Dr Bhat's Surgery

Updated 28 September 2017

Dr Bhat’s surgery (also known as Higher Heys Surgery) is based at Stonebridge House, Higher Heys in Oswaldtwistle, Accrington, and is part of the East Lancashire Clinical Commissioning Group (CCG). The practice has 2276 patients on their register. The practice holds a General Medical Services (GMS) contract with NHS England.

Information published by Public Health England rates the level of deprivation within the practice population group as four on a scale of one to 10 (level one represents the highest levels of deprivation and level 10 the lowest). Male and female life expectancy in the practice geographical area is 76 years for males and 81 years for females both of which are slightly below the England average of 79 years and 83 years respectively.

The service is provided by a single handed GP (female). The practice also employs two practice managers (a job share), one female practice nurse, a female health care assistant as well as a team of reception and administrative staff.

The practice is based in a purpose built health centre, under contract with NHS East Lancashire, and offers a comprehensive range of services. It is fully equipped with facilities for the disabled including disabled parking at the rear of the building, access ramps, double doors, and a disabled toilet, All consulting rooms are on the ground floor and there is a large office and meeting room on the upper floor.

The surgery is open 8am to 6.30pm on Monday, Wednesday, Thursday and Friday and 8am to 8pm on Tuesday. Consultations are accessed by appointment and at an open surgery three mornings each week. There is provision for ill children to be seen the same day. When appropriate, patients are redirected to East Lancashire Medical Service, the out of hour’s service.

The practice is accredited for training medical students.

Updated 28 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bhat’s Surgery (also known as Higher Heys Surgery) on 2nd August 2017. 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 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.
• The practice was above average for its satisfaction scores on consultations with GPs and nurses.
• The health and wellbeing of patients in relation to their caring responsibilities was reviewed when they attended for a consultation or health check. They were directed to the various avenues of support available to them.
• Information about the services provided 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 told us they found it easy to make an appointment with the 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.

There were areas of outstanding practice:

• Following a talk from the fire brigade the staff contacted older patients to obtain their consent for the fire service to visit them to do a fire safety inspection and provide advice.
• A survey for young people between the ages of 14 - 18 years had been carried out to try to identify why young adults in this group did not visit the surgery. Staff wished to encourage young people to come to the surgery to discuss their concerns particularly with regard to mental health.
• Staff encouraged children to engage in health promotion activities, for example they ran a competition to produce a drawing reflecting the dangers of smoking. The winner received a prize and the drawings were placed on the No Smoking Board.

There were areas where the provider should make improvements:

• Consideration should be given to fitting a hearing loop in the reception area.
• One staff member should receive update training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 28 September 2017

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 encouraged patients to engage with their own care plan, providing them with information regarding their own care. The practice completed a health check on all newly registering patients which helped to identify any long term conditions early in the relationship with the practice.

• The practice nurse had recently attended training to run an insulin initiation service which meant that patients did not need to travel to the hospital for this treatment.

• Patients with COPD were seen regularly. This was also an opportunity to provide flu and pneumonia vaccination and issue patients with rescue packs including antibiotics for respiratory conditions.

• A smoking cessation service was offered locally by Quit Squad, a CCG funded service.

• Longer appointments and home visits were available when needed. Longer appointments were available one morning each week for people with long term conditions.

All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 28 September 2017

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

• There were comprehensive 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 and those who did not attend secondary care appointments.

• According to unvalidated figures provided by the practice, immunisation rates for all standard childhood immunisation programmes achieved up to 90% in 2016/17, which was the national target. These were provided both at immunisation clinics and by appointment.

• In 2015/16 79% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This compared to a CCG average of 82% and a national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Staff suggested to parents that they book appointments in timed clinics as waiting time might be long in the open clinic.

• We saw positive examples of joint working with midwives and health visitors.

• All parents or guardians calling with concerns about a child under the age of 18 were offered a same day appointment.

• A survey for young people between the ages of 14 - 18 years had been carried out to try to identify why young adults in this group did not visit the surgery. Staff wished to encourage young people to come to the surgery to discuss their concerns particularly with regard to mental health.

• Mental health practitioners visited the surgery regularly and promote these sessions when they go in to schools in the area .This service is targeted at all patients from all practices in the locality.

• The practice offered appointments to discuss sexual health, undertake pregnancy testing and contraception.

