Dr H. Ullah & Partners

Updated 14 November 2016

Dr H Ullah & Partners, also known as Bedford Street Surgery, provides a range of primary medical services, including minor surgical procedures from its location at Bedford Street in Milton Keynes. The practice has a branch surgery known as the Furzton Medical Centre, located on Dulverton Drive in Furzton, Milton Keynes. We visited the branch surgery on the day of our inspection but did not undertake a complete inspection of the branch.

The practice serves a population of approximately 12,500 patients with slightly higher than average populations of males and females aged 35 to 49 years. The practice population is largely White British, with increasing populations of European and Asian patients. National data indicates the area served is one of slightly less than average deprivation in comparison to England as a whole.

The clinical team consists of four female and four male GP partners, two nurse practitioners (qualified as Independent Prescribers), a practice nurse, two health care assistants and a phlebotomist. The team is supported by a practice manager, a finance manager, a reception manager and a team of administrative staff. In the 18 months preceding our inspection the practice had experienced an unusually high turnover of both clinical and non clinical staff. The practice told us that this had impacted on access to appointments and patient satisfaction. We saw that the practice had successfully recruited additional staff and at the time of our inspection had stabilised the practice team.

The practice recently changed its contract with NHS England and now holds a General Medical Services (GMS) contract for providing services, which is a nationally agreed contract between general practices and NHS England for delivering general medical services to local communities.

The practice at Bedford Street operates from a two storey converted property and patient consultations and treatments take place on ground level and first floor treatment room. There are limited designated car parking spaces available outside the practice with designated disabled parking bays. There is restricted hours parking available on the surrounding roads. The branch surgery is located in a single storey purpose built property. There is a car park outside the branch surgery, with disabled parking available.

Dr H Ullah & Partners is open at both the main site and branch surgery between 8am and 6.30pm Monday to Friday. In addition, pre-bookable appointments are available at both sites from 6.30pm to 7.30pm on Mondays, Tuesdays and Fridays. The practice is a member of the local ‘Prime Ministers Challenge fund’ (PMCF) collaboration called MKExtra, enabling their patients, wishing to be seen outside of the practice’s extended and core hours, to receive routine GP care at a network of practices across the locality.

The out of hours service is provided by Milton Keynes Urgent Care Services and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website and telephone line.

Updated 14 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr H.Ullah & Partners on 11 October 2016. 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 well 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 and they were involved in their care and decisions about their treatment.
• Information about services 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 said they found it difficult to make an appointment but that there was continuity of care when they received an appointment, with urgent appointments available the same day.
• We saw evidence of improvements made by the practice to improve access to appointments, including the introduction of a minor illness/injury service.
• 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.

The areas where the provider should make improvement are:

• Develop systems to identify and support more carers in their patient population.
• Continue to monitor and ensure improvement to national patient survey results including access to GP appointments.
• Secure the storage bin for clinical waste outside the premises to ensure that it cannot be removed.
• Continue to monitor and encourage patient uptake of screening and vaccination programmes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 November 2016

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

• A specialist nurse for long term conditions led chronic disease management clinics supported by GPs and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable to the clinical commissioning group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the preceding 12 months, was 71%, where the CCG average was 74% and the national average was 78%.
• Longer appointments and home visits were available when needed.
• The practice provided an insulin initiation service for diabetic patients.
• A robust recall system was utilised to manage these patients.
• Patients with long term conditions benefitted from continuity of care with their GP or nurse. 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 more complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• All discharge summaries were reviewed on the day they were received ensuring medicines were adjusted and appropriate primary care follow-up was arranged.

Updated 14 November 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 may be 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.
• The practice’s uptake for the cervical screening programme was 77%, which was comparable to the CCG average and national averages of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Children and infants who were unwell were always seen on the same day.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Family planning and contraceptive advice was available. The practice provided a variety of health promotion information leaflets and resources for this population group for example the discreet provision of chlamydia testing kits.

Updated 14 November 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.
• All patients over the age of 75 had a named GP.
• The practice had a lead nurse for elderly patients aged over 75 years who worked to optimise their care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice provided influenza, pneumonia and shingles vaccinations.
• A phlebotomy clinic ran daily enabling patients to have blood tests conducted locally rather than at the local hospital.
• The practice offered health checks for patients over the age of 75.

Updated 14 November 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.
• Pre-bookable appointments were available at both sites from 6.30pm till 7.30pm on Mondays, Tuesdays and Fridays.
• The practice provided telephone consultations daily.
• A HIV quick test was available for all new patients registering at the practice (that met specified criteria).
• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.
• The practice encouraged the use of the on line services to make it easier to book appointments and order repeat prescriptions.
• The practice encouraged screening for working age people such as bowel screening and cervical screening. Practice staff followed up any patients who did not respond to screening invitations so that they knew they were welcome to make contact if they wished to re-engage.

Updated 14 November 2016

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

• The practice had successfully secured funding to become a dementia friendly practice in February 2015, working alongside the Oxford research project. The practice had used funds to train all staff as dementia friends and made improvements to the care provided to these patients.
• The percentage of patients with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was 84% where the CCG average was 78% and the national average was 88%.
• The practice provided dementia screening services for patients identified as at risk of developing dementia to allow for early intervention and support if needed.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice held a register of patients experiencing poor mental health and invited them to attend annual reviews. The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 November 2016

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

• The practice had developed a register of patients in vulnerable circumstances including homeless people and those with complex social needs.
• 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, including corroborative working at locality wide multi-disciplinary meetings.
• The practice informed vulnerable patients about how to access support groups and voluntary organisations.
• The practice held palliative care meetings in accordance with the national Gold Standards Framework (GSF) involving district nurses, GP’s and the local Willen Hospice nurses.
• 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.

• The practice had identified 108 patients (approximately 0.9% of the practice list) as carers. The practice was continuing with efforts to ensure all carers within their population were identified and supported. We saw that a member of staff had trained as a Carers Champion.