Archived: Dr Bhikhu Pattni Also known as Yardley Medical Centre

Updated 10 May 2017

The surgery is situated in Yardley, East Birmingham. Parking is restricted and available only in a side street adjoining the practice.

The practice occupies two floors, with all clinical services being offered on the ground floor. Disabled facilities are provided.

The practice provides services to 1,253 patients. There is one male GP working at the practice and a locum who covers the GP’s absence during annual leave or sickness. The practice does not currently employ a nurse or health care assistant. There is a part-time practice manager and two part-time receptionists. The practice also retains the services of a business manager, who also supports two other practices in the area.

10% of the patients are aged over 75 and the practice population experience lower than average levels of deprivation.

The practice offers placements to 5th year students from the University of Birmingham Medical School.

The practice is open between 8.30am and 1pm and between 2.30pm and 6.30 pm on Monday, Tuesday, Thursday and Friday. On Wednesday, the practice is only open in the morning between 8.30 and 1pm. Whenever the practice is closed, out of hours cover is provided by Badger GP OOHs service.

Appointments are from 9am to 12am and 4.30pm to 6.30pm on Monday, Tuesday, Thursday and Friday and from 9am to 12am on Wednesday.

Once the practice merger had taken place, the practice told us they wished to preserve their existing identity and values and to make the transition process as smooth as possible, in order to provide continuity of care to their patients and to improve the all-round quality and variety of services in the future. They told us that once the merger was completed, both practices had undertaken to focus and prioritise on patient services. Following the inspection we were informed that the merger had been completed, this had resulted in patients having regular access to a nursing team.

The practice is a member of the East Birmingham Health Organisation, which is a federation formed by a group of practices to look after the needs of around 200,000 patients.

Updated 10 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr. Bhiku Pattni on 9 November 2016. Overall the practice is rated as requires improvement. 

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.
• Data showed the practice performance in respect of QOF was mixed with the practice performing significantly below local and national averages in relation to some clinical conditions. 
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment but this did not align with national patient survey data.
• Patients said they found it easy to make an appointment with the GP and there was continuity of care, with urgent appointments available the same day.
• 100% of patients in the national patient survey said they found the receptionists at the practice helpful, compared to the CCG average of 84% and the national average of 87%.
• The practice employed two receptionists and the Practice Manager. There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the duty of candour.

• The practice was in the process of merging with a larger local practice and negotiations were at an advanced stage. We were informed by the Clinical Commissioning Group (CCG) that they were currently processing the formal documentation. Applications for this registration have not yet been submitted to CQC, we are working with the provider to resolve this.

The areas where the provider must make improvement are:

• Have a system to effectively monitor patient outcomes in order to drive improvement.

The areas where the provider should make improvement are:

• Review the availability and impact on skills mix of all staff.

• Review care plans to ensure they are all fully documented.

• Review arrangements in place for the diagnosis of Chronic Obstructive Pulmonary Disease (COPD) using spirometry, to ensure appropriate monitoring and outcomes for patients. 

• Continue to seek and monitor patient feedback in order to identify areas for further improvement. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 May 2017

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

• In the absence of a nurse or healthcare assistant the GP took responsibility for chronic disease management.

• The practice performance in relation to long term conditions was mixed, with some areas of low performance, for example in relation to asthma the practice performance was 24% points below the CCG and England average.

• Although performance in relation to diabetes indicators overall was 8% above the CCG and 9% above the England average, this was achieved with very high exception reporting in seven of the eleven indicators ranging from nine to 18% higher than CCG and national averages.

• The practice did an initial assessment of patients with COPD and then referred them to a neighbouring practice for spirometry testing

• Longer appointments and home visits were available when needed.

• Patients were allocated to the sole GP for a structured annual review.

• 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 10 May 2017

The practice is rated as requires improvement 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. 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.

• 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 10 May 2017

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

• The practice performance in respect of conditions affecting older people was mixed with some high exception reporting. The practice were aware of their outcome data.

• The practice was responsive to the needs of older people, and offered home visits and urgent same day urgent triage appointments for those with enhanced needs.

• Same day telephone consultations were also available. Longer appointments were offered to enable patients to discuss concerns in greater detail, or more than one complaint.

Updated 10 May 2017

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students).

• Patients told us that the practice did not necessarily offer services to working aged people who could not attend the practice between 9am and 5pm.

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

• 46% of women aged 25-64 were recorded as having a cervical screening test in the preceding five years compared to the national average of 81%. Arrangements were in place for a nurse from a neighbouring practice to offer cervical screening to patients. The practice told us access to nursing appointments would be improved on completion of the practice merger. 

Updated 10 May 2017

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

• The practice carried out advanced care planning for patients with dementia but their exception reporting was significantly above local and national averages at 50%.
• The practice achievement in relation to mental health was 88% which was 4% below the CCG and 5% below the national average. Their exception reporting was significantly higher than the CCG and national average for four of the six clinical indicators. This ranged from 15% to 98% above.
• For example 100% of patients diagnosed with dementia that had their care reviewed in a face to face meeting in the last 12 months, which was higher than both the CCG and national averages but the exception reporting for this indicator was 20% above the CCG average and 18% above the national average. The practice equated the high exception reporting to the small number of patients registered at the practice. However patient records we reviewed did not record the rationale for exception reporting. 

• The practice had engaged in an exercise with other practices in the area to analyse the high level use of benzodiazepines. This resulted in a protocol being produced, together with a more effective review process, action plan and audit cycle, resulting in lower levels of prescribing. There was also a named drug and substance misuse worker supporting patients on a shared care basis.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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.

Updated 10 May 2017

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

• The practice offered longer appointments for patients with a learning disability .

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• 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.