Dr Abid Hussain

Updated 4 October 2017

Dr Abid Hussain’s practice is known locally as Pearl Medical Centre. It is located in Ward End, Birmingham which is an area of high deprivation and associated health needs. The practice is based across two adapted shops and one residential property that have been extended to provide primary care services. The practice has approximately 10,000 registered patients. Pearl Medical Centre has an inherently younger population with twice the national average of five to 14 year olds (23% compared to 13%) and very low numbers of older patients. For example, the practice has 2% of patients aged 75 years or over registered with the practice compared to a national average of 7%. The practice population includes a high ethnic population, with a high number of refugees, Eastern European population with low levels of economic activity locally.

This is a single-handed practice. (A practice with one GP who has managerial and financial responsibility for running the business). The principal GP is supported by three salaried GPs and two regular locums. The GPs are supported by a practice manager, two practice nurses, two practice pharmacists, three healthcare assistants and receptionists. A consultant practice manager continues to provide support and quarterly quality monitoring for the practice. The practice is a member of a GP federation of 15 practices.

The practice has a Primary Medical Services Growth contract with NHS England. This contract enables the practice to respond to the needs of the community by allowing more flexibility in the approach to disease management by utilising a wide variety of health care professionals. The practice also provides some enhanced services. Enhanced services require an enhanced level of service provision above what is normally required under the core GP contract.

The practice treats patients of all ages and provides a range of medical services. This includes disease management such as asthma, diabetes and heart disease. Other appointments are available for services such as minor surgery, well women clinics, child health surveillance and smoking cessation.

The practice is open on Monday to Friday each week from 8.30am to 6.30pm. Telephone lines remain open when the practice is closed at lunchtime from 1pm to 2pm. Extended hours appointments are available on Monday evenings from 6.30pm to 8pm and on Saturday mornings from 9am to 1pm.

The practice does not provide an out-of-hours (OOHs) service but has alternative arrangements in place for patients to be seen when the practice is closed. OOHs support is provided from 6.30pm to 8.30am weekdays. (The OOHs care provider is Badger). The practice has a recorded message on its telephone system advising patients on the numbers to call. This information is also available on the practice’s website and in the practice leaflet.

Home visits are also available for patients who are too ill to attend the practice for appointments. There is also an online service which allows patients to order repeat prescriptions and book routine GP appointments. Booking of appointments can also be made up to three weeks in advance.

Updated 4 October 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Dr Abid Hussain, known as Pearl Medical Practice on 19 April 2016. As a result of our inspection the practice was rated as requires improvement in caring and responsive with an overall rating for the practice as requires improvement. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Abid Hussain on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 7 August 2017 to confirm that the practice had carried out their plan to address the areas requiring improvement that we identified in our inspection in April 2016. This report covers our findings in relation to requirements and improvements made since our last inspection.

We found the practice had carried out a detailed analysis of the previous inspection findings, involving staff and their Patient Participation Group (PPG). The practice had made extensive changes which had resulted in significant improvements. Practice staff had taken responsibility for embedding and maintaining these improvements themselves. There was evidence of a cultural and leadership change within the practice, and we saw a positive approach to performance and improvement throughout.

Our key findings were as follows:

• Risks to patients were assessed and managed through practice meetings and through discussions with the multi-disciplinary teams.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• The structured, open and transparent approach to the reporting and recording of significant events and complaints had been maintained and further developed since our previous inspection. Six monthly analyses identified themes and trends. Staff were aware of and understood their responsibilities to report these. Learning was shared with staff at team meetings.
• Easy to understand information about services and how to complain was available to patients in the reception area and on the practice website. Full analysis and reviews of complaints were carried out to identify learning, themes and trends.
• Staff had completed training to ensure they had the skills, knowledge and experience to deliver effective care and treatment. Staff training needs had been identified and planned for the coming year. Assessments of clinical staff skills had been carried out with details of specific skills assessed recorded.
• Records were viewed and showed that recruitment procedures had been followed when recruiting staff. Records confirmed that the practice had obtained Disclosure and Barring Services (DBS) checks for non-clinical staff who carried out chaperone duties or had unsupervised access to patients.
• There was effective oversight, planning and responses to practice performance.
• 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.
• Staff were enthusiastic about improvements made to the practice and told us they had worked hard to provide the best services for patients.
• The practice sought regular feedback from staff and patients. The Patient Participation Group (PPG) worked with the practice to promote health care and the services offered by the practice. Open days took place so patients could share their views and ideas. Awareness days were held to support patients with their health management such as Diabetes Awareness, with future plans for heart disease and asthma awareness days.
• The practice had identified 4% of its patients as carers.
• Regular checks were carried out to ensure emergency equipment was available for use at all times.
• Patients confirmed on the comment cards that they were listened to, that they were given full explanations for their treatment and care, and that everyone at the practice was helpful and friendly.

