Archived: Dr Hanume Thimmegowda Also known as Albion Mount Medical Practice

Updated 7 September 2016

Dr Hanume Thimmegowda provides primary medical services to 6108 patients in Dewsbury under a personal medical services (PMS) contract. The practice is known locally as The Albion Mount Medical Practice.

The practice is located in a purpose built, newly extended building in central Dewsbury close to local bus and train stations and the market.

There are five consulting rooms, two nurse/treatment rooms, a meeting room, reception area, waiting room, offices and staff areas. There is an attached pharmacy and parking is available.

The practice has a single storey purpose built branch surgery which is located at Mountain Road Surgery, 111 Mountain Rd, Thornhill, Dewsbury, WF12 0BS. The majority of staff work at both sites.

There are three GP partners (two male and one female), a female advanced nurse practitioner, four female practice nurses, a female health care assistant, a practice manager, assistant practice manager and a team of administrative staff.

The practice accepts three third year medical students per year for five week periods.They are in the process of applying to be a training practice.

The Albion Mount surgery is open between 8am and 6.30pm on Monday, Tuesday and Friday, 8am to 7pm Wednesdays and 7.30am to 7.30pm Thursdays.

The Mountain Road branch practice is open between 8am and 1pm Monday, 7.30am to 6.30pm Tuesday, 8am to 4pm Wednesday and Friday and 8am to 12.30pm Thursdays.

When the practice or branch closes early an answerphone message asks patients to telephone the other surgery. When the surgery is closed, telephone calls are transferred to Local Care Direct which is the out of hours service provider.

Twenty four per cent of the patient population are of black and ethnic minority, a significant proportion of which are of South Asian origin. Twenty eight per cent of older people are affected by income deprivation (national average 16%).

Updated 7 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hanume Thimmegowda on 29 June 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

• The practice used every opportunity to encourage eligible women to attend for cervical screening. The uptake for the cervical screening programme was 91%, which was significantly higher than the Clinical Commissioning Group (CCG) and national average of 82%.

• The practice could demonstrate significant improvements for patients with chronic obstructive pulmonary disease (COPD). Data showed that COPD related indicators were higher than the national average and the practice demonstrated additional improvements in 2015/16. For example, 2014/15 data showed that 94% of patients with COPD had their diagnosis confirmed by in-house post bronchodilator spirometry (CCG average 92%, national average 90%). We saw evidence that this increased to 99% in unverified 2015/16 data provided by the practice.

The areas where the provider should make improvement are:

• Carry out risk assessments of non-clinical staff to identify whether Disclosure and Barring (DBS) checks are necessary.
• Put arrangements in place for the periodic testing of building electrical systems.
• Provide emergency oxygen at the branch practice.
• Install and train staff in the use of secondary temperature monitoring devices for the vaccine fridges and take appropriate action to ensure the vaccine fridge at the branch practice cannot be switched off or unplugged by mistake.
• Put systems in place to identify patients who are carers and support them as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 September 2016

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.
• The nurse practitioner lead on diabetes care. Ninety two per cent of patients with diabetes had a record of a foot examination and risk classification within the preceding 12 months (CCG average 89%, national average 88%).
• A practice nurse had received additional training and specialised in the care of COPD patients. Staff carried out spirometry testing in house, 94% of patients with COPD had their diagnosis confirmed by post bronchodilator spirometry (CCG average 92%, national average 90%). Data from 15/16 showed this had increased to 99%.
• Longer appointments and home visits were available for patients with long term conditions when needed. Two patients told us that they had found it easy to arrange home visits.
• All these patients had a named GP and a structured annual review to check their health and medicine 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 7 September 2016

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

• 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. 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 practice used every opportunity to encourage eligible women to attend for cervical screening. The practice’s uptake for the cervical screening programme was 91%, which was better than the CCG and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice hosted weekly midwife sessions. Postnatal examinations and baby checks were managed jointly by the practice nurses and GPs.
• A full range of contraceptive advice was provided. A GP was trained in fitting and removing intrauterine coils and contraceptive implant devices.
• We discussed positive examples of joint working with midwives, health visitors and school nurses.
• Posters promoting family support and sexual health clinics were displayed throughout the practice.

Updated 7 September 2016

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.
• The practice provided influenza, pneumonia and shingles vaccinations, as well as annual checks for patients over the age of 75, who did not have identified long-term conditions and may otherwise not have attended.
• Older people with long term conditions, with frequent A&E or out-of-hours contact, were included on the avoiding unplanned admissions register. This provided patients with an individual care plan which enhanced GP awareness of any specific needs.
• The practice referred patients with long term conditions and those at risk of unplanned admission (but not under the care of a community matron) to the clinical care co-ordinator. Care co-ordinators assist older people to navigate health and social services successfully.
• GPs and the nurse practitioner carried out regular medication reviews. The practice recently participated in the local CCG polypharmacy review scheme, to improve support to people who required 10 or more repeat medications.
• The health care assistant and practice nurse regularly visited patients who were unable to attend the surgery in their own homes, to take bloods, complete annual health checks and electrocardiograms (ECGs). This is a test which measures the electrical activity of the heart.
• The practice supported older patients who were residents in local care homes. The GPs carried out regular visits for necessary checks. For example, medication reviews, diet advice and carer updates.

Updated 7 September 2016

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.
• The practice provided extended hours pre-bookable appointments, covering early mornings and late evenings for working people.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs of this age group. They provided online access to new patient checks, depression/alcohol questionnaires and travel vaccinations.
• The practice offered electronic prescribing. Medications were available directly from the pharmacy who ordered them on patients’ behalf.
• Students were encouraged to register with the practice for a temporary registration of up to three months to cover health requirements, whilst away from university or college.

Updated 7 September 2016

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

• 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months (CCG average 89%, national average 88%).
• 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 did not prescribe long term benzodiazepines and information was provided to all patients upon registration that patients taking these medications would be supported to reduce or gradually stop them. Patients in need of additional support were referred to local agencies.
• 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia. Staff had received additional training to understand the needs of dementia patients.

Updated 7 September 2016

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

• In partnership with local drug/alcohol support agencies, practice nurses carried out brief intervention advice during health checks and new patient registration, identifying patients who may have dependency problems. The practice hosted a weekly shared care alcohol service for registered patients.
• Patients experiencing addiction issues, either to prescription medications or street drugs, were referred to local support organisations for additional support.
• 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 registered patients from the local bail hostel. There was a no discrimination policy and vulnerable patients were welcomed. For example, homeless, travellers, vulnerable migrants, sex workers and patients with mental health or addiction issues, which may make them vulnerable.
• The practice informed vulnerable patients about 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.
• The practice identified patients who were carers and provided information to signpost them to local support services. A member of staff was identified as a Carers Champion and there were plans to improve the support offered to carers.