Archived: Dr Nisar- Ul Haque Also known as Dr. N U Haque PCHC

Updated 2 August 2017

Dr Nisar- Ul Haque is situated on the ground floor of a purpose built health centre providing NHS services to the local community in West Bromwich, West Midlands. The practice has an approximate patient population of 2100 and is part of the NHS Sandwell and West Birmingham Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

Dr Nisar- Ul Haque is registered with the Care Quality Commission to provide primary medical services. The practice has a general medical service (GMS) contract with NHS England. Under the GMS contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care.

Based on data available from Public Health England, the levels of deprivation (deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by Dr Nisar- Ul Haque are below the national average, ranked at one out of 10, with 10 being the least deprived.

The practice staffing comprises of one lead GP (male), two regular locum GPs (both male), a practice nurse, an advanced nurse practitioner and a healthcare assistant. The GP and the practice manager form the practice management team and were supported by a team of administration and reception staff.

The practice is open between 8am to 6.30pm Monday to Friday except on Thursdays when it closed at 1pm. The practice offered extended opening on Wednesdays from 6.30pm to 7.30pm. The practice collaborated with four other local practices locally to offer expanded services such as increased access. When the practice was closed on Thursday afternoons, patients were able to make an appointment at another local practice. We were told Saturday opening was also available at this site from 9.30am to 12pm and calls were automatically diverted.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by the external out of hours service provider.

Updated 2 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Dr Nisar- Ul Haque on 17 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Nisar- Ul Haque on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 30 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

• We saw arrangements had been made to receive MHRA alerts and a spreadsheet demonstrated actions that were being taken following receipt and discussions that had taken place between the clinical team. The patient record system we looked at showed searches were carried out on the system to identify relevant patients following receipt of alerts.

• We were told that the practice was taking part in the CCGs Primary care Commissioning Framework (PCCF) to improve quality. As part of PCCF (standard 8) the practice was required to encourage patients to attend cancer screening. We looked at the patient record system which showed that since April 2017, 68 patients had missed their appointment to attend screening for bowel cancer. However, 58 patients had been reminded by the practice to attend their appointments. We saw evidence that there was a plan to improve and monitoring was in place.

• When we inspected the practice in January 2017, we saw results from the national GP patient survey was generally below local and national averages for questions about their involvement in planning and making decisions about their care and treatment (with both Nurses and GPs). The practice had a strategy to improve and was monitoring this through ongoing in-house patient surveys using the same questions as the national GP patient survey. We saw an analysis of the in-house patient survey conducted in October 2016 which showed further improvements were required. At this inspection, another in-house survey from March 2017 showed significant improvement in patient feedback.

• During our previous inspection we saw that the practice was collaborating with four other local practices to offer extended opening hours, including Saturday afternoon appointments. However, the practice had not informed patients of this arrangement by updating information on the practice leaflet and website. At this inspection we saw that the practice leaflet and website had been updated with current and up to date information.

• At our previous inspection we saw QOF achievement for mental health indicators were above local and national averages. However, in some areas the exception reporting was above local and national averages. We were told that that this was due to the low number of patients on the register. We looked at the patient record system which confirmed this. We saw appropriate processes were in place to ensure patients were reviewed appropriately.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 May 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. A separate telephone line was available to high risk patients.
• Longer appointments and home visits were available when needed.
• Performance for diabetes related indicators was 86% compared to the CCG average of 88% and national average of 90%.
• Other long term conditions such as chronic obstructive pulmonary disease (COPD), asthma and hypertension showed patient outcomes were in line with the CCG and national averages.
• We saw evidence that multi-disciplinary team meetings took place on a regular basis.
• For convenience the practice offered a range of services in-house to support the diagnosis and monitoring of patients with long term conditions such as phlebotomy (blood taking) and electrocardiographs (ECGs) at the practice.
• 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 11 May 2017

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

• Immunisation rates for the standard childhood immunisations were above local and national averages.
• 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.
• The practice collaborated with four other surgeries and patients could access a GP at another practice on Saturdays. The practice also offered extended evening appointments from 6.30pm to 7.30pm on Wednesdays.
• Staff we spoke with demonstrated positive examples of joint working with midwives and health visitors.
• The practice was located in a purpose built health centre and was suitable for children and babies.
• Data from 2015/16 showed that the practice’s uptake for the cervical screening programme was 83%, compared to the CCG average of 80% and national averages of 81%.

Updated 11 May 2017

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

• 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. All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.
• The practice had effective systems in place to identify and assess patients who were at high risk of admission to hospital.
• A separate phone line was available for these patients and other high risk patients.
• Immunisations such as flu and shingles vaccines were also offered to patients at home, such as housebound patients who could not attend the practice.

• The practice was accessible to those with mobility difficulties.

Updated 11 May 2017

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

• 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 could access appointments and services in a way and at a time that suited them. Appointments could be booked over the telephone, face to face and online.
• The practice used text messaging to help remind patients of their appointments and for ease of cancelling.
• The practice offered extended evening appointments from 6:30pm to 7.30pm on Wednesdays to suit their working age population. The practice collaborated with four other local practices and offered Saturday appointments at another local surgery.
• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group. Practice data highlighted that they identified and offered smoking cessation advice and support to 80% of their eligible patients.

• For accessibility, telephone consultation appointments were available with a GP.
• The practice offered al range of health promotion and screening that reflects the needs for this age group. This included NHS health checks.
• The practice had taken on an enhanced service to provide screening for tuberculosis (a bacterial infection) to migrant patients and those that had travelled to high risk areas within the last six months.

Updated 11 May 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice regularly worked with other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia.
• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the local CCG and national averages. There were three patients on the register and the exception reporting was 0%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• A mental health counsellor held weekly clinics at the surgery and patients were seen through a referral process by their GP.

Updated 11 May 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Vulnerable patients were regularly seen in practice for care planning and medication reviews. The practice operated an effective recall system and individual care plans were developed to help ensure a tailored approach to care. For example, there were 14 patients registered at the practice with a learning disability, 33 with mental health as well as 40 patients with Chronic Obstructive Pulmonary Disease (COPD). The GP visited some of these patients at home, carried out reviews and administered vaccines where appropriate.
• Staff we spoke with knew how to recognise signs of abuse in vulnerable adults and children. Staff was 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 was actively trying to increase the number of carers registered with the service. The practice encouraged registration by offering access to a range of services, for example annual health checks and flu vaccinations. Data provided by the practice showed that the practice had increased the number of carers since our last inspection in March 2016.
• The practice offered longer appointments for vulnerable patients such as those with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.