The practice is now rated as good for providing safe, effective, caring, responsive services, and for being well-led. The overall rating for the practice is now good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 October 2017

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

• GPs were supported by the practice nurses in their 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. All these patients had a named GP and a structured annual review to check that their health and medicine needs were being met. The practice employed two pharmacists who worked closely with the principal GP to ensure safe and effective prescribing through medicine reviews.
• For patients with the most complex needs, the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The quality monitoring data (QOF) for 2015/2016 showed that management of patients with long-term conditions was generally in line with the local and national averages, although exception rates were higher than both local and national levels. For example, the number of patients with Chronic Obstructive Pulmonary Disease (COPD) (lung diseases) who had a review of their condition in the preceding 12 months was 94%. The exception rate of 13% was higher than the local average of 7% and in line with the national average of 11%. The practice had increased the numbers of clinics provided to ensure more regular patient reviews were completed to address the high rates of exception reporting. Unpublished data showed that improvements had been made across all areas for patients with long term conditions. For example, patients with COPD who had a review of their condition in the preceding 12 months (2016/2017) was 96% which showed a continued increase on the previous year.

Updated 4 October 2017

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 patients who had a high number of accident and emergency (A&E) attendances.
• Childhood immunisation rates for the vaccinations given were in line with the local Clinical Commissioning Group (CCG) averages for under two year olds, but they were slightly lower than CCG averages for under five year olds (81% which was slightly lower than local averages of 89% and national averages of 91%). Unpublished data showed that improvements had been achieved with rates for 2016/2017 increased to 90%.
• Appointments were available outside of school hours.
• We saw positive examples of joint working with midwives and health visitors. The practice contacted parents when babies and children did not attend for their vaccinations and informed Child Health Services when appropriate. We saw minutes of meeting where issues relating to children were discussed.
• The practice’s uptake for the cervical screening programme was 99% which was above the local average of 80% and above the national average of 81%. Exception reporting at 40% was higher than both local and national averages of 13% and 7% respectively.

Updated 4 October 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 patients in its population. The number of older patients registered with the practice was 6% which was low in comparison to the local average of 23%, and the national average of 27%. Most of their older patients were cared for at home.
• They were responsive to the needs of older patients. Home visits were offered and urgent appointments for those patients unable to access the practice.
• The practice held regular meetings with the multi-disciplinary team (MDT) for the planning and delivery of palliative care for patients approaching their end of life. The practice knew how many patients they had who were receiving palliative care and kept a palliative care register.
• A mobile number was given to patients with enhanced needs so they could contact the GP at weekends and out of hours so that continuity of care could be maintained.

Updated 4 October 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.
• With the launch of the practice website the practice had been proactive in offering online services as well as a full range of health promotion and screening services that reflected the needs of this age group.
• The practice nurses had oversight for the management of a number of clinical areas, including immunisations, cervical cytology and some long term conditions. This was advertised on the practice website.
• Extended hours appointments were available so that patients did not need to take time off work. Patients could also book appointments up to four weeks in advance or order repeat prescriptions online.
• 16% of the patients over 30 years of age at this practice had a diagnosis of diabetes, compared with the national average of 6%. The practice had recognised the need for more effective monitoring and this was reflected in their diabetes management achievements for 2015/2016. Performance for diabetes related indicators was higher than the local and national average. For example, patients with a record of a foot examination and risk classification was 94% compared with the CCG and the national averages of 91% and 88% respectively. The practice exception rate of 5% was in line with the CCG average of 6% and lower than the national average of 9%.

Updated 4 October 2017

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

• The practice held a register of patients living in vulnerable circumstances including those patients with dementia. Annual health checks were carried out for all 14 patients on the practice’s register.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months was in line with local and national averages.
• The GPs and the practice nurses understood the importance of considering patients’ ability to consent to care and treatment and dealt with this in accordance with the requirements of the Mental Capacity Act 2005.
• The practice had given patients experiencing poor mental health information about how to access various support groups and voluntary organisations.
• There was a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
• Counselling services were available at the practice, provided by Healthy Minds and Faith Counselling.

Updated 4 October 2017

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

• The practice held a register of patients living in vulnerable circumstances including patients with a learning disability. Annual health checks were carried out and patients were offered longer appointments for these.
• Staff had received training and knew how to recognise signs of abuse in vulnerable adults and children who were considered to be at risk of harm. 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 regularly worked with multi-disciplinary teams in the case management of vulnerable patients. Information was provided for patients about how to access various support groups and voluntary organisations. For example, leaflets were available in the waiting area and on the practice’s website.
• Vulnerable patients were supported to register with the practice, such as homeless people.
• The practice had a palliative care register and provided culturally sensitive end of life care for patients.
• Interpreters and chaperone services were available to patients.