available informing patients about the on-line booking and how to access it.

The practice offered a range of services for the working age population, those recently retired and students. These included NHS health checks, cervical screening and most travel vaccinations. Uptake of these services was not monitored or actively followed up to encourage attendance. There was some health promotion material available at the practice but this was limited.

The rating for working age people is requires improvement. This is because the provider was rated as requires improvement for safety, effective, caring, responsive and well-led. The concerns which led to those ratings apply to everyone using the practice, including this population group.

Updated 31 March 2015

The practice is rated as requires improvement for the population group of people experiencing poor mental health (including people with dementia).

The practice had a register for patients with poor mental health. Data available nationally indicated that the practice was in line with other practices for the proportion of patients with a mental health care plan. The practice dementia diagnosis rates were lower than the national average however the GPs told us that they were starting to identify patients in this group in order to develop appropriate plans of care for them.

Clinical staff we spoke with had an understanding of the Mental Capacity Act and about the appropriate use of restraint which was documented. There was limited evidence of multi-disciplinary working with the mental health service in the case management of patients experiencing poor mental health or for the availability of information for relevant support organisations.

The rating for people experiencing poor mental health (including dementia) is requires improvement. This is because the provider was rated as requires improvement for safety, effective, caring, responsive and well-led. The concerns which led to those ratings apply to everyone using the practice, including this population group.

Updated 31 March 2015

The practice is rated as requires improvement for the population group of people whose circumstances make them vulnerable. The practice is located in one of the most deprived areas in the country. The practice held registers for some vulnerable groups such as patients with learning disabilities and could identify patients who were at risk through alerts on patient records. Some staff had received training and had an understanding of how to recognise and what action to take if they were concerned a patient may be at risk of harm.

Annual health checks were available for patients with learning disabilities and we saw some evidence of this. Multi-disciplinary team working to support vulnerable patients with complex care needs was limited. There were no specific arrangements in place so that patients who were homeless could receive health care at the practice. The practice was also unable to adequately demonstrate how it supported all patients whose first language was not English to access the service.

The rating for people whose circumstances may make them vulnerable is requires improvement. This is because the provider was rated as requires improvement for safety, effective, caring, responsive and well-led. The concerns which led to those ratings apply to everyone using the practice, including this population group.