Probert Road Surgery

Updated 23 October 2017

Dr Sanjay Mittal is registered with the Care Quality Commission (CQC) as an individual GP practice. The practice is located in an inner city area of Wolverhampton and has good transport links for patients travelling by public transport. Parking is available for patients travelling by car. The practice is accessible by patients with mobility difficulties, patients who use a wheelchair and families with pushchairs or prams.

The practice is part of the NHS Wolverhampton Clinical Commissioning Group (CCG). The practice holds a Personal Medical Services (PMS) contract with NHS England. A PMS contract is a locally agreed contract between NHS England and the practice and offers variation in the range of services that may be provided by the practice. The practice provides Directed Enhanced Services, such as childhood vaccinations and immunisations, management and support for patients with dementia and the care of patients with a learning disability. At the time of our inspection there were approximately 4,606 patients. The practice is located in one of the most deprived areas of Wolverhampton. People living in more deprived areas tend to have a greater need for health services. The practice patient population are mostly under the age of 65 years. There is a higher practice value for income deprivation affecting children and older people in comparison to the practice average across England. The level of income deprivation affecting children of 30% is higher than the national average of 20%. The level of income deprivation affecting older people is higher than the national average (27% compared to 16%).

The practice team consists of one male GP who works full time, approximately 10 sessions per week. The GP is supported by two advanced nurse practitioners. Clinical staff are supported by two practice managers, four reception staff and an information technology lead. One of the receptionists has a dual role as a phlebotomist (someone who takes blood from patients). In total there are 10 staff employed either full or part time hours to meet the needs of patients. The practice uses a GP buddy system, a regular local GP to cover short periods of absence and locum GPs occasionally.

The practice is accessible by phone between 8am and 6.30pm Monday to Friday. Appointments times for patients vary for the GP and advanced nurse practitioners and include both morning and afternoon clinic sessions. Appointments with the GP are available between 8am and 11am Monday to Friday, 4pm to 6.30pm Tuesday, Wednesday and Friday, 5pm to 8pm on a Monday and 5pm to 7.30pm on Thursday. The GP also carried out a baby clinic between 1pm and 3pm on a Thursday. The practice offers extended hours appointments on Monday and Thursday evenings. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service Vocare via the NHS 111 service.

Updated 23 October 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr Sanjay Mittal on 31 October 2016. After the comprehensive inspection, the practice was rated as requires improvement for providing well-led services.

We issued a requirement notice in relation to:

• Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Good Governance.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Sanjay Mittal on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 25 September 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 at our previous inspection on 31 October 2016. This report covers our findings in relation to those requirements.

Our key findings across all the areas we inspected were as follows:

• Systems were in place to show the action taken to address alerts about medicines that may affect patients’ safety.
• Systems to monitor children who fail to attend hospital appointments had been reviewed and procedures put in place to ensure these were appropriately managed.
• At risk registers for children and vulnerable adults were maintained and appropriately managed.
• Employment checks required by legislation had been completed for all staff employed.
• The plans for ongoing clinical audits that support improvements for patients had been reviewed.
• Arrangements to ensure the GP was actively involved in the appraisal and supervision of the advanced nurse practitioners had been introduced.
• Systems were in place to ensure patients discharged from hospital were followed up in a timely way.
• Plans were in place to review the reasons for lower patient satisfaction in the GP national survey for patient experience of their interaction with GPs. For example, the GP was looking at using an accredited patient satisfaction survey as part of their revalidation.
• Pro-active plans had been introduced to identify carers and establishing what support they need. The number of carers identified remained just under 1% but had increased from 30 (0.65%) to 45 (0.97%).
• At this inspection we found that the practice had addressed all the concerns raised and is now rated as good for providing well-led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 March 2017

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

• The GPs, nurses and healthcare assistants had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The GPs and nurses worked with relevant health care professionals to deliver a multidisciplinary package of care to patients with complex needs.
• The practice Quality and Outcomes Framework (QOF) score for the care of patients with long-term conditions was higher overall compared to the local and national average. For example the practice performance for diabetes related clinical indicators overall was higher than the local Clinical Commissioning Group and England average (90% compared to the local average of 82% and England average of 89%).
• Longer appointments and home visits were available when needed

Updated 21 March 2017

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

• Immunisation rates were higher overall for all standard childhood immunisations.
• 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 had access to health visitors to discuss childhood development, immunisations and pre-school checks. Community midwives carried out an antenatal clinic one morning per week to support the care of pregnant women,
• The practice’s uptake for the cervical screening programme was 82% which was higher than the local Clinical Commissioning Group (CCG) average of 78% and the same as the England average.
• Protected daily appointments were available for children of all ages and children aged under the age of one were given priority and seen on the day. Appointments were available outside of school hours and urgent appointments were available for children.

Updated 21 March 2017

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

• The practice maintained a register of housebound older patients and older patients who required a home visit.
• Older patients were offered urgent appointments for those with enhanced needs.

Updated 21 March 2017

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

• The practice offered on telephone consultations.
• The practice offered extended clinic appointments three days per week for working patients who could not attend during the normal opening hours.
• The practice was proactive in offering online services which included making online prescription and appointment requests.
• Patients were signposted to a full range of health promotion and screening that reflects the needs for this age group.

Updated 21 March 2017

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

• Staff had a good understanding of how to support patients with mental health needs and dementia.
• 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 who experienced poor mental health. Clinical data for the year 2015/16 showed that 78% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

Updated 21 March 2017

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

• The practice supported patients who abused substances that could harm their health and wellbeing and provided health, social and professional support.
• The practice held a register of 24 patients with a learning disability and offered this group of patients’ longer appointments.
• The practice was alerted to patients whose circumstances may make them vulnerable or may present a risk to ensure that they were registered with the practice if appropriate.
• The practice had told vulnerable patients about how to access various support groups and voluntary organisations.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.