Archived: NHSTanhouse Clinic

Updated 19 April 2018

NHSTanhouse Clinic is a branch site of Dr Rajiv Chitre located on 168 Hamstead Road, Handsworth Road, Birmingham. NHS Tanhouse Clinic is located on Hamstead Road, Great Barr, Birmingham. The practice has a combined list size of approximately 5600 patients. Patients are able to visit either of the two sites in order to access primary medical services.

We inspected the main site at Dr Rajiv Chitre (168 Hamstead Road, Handsworth) on 7 March 2018. We did not visit NHSTanhouse Clinic as the staff group, polices, systems and procedures are centrally managed (at Dr Rajiv Chitre) and operate across both sites. However, both practices are registered individually with CQC and therefore have individual reports and ratings.

The two GP partners (both male) and two long term locum GP (both female) work across both sites along with two practice nurses and a healthcare assistant. The practice manager is responsible for overseeing both sites; there is an assistant practice manager who supports the practice manager. They are supported by an administration team that work across both sites.

The practice is located in an urban area of Birmingham in a converted residential building which is leased from a landlord. It was recently renovated through funding secured from the CCG.

Based on data available from Public Health England, the levels of deprivation (deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by NHS Tanhouse are below the national average, ranked at two out of 10, with 10 being the least deprived.

The practice is open from 8am to 6.30pm on Mondays, Tuesdays, Wednesdays and Fridays. On Thursdays it closes at 3pm but patients are able to go to the main site at Handsworth. Extended opening hours are offered from 6.30pm to 8pm Monday to Friday as well as Saturday and Sunday opening from 9am to 12pm. This was offered through a federation of practices organised by the CCG and patients had a choice of a number of practices they could attend.

Updated 19 April 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at NHSTanhouse Clinic on 17 August 2017. The overall rating for the practice good. However, the practice was rated as requires improvement for safe service. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for NHSTanhouse Clinic on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 17 August 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had reviewed it process to ensure patient safety alerts such as those from Medicines and Healthcare products Regulatory Agency (MHRA) were received and actioned appropriately.

• The practice had established a system to ensure relevant alerts were communicated to relevant staff at both sites. If there were urgent risks that needed to be communicated to staff they would be escalated by the practice manager either through a telephone call or by visiting the site.

• To meet the needs of the increasing patient list size the practice had recruited extra administration staff and increased clinical sessions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 October 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was 87% which was in line with the CCG average of 88% and national average of 90%. Diabetic patients were referred to structured learning programmes and a diabetes specialist consultant along with a specialist nurse held bi-monthly clinics for more complex cases. This was as part of the Diabetes Inpatient Care and Education (DICE) programme, a CCG funded area of enhanced care.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• Longer appointments and home visits were available when needed. Patients with long term conditions had a named GP and a structured annual review to check their health and medicines needs were being met.
• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions such as insulin initiation, electrocardiographs (ECGs) and spirometry.

Updated 10 October 2017

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

• From the sample of documented examples we reviewed we found there were systems 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.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Priority for appointments was given to sick children. The practice had baby changing facilities and offered a breast feeding friendly service.
• Appointments were available outside of school hours.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Updated 10 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• The practice regularly worked with other health professionals to review patients and to ensure the needs of those with the most complex care needs were being met. For example, patients with end of life care needs or that had an unplanned admission to hospital.

Updated 10 October 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, the practice offered extended opening hours on a Monday until 8pm. Extended Saturday opening was available from 9am to 12 noon at this site. This was useful for patients who were unable to attend due to work or other commitments during normal opening hours.
• 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.
• A telephone triage service enabled patients who were unable to attend the practice easily to seek clinical advice.
• Enhanced text messaging service was used to allow for two way interactive patient messaging.
• The practice offered virtual membership to its patient participation group to encourage feedback from this group of patients.

Updated 10 October 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG average of 84% and the national average of 84%. The exception reporting was 0% compared to the CCG and national average of 7%.
• 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 also used single point access to manage both routine and urgent referrals for working age adult mental health services.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A Mental Health Counsellor held weekly clinics at the site and offered links to other mental health services.

Updated 10 October 2017

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

• The practice offered longer appointments for patients with a learning disability and health checks were offered to them.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• A Drugs Misuse Support Worker held clinics at the practice to manage and support patients’ needs.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.