Archived: Dr Imran Haq Also known as Firs Surgery

Updated 4 October 2017

Dr Imran Haq’s Surgery (also known as Firs Surgery) is part the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

Services to patients are provided under a General Medical Services (GMS) contract with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care and is a nationally agreed contract. The practice also provides some enhanced services such as childhood vaccinations.

The practice is located in a residential property that has been adapted for the purpose of providing primary medical services. Clinical services are provided on the ground floor of the premises. There is limited parking available at the practice however, parking is permitted on the street.

The practice registered list size is approximately 3,000 patients. Based on data available from Public Health England, the practice is located within the 10% most deprived areas nationally. The practice population is slightly younger than the national average. For example 29% of the practice population is under 18 years compared with the CCG average of 24% and national average of 21%.

Practice staff consist of the principal GP (male), a salaried GP (female), a practice nurse (female), a healthcare assistant (female), a practice manager, a business manager and a small team of administrative / reception staff.

The practice is open between 8am and 6.30pm Monday to Friday with the exception of Wednesday afternoons when the practice closes at 1pm. Appointments with a GP are available from 9.30am to 11.30am and 4pm to 5.30pm Monday to Friday (except Wednesday afternoon). Nurse appointments are available from 8.30am to 12 noon on a Wednesday, 8.30am to 2pm on a Thursday and 8.30am to 12.00am on a Friday. Extended hours surgeries are available between 6.30pm and 8pm on a Thursday. Appointments in the extended hours are available with a GP. When the practice is closed during the out of hours period between 6.30pm and 8am on weekdays and all weekends and bank holidays the service is provided by another out of hours provider, Birmingham and District General Practitioner Emergency Rooms (BADGER). Patients are directed to this service via the practice answerphone. BADGER also provides cover on a Wednesday afternoon when the practice is closed.

Updated 4 October 2017

Letter from the Chief Inspector of General Practice

We previously carried out three announced comprehensive inspections and a focused inspection at Dr Imran Haq’s practice. Following an inspection in February and March 2015 the practice was rated inadequate overall and placed into special measures. Subsequent inspections in November 2015, February 2016 and July 2016 showed continuous improvement and the practice was rated as good overall in July 2016. The full comprehensive reports for these inspections can be found by selecting the ‘all reports’ link for Dr Imran Haq on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 September 2017 to confirm that the improvements made leading to the good rating in July 2016 had been sustained. The overall rating of good has been maintained.

Our key findings were as follows:

• Improvements leading to the good rating in July 2016 had been sustained and the practice continued to make improvements for example, in relation to the quality outcomes framework.
• Patient outcome data was mostly in line with local and national averages. However, performance was lower for childhood immunisations for under two year olds and uptake of bowel screening.
• The practice’s list size had recently increased by approximately 350 patients following the closure of a nearby practice. The practice was in the process of assessing what impact this was having and whether action was needed to increase staffing.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. These included safeguarding, medicines management and recruitment processes.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed high levels of patient satisfaction with the service. Patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Patients found it easy to make an appointment and access the service. Same day urgent appointments were available if needed. There was continuity of care.
• Information about services and how to complain was available.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure with strong managerial support. Staff felt supported and worked well as a team.
• Future direction and working with other local practices was currently in negotiation to identify areas for improving efficiency.
• The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Review and continue take action to improve the uptake of national screening programmes for bowel cancer and childhood immunisations for under two year olds.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 October 2016

• Longer appointments and home visits were available when needed.
• Patients had a structured annual review to check that their health and care needs were being met.
• Performance for diabetes related indicators for the practice was 77% which was slightly below the CCG average of 83% and a national average of 84%. Data available from the practice for 2015/16 showed that therehad been an improvement with the practice performance now at 80%. However, this was not published and verified data.
• For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice had care plans in place for 2% of patients with the most complex needs. We saw that since the last inspection, these care plans had been updated and refined.
• There was a large variation in the percentage of patients with hypertension having regular blood pressure tests which was below the national average. The practice average of 73% compared to a national average of 84%. Unpublished and unverified data available from the practice showed that therehad been significant improvement for the year 2015/2016.

Updated 6 October 2016

• Same day appointments were available for children and those with serious medical conditions.
• Immunisation rates for childhood vaccinations were in line CCG averages.
• The practice’s uptake for the cervical screening programme was 66% which was below the CCG average of 78% and the national average of 82%. However, we saw evidence to demonstrate that the most recent uptake rates had significantly improved through the implementation of various strategies.
• Appointments were available outside of school hours and the premises were suitable for children and babies and baby changing facilities were available.
• We saw positive examples of joint working with district nurses and health visitors
• Gaps previously found in the understanding of when a safeguarding referral may be appropriate had been fully addressed by the practice.

Updated 6 October 2016

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Longer appointments were also available for older people when needed.
• There were disabled facilities and translation services available.
• The practice had a level access to the front entrance.
• Online appointments were available as well as online repeat prescriptions.
• Older patients who were in the top 2% of complex needs had a completed care plan to support their needs.

Updated 6 October 2016

• The practice offered extended hours on Thursdays from 6pm to 8pm for working patients who could not attend during normal opening hours.
• Patients could book appointments or order repeat prescriptions online.
• Patients were able to book telephone consultations with the GP.
• The practice offered a full range of health promotion and screening that reflected the needs for this age group.

Updated 6 October 2016

• Performance for mental health related indicators was 94% which was above the CCG average of 87% and a national average of 87%.
• The percentage of patients with physical and/or mental health conditions whose notes recorded smoking status in the preceding 12 months was 86% for the practice compared to CCG and national averages of 94%. Unpublished and unverified data available from the practice showed that there were had been an improvement for the year 2015/2016. We saw that care plans were also now in place for these patients.
• The practice maintained a mental health register on the clinical system.
• Staff had received training on how to care for people with mental health needs.
• The practice had informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The GP we spoke with had knowledge of the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 October 2016

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability or suffering from poor mental health and alerts were in place on the clinical patient record system.
• Translation services were available.
• The practice offered longer appointments for patient requiring an interpreter or for those with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Since the last inspection, patients with learning disability or poor mental health now had a care plan in place to further support this.
• The practice had policies that were accessible to all staff which outlined who to contact for further guidance if they had concerns about a patient’s welfare.
• There was a lead staff member for safeguarding and we saw evidence to show that staff had received the relevant training.
• Staff members we spoke with, including the GP, were able to demonstrate that they understood their responsibilities with regards to safeguarding.