• Facilities for breastfeeding and nappy changing were available.

• Staff encouraged children to engage in health promotion activities, for example they ran a competition to produce a drawing reflecting the dangers of smoking. The winner received a prize and the drawings were placed on the No Smoking Board.

Updated 28 September 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 people in its population.

• The practice was responsive to the needs of older people, and offered home visits, longer appointments and urgent appointments on the same day. During the flu season the clinicians gave injections in their own home as well as assessing any other medical needs.

• There were patients on the Avoiding Unplanned Admissions register all of whom had a care plan.

• The practice was providing an enhanced service in shingle and pneumococcal vaccination to this group of patients. The practice proactively identified patients who were entitled for this vaccination and then contacted them. There were leaflets available at the reception regarding shingles vaccination.

• There was an Advanced Nurse Practitioner employed by the CCG to work with patients over 75 years in their own homes. The nurse assessed their needs and gave any treatment considered necessary. Joint visits with the GP were arranged when necessary.

• Staff sign posted older patients who were at risk of social isolation to a befriending service run by a voluntary sector agency.

• Following a talk from the fire brigade the staff contacted older patients to obtain their consent for the fire service to visit them to do a fire safety inspection and provide advice.

• When older patients attended consultations and were known to live some distance away staff offered to ring for a taxi and offered the patient a drink while they were waiting.

Updated 28 September 2017

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

• 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. This included pre-bookable appointments from 8.30am until 6pm Monday, Wednesday, Thursday and Friday and until 8pm Tuesday. Appointments were also available through 4 Hyndburn (a group of practices offering shared services) which included Saturday mornings. This service was advertisedon the urgent appointments notice board .Patients could also access services via NHS 111, or the local walk in centre.

• The practice was proactive in offering online services including repeat prescriptions as well as a full range of health promotion and screening that reflected the needs for this age group.

• Health checks were available for patients aged between 40-74years.

• Smoking cessation advice was available at a local clinic.

• Staff referred patients to the Exercise on Prescription service and the Healthy Living service.

• Students between the ages of 17 - 19years were encouraged to have the MenC vaccination (to protect against meningitis and blood poisoning) before going to University for the first time. They were sent for prior to the new intake in September.

Updated 28 September 2017

The practice is rated as Good for the care of people experiencing poor mental health.

• Memory assessment was carried out either opportunistically or as part of the chronic disease review process. Any patients identified as potentially having memory problems were referred to the consultant in older people’s psychiatry. There was a notice board dedicated to the subject of dementia in the waiting room with posters showing local support agencies, telephone numbers and addresses. Staff had recently received training in dementia from CCG staff.

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record in the preceding 12 months. This compared with a clinical commissioning group average of 88% and a national average of 88%.

• 100% of patients with mental health conditions had their alcohol consumption recorded in the preceding 12 months. This was higher than the CCG average of 90% and the national average of 89%.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations such as alcohol and drug services and patients were given contact details for helplines and the crisis team, single point of access.

• Patients with mental health problems were given longer appointments and were encouraged to take their time when talking to the clinicians.The clinicians encourage the patient to try and engage in self- help treatment.

• The surgery provided a wide range of information on schizophrenia, challenging behaviour, depression, post- traumatic stress disorder (PTSD) and many more conditions.

• The practice hosted a pilot scheme to help practices treat and support children with mental health problems (up to the age of 18).The mental health practitioner attended the practice two days per week. The GP referred patients direct to the practitioner based at the practice, instead of having to refer to services in Burnley. Other practices were able to refer their patients to this service.

Updated 28 September 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 carers and those with a learning disability. The practice undertook health checks for patients with learning disabilities at an extended appointment when a nurse undertook a physical check and the GP wrote an individual care plan.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients including hospice staff, palliative care nurses and district nurses.

• Staff knew how to recognise signs of abuse in vulnerable adults and children.

• Carers were identified during appointments with practice staff who carers were offered health checks and flu vaccination. Home visits were available if the patient could not attend appointments at the surgery.

• There were interpreter services available which could be booked for specific appointments for patients who did not speak English as a first language.

• There was information in the reception area for patients struggling to buy food. Vouchers were available from the receptionist which could be taken to the food bank in exchange for food.

• Practice staff supported various charitable initiatives such as collecting goods for people in third world countries.