Archived: Dr Umesh Chandra Kathuria Also known as City Health Centre

Updated 23 March 2017

Dr Umesh Kathuria, known locally as City Health Centre, is located in a residential area of Ladywood, Birmingham. The practice is registered with the Care Quality Commission (CQC) as a sole provider. The practice currently holds a Personal Medical Services (PMS) contract with NHS England. This is a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract. At the time of our inspection Dr Umesh Kathuria was providing medical care to approximately 1,463 patients.

The practice is in a converted house and is spread over two floors. All consulting rooms are on the ground floor.

There is one registered GP partner (male) and one salaried GP (male). A female locum GP works on a Thursday morning. The GPs are supported by a practice nurse, a practice manager and reception and administrative staff.

On Mondays the practice is open from 8.30am until 7pm. On Tuesdays, Wednesdays, Thursdays and Fridays, the practice opens between 8.30am and 6.30pm. Appointments are available during these times. Patients are referred to the out of hours provider between 8am and 8.30am. Out of hours cover is provided by Primecare. Patients can also use the three nearby walk in centres in the area, which are open daily from 8am to 8pm.

Updated 23 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Umesh Kathuria on 22 November 2016. Overall the practice is rated as inadequate.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, the majority of reviews were not thorough enough and there was minimal evidence of learning and communication with staff. No significant events were recorded in 2015.
• Risks to patients were generally assessed and managed, with the exception of those relating to recruitment checks. For example, one member of clinical staff did not have medical indemnity insurance.
• Data showed that patient outcomes were variable compared to the national average.
• Inconsistent coding meant that there was a risk of sharing incorrect information with other services.
• Under prevalence of chronic lung disease signified a potential lack of diagnosis and treatment.
• Although two audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• A female locum GP worked at the practice for one morning a week.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Patients said that they were treated with kindness, dignity and respect.
• Patients said that it was easy to make an appointment with a named GP and that they appreciated the continuity of care. Urgent appointments were available the same day.
• Information about services was available but the complaints leaflet was not available in hard copy in reception. Although three quarters of the patients were from ethnic minority backgrounds, the practice leaflet was only available in English.
• The practice had a number of policies and procedures to govern activity.
• The practice had a leadership structure, but there were limited effective formal governance arrangements. 

The areas where the provider must make improvements are:

• Review the coding of medical records to ensure that an accurate and contemporaneous record is maintained for all patients.
• Record safety incidents in a timely manner and ensure that learning is shared amongst all practice staff.
• Ensure that recruitment arrangements include all necessary employment checks for all staff, including medical indemnity cover.
• Ensure that the Hepatitis B status is recorded for clinical staff.
• Ensure that there is a system to identify carers and provide them with appropriate treatment and support.
• Carry out a systematic quality improvement programme, including patient identification and diagnosis, clinical audits and re-audits to ensure that improvements to patient outcomes have been achieved and maintained.
• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

In addition the provider should:

• Maximise the functionality of the computer system in order that the practice can run clinical searches, provide assurance around patient recall systems, consistently code patient groups and produce accurate performance data.
• Implement a system to track prescription pads through the practice.
• Adopt guidelines for checking uncollected prescriptions before destruction. Routinely review all patients who have been discharged from hospital.
• Take action to improve patient experience in relation to waiting times.
• Undertake a formal risk assessment before accepting a previously issued DBS check for a new employee.
• Continue to encourage patients to engage with the national bowel cancer screening programme.
• Ensure that key staff have offsite access to the disaster handling and business continuity plan.
• Provide practice information in appropriate languages.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 March 2017

The provider was rated as requires improvement for providing caring services and inadequate for safe, effective and well-led services. The issues identified as requiring improvement and inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was similar to the national average. For example, 88% had a specific blood glucose reading of 64 mmol/mol or less in the preceding 12 months compared to the CCG and national averages of 77% and 78%.
• Longer appointments and home visits were available when needed.
• QOF data showed low numbers for chronic lung disease (two patients were on the register). There was no dedicated clinic for chronic lung disease and spirometry was not provided at the practice. Patients were referred to other agencies for spirometry.
• We were told that training was ongoing for electrocardiograms (an electrocardiogram tests for problems with the electrical activity in the heart), diabetes initiation, phlebotomy (taking blood) and spirometry.
• Personalised care plans were in place, but a GP did not know how to access them.
• A diabetic consultant and nurse held a clinic at the practice every three months to review patients and to see patients face to face.
• 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. 

Updated 23 March 2017

The provider was rated as requires improvement for providing caring services and inadequate for safe, effective and well-led services. The issues identified as requiring improvement and inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• There were 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 A&E attendances. 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.
• The uptake for cervical screening programme for patients aged 25 to 64 in the preceding five years was 97%, which was higher than both the CCG average of 80% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies. 

Updated 23 March 2017

The provider was rated as requires improvement for providing caring services and inadequate for safe, effective and well-led services. The issues identified as requiring improvement and inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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.
• Patients who were aged 75 and over had a named GP, which provided continuity of care.
• The practice had signed up to the Unplanned Admissions enhanced service, which resulted in more personalised support being offered to those patients considered to be most at risk of unplanned admission, readmission and accident and emergency (A&E) attendance.

Updated 23 March 2017

The provider was rated as requires improvement for providing caring services and inadequate for safe, effective and well-led services. The issues identified as requiring improvement and inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 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.
• Patients were able to book routine GP appointments online as well as order repeat prescriptions at a time that was convenient for them.
• A full range of health promotion and screening was provided that reflected the needs for this age group.
• The practice provided NHS health checks for patients aged 40 to 74 years.

Updated 23 March 2017

The provider was rated as requires improvement for providing caring services and inadequate for safe, effective and well-led services. The issues identified as requiring improvement and inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 16% higher than the CCG and national averages. However, the exception reporting rate was 50%, which was 43% above both CCG and national averages.
• 90% of patients with poor mental health had a comprehensive care plan documented in the preceding 12 months, which was 1% below the CCG average and 1% above the national average.
• Two patients were on the dementia register and three were on the depression register. We were told that patients were coded as having anxiety or low mood instead, because they were reluctant to be diagnosed with either dementia or depression or accept the treatment.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice 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.
• The practice had a system to follow up patients who had attended A&E where they may have been experiencing poor mental health.
• Patients could be referred to external services for support, for example Birmingham Healthy Minds and Forward Thinking Birmingham (FTB). FTB provided services and facilities for 0-25 year old patients.

Updated 23 March 2017

The provider was rated as requires improvement for providing caring services and inadequate for safe, effective and well-led services. The issues identified as requiring improvement and inadequate overall affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• There were 12 patients on the learning disability register; 11 had had a review since April 2016.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients 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.
• Meetings were held every two months with other professionals to discuss cases of concern.
• The practice did not pro-actively identify carers and there was no carers’ register.