Archived: Dr Anil Indwar

Updated 14 December 2017

Dr Anil Indwar’s practice (also known as Walford Street Surgery) 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.

The practice is located in a residential property that has been adapted for the purpose of providing primary medical services. Clinical services are provided on the ground floor of the premises. There is limited parking available at the front of the building however, parking is also permitted on the street. The practice’s registered list size is approximately 2300 patients.

Based on data available from Public Health England the practice is located in an area with higher levels of deprivation than the national average (within the 30% most deprived areas). The population age distribution of the practice broadly follows the national average.

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.

The practice is owned by a single handed GP (male), currently supported by a long term locum GP (male) who had been working at the practice since December 2016. Other practice staff includes a practice nurse (female), a practice manager and a team of administrative staff.

The practice is open Monday to Friday 8am to 6.30pm with the exception of Wednesday afternoons when the practice closes at 1pm. On a Wednesday afternoon the practice has reciprocal arrangements with another local practice for patients to be seen there. Consulting times are between 8am to 12 noon and 4pm to 6pm. When the practice is closed services are provided by an out of hours provider which can be accessed through the NHS 111 telephone service.

Updated 14 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Anil Indwar (also known as Walford Street Surgery) on 23 June 2017. The overall rating for the practice was good. However, we rated the practice requires improvement for providing well-led services. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Dr Anil Indwar on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 November 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 23 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• There were six patents on the practices dementia list and examples we looked at showed that the practice used hospital letters which outlined the management of the patient as part of their care plan. Evidence we looked at showed that there was enough information to deliver effective care and family members had an input in the plan where appropriate.

• The practice held a register of patients on the palliative care list and we saw evidence of discussion at multidisciplinary meetings. Information to deliver appropriate care to the patient was embedded into the patient record system. However, key information such Do Not Attempt Cardiopulmonary resuscitation (DNACPR) and patient’s wishes for end of life was not immediately accessible which would be useful for other clinicians such as out of hours doctors or locum GPs.

• The practice had established a formal recording process for clinical supervision. The practice nurse and the GP met formally most Fridays to discuss case reviews of complex patients.

• We looked at three recruitment files and saw that appropriate recruitment processes had been followed.

• We spoke with two staff members and they demonstrated adequate knowledge of the role of a chaperone. We looked at training records which showed that staff had completed chaperone training.

• The practice had assessed the premises to consider access for patients who had difficulty with their mobility. We saw that appropriate action had been taken and arrangements were in place to signpost patients elsewhere if they were unable meet their needs at the practice.

• We saw evidence of actions taken to improve the uptake of national screening programmes for breast and bowel cancer. The practice was working with a representative from the screening services at the Clinical Commissioning Group (CCG). Evidence we looked at showed that improvements were being made to the number of patients engaging with the screening programme.

In addition the provider should:

• Make key information such Do Not Attempt Cardiopulmonary resuscitation (DNACPR) and patient’s wishes for end of life easily accessible on the patient record system for the benefit of other care providers such as the out of hours clinicians and locum GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2017

• The practice nurse supported the GP in long term disease management and had taken additional courses in the management of patients with diabetes and asthma.
• The practice had made improvement in relation to outcomes for patients with diabetes. At our previous inspection in June 2016 the practice was identified as an outlier for diabetes indicators. At this inspection the practice performance was comparable to the CCG and national averages. For example, 2015/16 QOF data showed the practice had achieved 76% for patients whose last HbA1c (an indicator of diabetic control) was 64mmmol/mol or less in the preceding 12 months compared to the CCG average of 77% and national average of 78%.
• Clinics with a diabetes consultant and specialist diabetes nurse were held to support the management of some of the practice’s most complex diabetes patients.
• The practice provided in-house services such as spirometry and phlebotomy (blood taking) for the convenience of patients.

Updated 4 August 2017

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, the practice followed up children and young people who did not attend from their immunisations.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals. Practice staff were aware of the right to confidentiality in children and young people. The practice also had purchased a changing mat and offered a breast feeding friendly service if needed.
• Appointments were available outside of school hours with both a GP or practice nurse.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice offered a one stop clinic for patients attending the 6 to 8 week baby checks and the first immunisations.

Updated 4 August 2017

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The practice aimed to offer older patients same or next day appointments.
• The practice met as part of a multi-disciplinary team to discuss the needs of those approaching end of life.
• Older patients were able to make requests for repeat prescriptions via telephone.
• The practice carried out over 75 year old health checks and told us that they had tried to do this opportunistically when patients had attended for flu vaccinations.
• Flu vaccines were provided during home visits if patients were unable to attend the surgery.

Updated 4 August 2017

• The needs of these populations had been identified and adjustments made to ensure services were accessible. The practice offered online services for appointments and repeat prescription requests but despite efforts to date there had there had currently been no uptake.
• Although, the practice did not currently offer extended opening hours, appointments were currently available until 6pm and the principal GP advised that he would see patients later on a Friday. The practice was also working with others in the local commissioning group to deliver seven day opening from September 2017.
• The practice offered a range of health promotion and screening that reflects the needs for this age group. However, there was low uptake of national screening programmes for breast and bowel cancer.
• The practice offered NHS health checks and enlisted support from a third sector organisation ‘My time active’ to promote and support healthier lifestyles.
• Travel vaccinations were available under the NHS. Patients requiring those available privately were signposted to other services.
• An electronic prescribing service was offered for the convenience of patients.
• The practice made use of texting to remind patients of their appointments.
• Patients were advised of the pharmacy first scheme in which they could get advice and support on some minor ailments.

Updated 4 August 2017

• Data for 2015/16 showed that 75% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG and national average of 84%. However, this indicator was skewed by the small numbers involved as only one patient had been exception reported.

• Data for 2015/16 showed 89% of patients with poor mental health had a comprehensive care plan agreed and documented in the records compared to the CCG average of 91% and the national average of 89%.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Counselling services were provided from the practice. Patients could self refer.

Updated 4 August 2017

• The practice held register of patients living in vulnerable circumstances such as those with a learning disability.

• Annual healthchecks were offered to patients with a learning disability.
• The practice offered longer appointments for patients who needed them.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. We saw positive examples of joint working through incident reporting to safeguard patients at risk of harm.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. For example, carers.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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. We saw positive examples of joint working to safeguard patients at risk of harm.
• The practice participated in a tuberculosis screening among new entrants into the UK (from contries with high prevalence) to identify those who are at risk of developing the disease so that it can be detected and treated at the earliest possible stage.
• The practice provided interpretation services and hearing loop for those who needed it. Some of the staff were also multilingual and able to support.
• Information was available to practice staff which informed them that they could register patients with no fixed abode using the practice address if needed.