The Heath Surgery

Updated 27 March 2017

Dr Qureshi & Partners provide primary medical services to approximately 6200 patients and is part of Lincolnshire West Clinical Commissioning Group. Services are provided under a general medical services (GMS) contract.

Services are provided from a main surgery located in the village of Bracebridge Heath, known as The Heath Surgery, and from a branch surgery located at 19 St Catherines, Lincoln. The branch surgery is known as South Park Surgery. We did not visit the branch surgery as part of our inspection. The main surgery was purpose built in 2007 and is accessible by public transport. Car parking is provided on site and all patient services are provided from the ground floor.

The level of deprivation within the practice population is below local and national averages with the practice falling into the eighth most deprived decile. The level of income deprivation affecting children is below local and national averages; income deprivation affecting older people is similar to local and national averages.

The clinical team is comprised of two GP partners (one male, one female), a long-term locum GP, a long-term locum nurse consultant (advanced nurse practitioner), one nurse prescriber, two practice nurses, a healthcare assistant and two phlebotomists.

The clinical team is supported by a practice manager and a team of reception and administrative staff.

The practice opens between 8am and 6.30pm daily with the exception of Wednesday when the practice opens until 8.15pm. Appointments are from 9am to 11.30am each morning. Afternoon appointment times vary but usually are from 3pm to 5pm or from 4pm to 6pm. Additional patients are seen at the end of morning and afternoon surgery as required. Extended hours appointments are offered each Wednesday evening. In addition to pre-bookable appointments that can be booked up to four weeks in advance, half of all appointments are available to be booked on the day for people that need them.

The practice has opted out of providing out of hours services for its patients; out of hours services are provided by Derbyshire Health United (DHU) and are accessed via 111.

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Qureshi & Partners on 17 January 2017. Overall the practice is rated as good.

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

• Systems and processes were in place to support the reporting and recording of significant events. Learning was identified from incidents and significant events and shared with relevant staff.
• Risks to patients and staff were generally assessed and well managed within the practice.
• Staff used current evidence based guidance to plan and deliver care for patients. Staff had undertaken training to equip them with the skills and knowledge they required to deliver effective care.
• Patient outcomes were generally in line with or above local and national averages. Staff worked closely with community based staff to meet the needs of their patients. Data showed that avoidable admissions to hospital for older people had reduced.
• Feedback we received as part of the inspection indicated that patients felt they were treated with compassion, dignity and respect and found staff polite, friendly and helpful.
• Information about services and how to complain was available and easy to understand. In addition information about raising complaints and concerns was provided on the practice’s website.
• Patients were generally able to access appointments when they required them. We saw evidence of ongoing reviews of the appointment system.
• The practice had good facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and staff were positive about the support they received from management.
• The practice proactively sought feedback from staff and patients; we saw evidence of action taken by the practice in response to feedback. The practice shared information in the waiting area about action taken in response to feedback.
• There was a clear vision for the future and a comprehensive action plan had been developed which supported this; the action plan was regularly reviewed.
• The patient participation group was active and met regularly; they were positive about their interactions with the practice.

The areas where the provider should make improvements are:

• Review or risk assess the arrangements for phlebotomy appointments when there may not be a qualified clinician on site
• Ensure all staff receive regular appraisals in line with the practice’s appraisal plan
• Increase the frequency of documented clinical meetings and consider how information from meetings can be effectively cascaded to locum staff
• Continue to review and address areas of lower patient satisfaction

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 March 2017

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

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators 98.3% which was 6.8% above the CCG average and 8.5% above the national average. The exception reporting rate for indicators related to diabetes was 7.4% which was below the CCG average of 9.9% and the national average of 11.6%.
• Performance for indicators related to hypertension was 100% which was 1.5% above the CCG average and 2.7% above the national average. The exception reporting rate for hypertension related indicators was 4.3% which was marginally above the CCG average of 3.2% and the national average of 3.9%.
• Longer appointments and home visits were available when needed.
• An in-house spirometry service was offered by the practice.
• All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met.
• For those patients with the most complex needs, their named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 27 March 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 people who had a high number of A&E attendances.
• Immunisation rates were relatively high for most standard childhood immunisations.
• Appointments were available outside of school hours including nursing appointments. The practice opened late one evening per week.
• The premises were suitable for children and baby changing facilities were provided.
• We saw examples of joint working with community based professionals to ensure children were safeguarded from abuse.

Updated 27 March 2017

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

• The practice offered personalised care to meet the needs of the older people in its population.
• Home visits and urgent appointments were available for those with enhanced needs. The practice also offered a home visiting phlebotomy service.
• All patients over 75 were assigned a named allocated GP who was responsible for overseeing their care.
• As part of the CCG project on supporting frail older people the practice had offered enhanced support to patients at risk of admission to hospital. Data demonstrated that the practice’s emergency hospital admission rate for all patients over 65 had fallen by 18% and for all patients over 75 this had fallen by 13%.

Updated 27 March 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. Extended hours services were provided one evening per week.
• Health promotion advice was offered and there was health promotion information available for patients in the waiting area.
• Online services were offered including prescription services and appointment booking. SMS reminders were sent for appointments.
• Information was displayed to encourage the uptake of national cancer screening programmes for bowel and breast cancer; uptake rates were in line with or above local and national averages.
• Published data from QOF indicated that the practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 84% and the national average of 81%.

Updated 27 March 2017

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

• Performance for mental health related indicators was 100% which was 7.8% above the CCG average and 7.2% above the national average. The exception reporting rate for mental health related indicators was 12.79% which was in line with the CCG average of 14.6% and the national average of 11.3%.
• 97.1% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 10.2% above the CCG average and 13.4% above the national average. This exception reporting rate for this indicator was 5.4% which was below the CCG average of 8.4% and the national average of 6.8%.
• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Information was available for 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.

Updated 27 March 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people and those with a learning disability. During our inspection the practice provided us with examples of care provided to patients living in vulnerable circumstances including patients with substance misuse problems and patients who were homeless.
• Longer appointments were provided for patients with a learning disability where required.
• 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.