Archived: Dr Priyanand Hallan Also known as Valhalla Clinic at Park House Surgery

Updated 23 December 2016

Dr Priyanand Hallan’s practice is located within the Park House Surgery in the Great Barr area of Birmingham. The practice has a Personal Medical Services contract (PMS) with NHS England. A PMS contract offers local flexibility by offering variation in the range of services which may be provided by the practice. The practice also provides some directed enhanced services such as childhood vaccination and immunisation schemes. The practice had an approximate list size of 2300 patients

The practice is based within the Sandwell and West Birmingham CCG area. The practice is run by a lead male GP (provider). There is one practice nurse and the non-clinical team consists of administrative and reception staff and a practice manager.

The practice opening times are from 8am to 6.30pm Monday to Friday, except Wednesday when the practice closes at 1pm, during this time phone lines are diverted to another local practice. Saturday opening is also available from 9am to 12 noon. The practice has opted out of providing out-of-hours services to their own patients. When the practice is closed an out of hours answerphone message informs patients to contact the NHS 111 service which would assess and refer patients to the out-of-hours service provider Primecare.

The practice serves a higher than average population of women aged 30-34 years. The area served has lower deprivation compared to England as a whole and ranked at six out of ten, with ten being the least deprived.

The current premises pose difficulties with no parking or disabled facilities and limited space inside the building. The practice has amalgamated with another two local practices to purchase land and is in the process of having a new health centre built to house all three practices.

Updated 23 December 2016

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dr Hallan’s Surgery, also known as Park House Surgery on 20 October 2016. We had previously inspected this practice on 2 June 2015. As a result of that inspection the practice was rated as good overall and requires improvement for providing safe services. Following the inspection the practice wrote to us to say what they would do to meet the legal requirements.

As a period of 12 months had elapsed since the publication of the report we carried out a second comprehensive inspection of the practice and we also checked to see whether the improvements identified at the first inspection had been actioned.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Since the last inspection in June 2015, the practice had introduced a system to analyse significant events and incidents, these were documented and shared with staff.
• Effective recruitment procedures have been implemented since being identified at the comprehensive inspection in June 2015. This included undertaking Disclosure and Barring (DBS) checks for staff that required them.
• Systems had been put in place identified as an area of improvement at the last inspection, to ensure patients’ needs were assessed and care was planned and delivered following best practice guidance.
• The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.
• The practice had implemented effective systems in the management of risks including infection control procedures.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice had reviewed their current patient record system to ensure that read codes were being used appropriately.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice worked closely with other organisations in planning how services were provided to ensure that they met patients’ needs.
• The building posed limitations with no parking, no disabled facilities and restricted space, but the practice had joined with two other local practices to purchase land and was planning on moving to new premises in the near future.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result. The provider was aware of and complied with the requirements of the duty of candour.
• There was a clear leadership structure and staff felt they were supported by the practice manager and GP. The practice proactively sought feedback from staff and patients, which it acted on.

There are areas where the provider should make improvements:

• Improve the system for the identification of patients who are carers and provide them with appropriate support.
• 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.
• Ensure the risk assessment for not having a defibrillator in place is effective in mitigating risks.

• Continuously monitor the availability of emergency medicines to ensure sufficient quantities are available when required.

• Continue to review patient satisfaction scores to ensure patients' needs are being met.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 December 2016

• Nursing staff had lead roles 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.
• 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. We saw evidence that meetings were held every three months.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions, including a DMARD monitoring service.
• A consultant led diabetes clinic was held every three months to support patients with complex diabetes needs.
• Practice data showed that there were 38 patients on the Chronic Obstructive Pulmonary Disease COPD register and 68% had received their flu vaccination since the flu campaign had commenced in September 2016

Updated 23 December 2016

• 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 A&E attendances.
• Appointments were available outside of school hours and the premises were suitable for children, but there were no baby changing facilities available. Staff told us that if a mother required somewhere for baby changing or breast feeding they would be offered a private room.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The midwife provided antenatal care every week at the practice.
• Childhood immunisation rates for under two year olds ranged from 88% to 100% compared to the CCG averages which ranged from 52% to 94%. Immunisation rates for five year olds ranged from 86% to 96% compared to the CCG average of 55% to 95%.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice’s uptake for the cervical screening programme was 87% which was higher than the national average of 82%.

Updated 23 December 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Care plans were in place for those at risk of unplanned admissions. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included blood tests, vaccinations and a dedicated phone line for those patients who were unable to access the practice.
• The practice worked closely with multi-disciplinary teams so patients’ conditions could be safely managed in the community.

Updated 23 December 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 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.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years..
• The practice offered a choice of extended hours to suit their working age population, with later evening appointments available once a week and on a Saturday morning. Results from the national GP survey in July 2016 showed 72% of patients were satisfied with the surgery’s opening hours which was similar to the CCG average of 71%, but lower than the national average of 78%.

Updated 23 December 2016

• Data from the Quality and Outcome Framework (QOF 2015/16) showed 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Data from QOF (2015/16) showed 100% of patients on the practice’s mental health register had had their care plans reviewed in the last 12 months, which was higher than the national average of 88%.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 December 2016

• The practice held a register of patients living with a learning disability, frail patients and those with caring responsibilities and regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice offered longer appointments and annual health checks for people with a learning disability. Data provided by the practice showed that there were five patients on the learning disability register and two had received their annual health checks within the last 12 months. The practice sent regular appointments to patients and was actively trying to reduce the number of patients who did not attend their health checks.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and held meetings with the district nurses and community teams every three months.
• 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.
• The practice’s computer system alerted GPs if a patient was also a carer. There were 12 patients on the practices register for carers; this was 0.5% of the practice list. The provider had produced a carer’s pack and had a carer’s corner .
• The practice held an audiology clinic every week for patients who were suffering hearing difficulties.