Archived: Dr P Pal and Jemahl

Updated 7 June 2017

Dr P Pal and Jemahl provide primary medical services to approximately 6000 patients of various ages in the local community. There are two GP partners (both male) and two part time salaried GPs (one male and one female). The practice is based in the Great Barr area of the West Midlands.

The GPs are supported by a practice nurse and two health care assistants. The non-clinical team consists of a team of six administrative and reception staff and a practice manager. Supporting the practice manager was an assistant practice manager.

Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The practice is open between 8.15am and 6pm Mondays to Fridays except Thursdays when it closed at 1pm. The practice is also open every Saturday from 8am to 11am. The practice has opted out of providing out-of-hours services to their own patients. This service is provided by ‘an external out of hours service provider. There were notices to inform patients of this arrangement in the surgery as well as through the practice website.

Updated 7 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr P Pal and Jemahl on 19 April 2016. The overall rating for the practice was Good. However, for providing safe service the practice was rated as requires improvement. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr P Pal and Jemahl on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 April 2017 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. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection on the 19 April 2016.

Overall the practice is rated as Good.

Our key findings were as follows:

• During our previous inspection in April 2016 we saw that the practice had considered the risks associated with not undertaking Disclosure and Barring Service (DBS) checks for some staff. However, these risk assessments were not effective to mitigate all risks. During this inspection we saw that all staff had undergone a DBS check.

• When we inspected the practice in April 2016, we saw that the practice had carried out an annual analysis of significant events. However, all recorded incidents and significant events were not included in the analysis. During this follow up inspection, the practice had carried out an annual significant event audit including all significant events and occurrences.

• At our previous inspection we saw evidence that patient medicine safety alerts were received and cascaded to relevant staff. However, the practice could not evidence the actions taken following receipt of safety alerts. During this follow up inspection the practice could demonstrate that a process was in place for the monitoring of actions taken following the receipt of medicine safety alerts.

• When we inspected the practice in April 2016 we saw that health and safety risk assessments were not in place. At this follow up inspection we noted that actions had been taken to manage and mitigate risks related to health and safety.

• During our previous inspection in April 2016 we saw the practice had a whistle blowing policy which needed review as it did not reflect existing guidance. During this follow up inspection we saw that the policy had been reviewed and staff members we spoke with were aware of the changes.

• Treatment protocols clearly set out what actions should be taken in response to the results of health assessments, explaining the reason and justification for each action for health care staff. When we inspected the practice in April 2016, we saw the practice did not have protocols for the nurse and the healthcare assistant to guide decision-making around specific health issues. For example, the frequency of a structured review for an asthma patient. During this follow up inspection we saw that treatment protocols were available for staff on the practices computer system and they were based on the National Institute for Health and Care Excellence (NICE) guidance. They included protocols on Hypertension, Asthma, and Angina amongst others.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 June 2016

The practice is rated as requires improvement for the care of people with long-term conditions. The practice offered a range of clinical services which included care for long term conditions such as diabetes, a range of health promotion and chronic disease support. Patients at risk of hospital admission were identified as a priority through the use of risk assessment tools. Longer appointments and home visits were available when needed. All these patients 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. However, data we looked at showed that the practice achievement for diabetes was significantly lower compared to local and national averages for the previous two years. The practice was aware of this and had responded by providing specialist training for the practice nurse.

Updated 10 June 2016

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 all standard childhood immunisations were similar to or above local averages. Appointments were available outside of school hours and children were given appointments as a priority.

Updated 10 June 2016

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 and had a range of enhanced services, for example, shingles catch up vaccination, dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice nurse undertook home visits to housebound patients for medicine reviews. The practice had effective systems in place to identify and assess patients who were at high risk of admission to hospital. These patients were reviewed and care plans developed to reduce the need for them to go into hospital.

Updated 10 June 2016

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. The practice offered online services and telephone consultations as well as a full range of health promotion and screening that reflected the needs of this age group. The practice offered Saturday opening as well as early morning appointments. This was beneficial for patients unable to visit the practice during the main part of the day such as those patients who worked during these hours.

Updated 10 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). We saw that there were 48 patients on the mental health register and the practice had carried out annual physical health checks for all of those on the register. The practice regularly worked with multidisciplinary teams in the case management of people 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. Information was made available at the practice to sign post patients to various support groups and services. This was also available on the practice website. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 10 June 2016

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 those with a learning disability. We saw that there were 11 patients on the learning disability register and the practice had carried out annual health checks for nine people on the register. It offered longer appointments for people 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.

The practice was taking part in a domestic violence and abuse (DVA) pilot scheme, Identification and Referral to Improve Safety (IRIS) and held domestic violence multidisciplinary meetings. Minutes of meetings we looked at showed a number of patients had been discussed and reviewed. The GP partners told of specific cases where they had supported patients suffering abuse. 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.