Archived: Dr. Muktar and Partners

Updated 13 April 2016

Dr Muktar and Partners provides primary medical services in Sutton to approximately 4938 patients and is one of 27 practices in Sutton Clinical Commissioning Group (CCG). The practice population is in the least deprived decile in England.

The practice population has a lower than CCG average representation of income deprived children and older people. The practice population of children are slightly below local and national averages, the practice population of those of working age is in line with local and national averages at 66% and the number of older people registered at the practice is higher than local and national averages; 19% of patients are over the age of 65. Of patients registered with the practice, 80% are White or White British, 13% are Asian or Asian British and 2% are Black or Black British.

The practice operates from a purpose built GP centre. The practice shares the GP centre premises with two other practices. The three practices at the GP centre operate a shared business model, whereby the nursing and administrative teams work across all three practices located in the GP centre. Most patient facilities are on the ground floor and are wheelchair accessible. This practice has access to three doctors’ consultation rooms and four nurses’ treatment rooms; one of the treatment rooms was on the first floor accessed via stairs. The practice team at the surgery is made up of one full time male GP who is a partner, one full time female GP who is a partner and one full time male salaried GP. The total number of GP sessions per week is 22. The nursing team consists of a full time nurse manager who is a nurse prescriber, three part time female practice nurses and two part time health care assistants. The administrative team includes a practice business manager, four administrative staff and 11 reception staff members.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). The practice provides teaching to pre-registration nursing students.

The practice reception and telephone lines are open from 8am to 6.30pm Monday to Friday. Appointments are available between 8am and 1pm every morning and 2pm and 5.30pm every afternoon. Extended hours surgeries are not offered at the practice. The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6.30pm and 8am and directs patients to the out-of-hours provider for Sutton CCG.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services, family planning services, maternity and midwifery services, treatment of disease, disorder or injury and surgical procedures.

Updated 13 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Muktar and Partners on 2 February 2016. Overall the practice is rated as good.

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. All opportunities for learning from internal incidents were maximised.

• 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 thoroughly assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example the practice had invited a number of support organisations to provide a range of educational and advisory events for practice patients.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Patients said they were able to get appointments when they needed them, with urgent appointments available the same day.

• Patients did not find it easy to contact the practice via telephone.

• 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 practice had a robust governance system in place to ensure that risks were identified and monitored and improvements to the service were made.

• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw three areas of outstanding practice:

• The practice benefited from a pharmacy co-located next to the health centre and they maintained close links with this service. We were given many examples where GPs were able to take prescriptions and medicines on urgent home visits pre-emptively, so patients received their medicines immediately. Where the medicines were not required by patients, the practice and pharmacy had an arrangement whereby they could be returned to the pharmacy with the prescription. Reception and administrative staff also worked closely with the pharmacy and ensured that those patients’ prescriptions requested at the end of the day were all received by the pharmacy prior to the practice closing to avoid delays in processing of prescriptions.

• The practice had arranged for a number of educational and support events for practice patients, in conjunction with the Patient Participation Group (PPG). For example, a diabetes information evening was held in October 2015 where an external speaker from a national diabetic charity offered advice on diet and exercises and provided information leaflets for patients. A practice nurse and a representative from the health lifestyle advisory service were also present to provide information to patients. The practice nurses also used this evening as an opportunity to provide flu immunisations to their diabetic patients and the PPG encouraged patient feedback by promoting the NHS Friends and Family Test. Of those 37 who attended the event across the three practices, 21 patients received the flu immunisation.

• The practice had robust governance arrangements in place, which included the use of work plans to address key areas of quality improvement; a comprehensive policy schedule outlining all policies and procedures, all review dates and the named staff member for updating the policy; and a comprehensive programme of continuous internal audits to monitor performance which were discussed in monthly management meetings. All management meetings were between the business manager and the partners of the three practices co-located in the shared premises which encouraged a culture of shared leaning and development.

The areas where the provider should make improvements are:

• Implement a clear system for tracking and monitoring the use of prescription pads across the practice.

• Ensure that care plans used are personalised and patient-centred in order to ensure that patients’ needs are effectively assessed.

• Ensure that vulnerable patients with a learning disability are monitored effectively via annual physical health checks.

• Ensure that consent for minor surgical procedures is adequately recorded on the electronic patient record system.

• Ensure that comprehensive minutes are kept of practice weekly clinical meetings.

• Consider providing extended hours surgeries to improve appointment availability for patients of working-age and provide an online appointment booking facility.

• Improve telephone access for patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 13 April 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, for example patients with diabetes.
• Performance for diabetes related indicators was above Clinical Commissioning Group (CCG) and national averages. For example, 85% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the CCG average of 74% and the national average of 78%.
• The percentage of diabetic patients which had received the flu vaccination in 2014/15 was 96%, which was above CCG and national averages.
• The practice were signed up to provide an anticoagulation service for patients, four days per week.
• The practice maintained close links with the pharmacy located next to the premises. GPs had arrangements in place with the pharmacy to take prescriptions and medicines and on urgent home visits, to ensure patients received their medicines immediately.
• The practice had invited a number of external organisations to the practice to provide education and advice to patients, for example, they had arranged a diabetes awareness evening.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met, however care plans were not always personalised. Robust re-call systems were in place to invite patients with long term conditions for health checks and reviews.
• For those patients with the most complex needs, such as those at risk of admission to hospital and those at the end of life, the GPs worked with relevant health and care professionals to deliver holistic care.

Updated 13 April 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 Accident and Emergency (A&E) attendances.
• The practice met with a health visitor monthly to flag children at risk.
• Immunisation rates were high for all standard childhood immunisations and effective re-call systems were in place to follow up those who did not attend.
• 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’s uptake for the cervical screening programme was 81%, which was comparable to the Clinical Commissioning Group (CCG) average of 83% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 13 April 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. Self-care plans were provided to those patients most at risk and those over 75.
• The practice had links with local older people’s support services and invited these organisations to speak with practice patients.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were above averages. For example, the percentage of patients over 75 with a fragility fracture who were on the appropriate bone sparing medication was 100%, which was above CCG average of 95% and national average of 93%.
• The percentage of people aged 65 or over who received a seasonal flu vaccination was in line with the national average.

Updated 13 April 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 some of the services it offered to ensure these were accessible to patients.
• The practice was proactive in offering a full range of health promotion and screening that reflected the needs for this age group, including travel clinics. Their achievement for bowel cancer screening was one of the highest in the Clinical Commissioning Group (CCG).
• The practice offered online services for repeat prescriptions, however due to known limitations with their computer system, they were not able to offer online appointment booking. Both patients and staff recognised that this would be beneficial for the practice.
• The practice did not offer extended opening hours for appointments.

Updated 13 April 2016

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

• 83% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the Clinical Commissioning Group (CCG) and national averages.
• Performance for mental health related indicators was above the CCG and national averages; 92% of patients had received an annual review compared with CCG average of 87% and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice provided self-care plans for people with dementia.
• 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.
• The practice was a dementia friendly practice. They performed monthly searches of patients at risk of dementia. A range of clinical and non-clinical staff had received dementia training.

Updated 13 April 2016

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 homeless people, carers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice had made improvements to ensure patients with hearing impairments were able to access the service.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and had invited a number of external organisations to events to provide advice and education to patients, for example support for carers.
• 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.
• Of 19 patients on the practice’s learning disabilities register, four patients which was 21% had received a health check in the last 12 months.