Archived: Dr Karim Ladha Also known as The Dovecote Surgery

Updated 23 July 2015

Dr Karim Ladha (The Dovecote Surgery) is based in the Birmingham Cross City Clinical Commissioning Group (CCG) area. The practice provides primary medical services to approximately 1,900 patients in the local community. The population covered is mixed with a high percentage of Asian patients registered at this practice.

The lead GP at the Dovecote Surgery is male. Two female locums also work at the practice on a regular basis. Additional staff included a practice manager, a practice nurse (female), and health care assistant (female). There were two administrative staff that supported the practice.

The practice offers a range of clinics and services including, asthma, child health and development, family planning and diabetes.

The practice opening hours are 9am to 12.30pm and 4.30pm to 6.30pm on Monday, Wednesday and Friday. The practice closes early on a Thursday and the hours of opening are 9.30am to 12.30pm, During the daytime when the practice is closed telephone lines are covered by Southdoc. Extended opening hours are provided on a Tuesday and appointments are available upon request from 7am to 8am, 10am to 12.30pm and 4.30pm to 6pm.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by Primecare, who are an external out of hours service provider contracted by the CCG.

Updated 23 July 2015

Letter from the Chief Inspector of General Practice

We completed a comprehensive inspection at The Dovecote Surgery on 10 February 2015. Overall the practice is rated as good.

We found that the practice was good for providing a safe, effective, caring, responsive and well led service. We found the practice provided good care to people with long term conditions, families, children and young people, older people, people in vulnerable groups and people experiencing poor mental health.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from incidents were maximised.

• Patients were protected from the risk of abuse and avoidable harm. The staff we spoke with understood their roles and responsibilities and there were policies and procedures in place for safeguarding vulnerable adults and children.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• Patients received care and treatment which achieved good outcomes, promoted a good quality of life and was based on the best available evidence. Systems were in place to review the care needs of those patients with complex needs or those in vulnerable circumstances.

• The practice worked collaboratively with other agencies and regularly shared information to ensure good, timely communication of changes in patients care and treatment.

• The practice had a clear vision to deliver high quality care and promote good outcomes for patients. This was evident when speaking with staff and patients during our inspection. There was a clear leadership structure with named staff in lead roles. Staff were aware who they should speak with if they needed guidance or advice. Staff reported that they worked well as a team and could approach the practice manager or GPs if they needed to discuss anything.

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

Importantly the provider should:

• Implement systems to identify patients at the practice with caring responsibilities including young patients with caring responsibilities.
• Implement robust systems to identify and manage risks to patients and others who use the service regarding the premises, including a fire risk assessment.

• Ensure equipment such as oxygen is available to deal with a medical emergency or provide an assessment of risk to demonstrate why this equipment is not required.

• Provide evidence to demonstrate that a legionella risk assessment has been carried out to identify all risks and ensure that the practice is managing any risks identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 July 2015

The practice is rated as good for the population group of people with long term conditions. When needed longer appointments and home visits were available. All these patients had a named GP and structured reviews (six monthly and annually) to check their health and medication needs were being met. GP led diabetic clinics included reviews of medication to ensure conditions were being managed appropriately. Emphasis was given to important aspects of a patient’s management of their health needs as well as providing advice of latest guidelines and recommendations. For those people with the most complex needs the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 23 July 2015

The practice is rated as good for the population group of families, children and young people. Systems were in place for identifying and following-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. However, the practice did not have information regarding young carers to enable appropriate support to be provided.

All children received child health checks and these were integrated with the first immunisation scheduled and maternal follow up. Immunisation rates were high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We were provided with good examples of joint working with midwives and health visitors. The practice provided health promotion advice and signposting to support organisations for children and young people with mental health problems for example Birmingham Healthy minds.

Updated 23 July 2015

The practice is rated as good for the care of older people. Systems were in place to ensure that those patients in this population group at risk of abuse or those who needed extra support were signposted to other services, referred to appropriate agencies and these patients were discussed at practice meetings and multi-disciplinary team meetings.

The practice was responsive to the needs of older people, including offering home visits and rapid access appointments for those with enhanced needs. We saw evidence to demonstrate that patients were signposted to local support groups to enable them to maintain a good quality of life.

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. All older patients over 65 were contacted with offer of flu vaccinations. The practice took part in the national vaccination programmes for example shingles and flu and actively contacted patients to offer the service. Systems were in place to ensure that medication reviews were undertaken on a regular basis for patients in this population group and within five working days following any discharge from hospital. Care plans were also reviewed and updated as required.

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 in dementia.

Updated 23 July 2015

The practice is rated as good for the population group of the 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 was proactive in offering health promotion in partnership with Birmingham Healthy Lifestyle Services with formal referrals and self-referrals being available. The smoking status of patients was identified and where appropriate smoking cessation was suggested. The blood pressure of working age people was checked during appointments, and we saw that 92% of these checks were recorded as having taken place.

A variety of appointment types were available, including pre-bookable, same day and urgent/emergency appointments. Extended opening hours and telephone consultations enabled patients who had work commitments to have access to the practice.

Updated 23 July 2015

The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia). Patients experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care was tailored to meet individual needs and examples of this were discussed.

The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations including Birmingham Healthy Minds, Change and the Health Exchange Service. Patients were provided support within the practice until formal Improving Access to Psychological Therapies (IAPT) service was available and follow-up was continued by the practice until no longer required.

The practice had a system in place to ensure regular monitoring of prescribing for patients with mental health issues. Computer flags alerted staff if a patient requested a repeat prescription too early or did not request a repeat prescription. Anti-depressant medication was not prescribed on repeat prescriptions; this maintained the provision of regular medication reviews at each request for a prescription.

Updated 23 July 2015

The practice is rated as good for the population group of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those with learning disabilities. The practice had carried out annual health checks for patients with learning disabilities and all of these patients had received a follow-up. The patient’s family, carers and the learning disability nurse attended pre-arranged health check consultations. The practice worked in conjunction with the Community Learning Disability Service. Carer support and advice was made available with the practice facilitating any community support services. The practice offered longer appointments for people with learning disabilities.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector organisations. 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 and out of hours.

The practice worked to support the health of the local population, the practice issued food vouchers to patients and signposted them to the local food bank. Chlamydia packs were available in the toilets and a sign in the surgery notified patients of their availability. Computer systems alerted GPs if patients registered at the practice with drug and/or alcohol addiction did not attend recommended health promotion activities such as smoking cessation or cervical cytology and these patients were contacted by practice staff to arrange alternative appointments.