Archived: Dr Usman Akbar Also known as The Family Practice

Updated 17 August 2016

Dr Usman Akbar is also known as The Family Practice and provides services for 1,994 patients. The surgery is situated within the Bradford City Clinical Commissioning group and is registered with Care Quality Commission (CQC) to provide primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

Dr Usman Akbar is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery services. They offer a range of enhanced services such as childhood immunisations, improving patient access on line and enhanced services for patients with a learning disability.

There is a higher than average number of patients under the age of 39, in common with the characteristics of the Bradford City area. There are fewer patients aged over 45 than the national average. The National General Practice Profile states that 72% of the practice population is from an Asian background with a further 8% of the population originating from black, mixed or non-white ethnic groups. The practice has also identified that they have a growing number of patients who are from an Eastern European background.

Dr Usman Akbar works in close collaboration with two other GP practices in the local area and have formed a group called the BD8 Group of surgeries (BD8 refers to the practice postcode). The group employ and utilise staffing flexibly, hold joint clinical, staff and PPG meetings and discussed with us the possibility of a merger in the future.

The registered provider at the practice is Dr Usman Akbar. Clinical sessions at the practice are covered by long term locum GPs one of whom is female and offers two sessions per week. The practice also has a part time practice nurse and is in the process of recruiting an advanced nurse practitioner. Additional clinics are also supported by other nursing staff who work across all three sites. There is one part time male health care assistant.

The clinical team is supported by a practice manager and a team of administrative staff. The practice also benefits from the services of a pharmacist and a data quality lead for four hours per week.

The characteristics of the staff team are reflective of the population it serves and they are able to converse in several languages including those widely used by the patients, Urdu, Punjabi, English and a number of eastern European languages.

The practice catchment area is classed as being within one of the most deprived areas in England. People living in more deprived areas tend to have a greater need for health services. The practice discussed with us a high birth rate in their population and high rates of illiteracy.

Dr Usman Akbar is situated within a purpose built building with car parking available. It has disabled access and facilities.

The reception is open from 8.00am until 7.30pm on a Monday and from 8.00am until 6.30pm Tuesday to Friday. Appointments are available from 8.30am to 7.30pm on a Monday. Appointments are available from 8.30am on a Tuesday, 9.00am on a Wednesday and Friday and 9.30am on Thursdays: on these days the surgery closes at 6.30pm. An extended hours clinic is offered until 7.30pm on a Monday but patients can also access a GP until 7.30pm on a Tuesday and a Wednesday at the other BD8 group sites.

When the surgery is closed patients can access the Pharmacy First minor ailments scheme or the Local care direct walk in centre at Hillside Bridge Health centre. Patients are also advised of the NHS 111 service for non –urgent medical advice.

Updated 17 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Usman Akbar also known as The Family Practice on 19 July 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. The practice worked closely with two other practices in the area and outcomes and learning from complaints and significant events were shared appropriately between the practices at joint team meetings.

• We saw evidence of “competition” between three collaborating practices which helped incentivise staff to ensure that patient needs were prioritised for example; we saw that flu vaccination targets were met.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. We saw that development and learning was prioritised by the practice and staff had 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 during consultations with their GP. Satisfaction rates for consultations with nursing staff was lower than the national average but comparable to other practices in the area.
• 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 we spoke with on the day said it was difficult to make an appointment with their preferred GP. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs. However, the practice shared with us that they faced a number of challenges with the building.
• There was a clear leadership structure and staff felt supported by management. Staff told us that they would feel confident to raise any concerns with the lead GP or practice manager.
• The practice sought feedback from patients and the Patient Participation Group (PPG), which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

The practice offered a level two diabetes clinic where patients could be commenced on insulin therapy without having to attend the hospital. (Insulin is a drug used for diabetics which keeps blood sugar levels from getting too high or too low). This combined clinic could offer a multi-disciplinary service, including the input of a specialist dietician, a podiatrist and the lead GP who had specialist knowledge in this area. By offering these services closer to the patients’ home the practice could also reduce the burden on hospital services. In an area of high deprivation where travel costs could be prohibitive for some patients, services were planned to meet patient needs.

Patients at the practice could be difficult to engage due to their cultural diversity and understanding of health services. However, the percentage of women who had undergone a cervical screening test was 88% which was higher than the Clinical Commissioning Group (CCG) average of 77% and the national average of 82%. Patients would be contacted by the nurse who would explain the importance of this test in a culturally sensitive manner and in the patients' own language where appropriate.

The areas where the provider should make improvements are:

The service should continue to review the access to appointments and review the necessity of making changes to the telephone systems.

The practice should continue to review the results of patient satisfaction surveys in order to meet the needs of the patient population in the future taking into account improvements to the accessibility of services and clinicians.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Nursing staff were encouraged to develop competencies and skills to lead in the management of long term conditions.
• Patients diagnosed with diabetes were offered longer, 40 minute appointments, so that they could discuss every aspect of their condition.
• The practice offered a level two diabetes clinic where patients could be commenced on insulin therapy without having to attend the hospital. This innovative combined clinic could offer a multi-disciplinary service, including the input of a specialist dietician, a podiatrist and a lead GP with specialist knowledge. By offering these services closer to the patients’ home the practice could also reduce the burden on hospital services.
• Outcomes for diabetes related indicators were comparable to other practices. For example the percentage of patients on the register who had a flu immunisation in the preceding 12 months was 98% compared to the CCG average of 96% and the national average of 94%. For some indicator results, the practice were slightly lower than national averages.
• Patients could access Spirometry testing at the practice, this is a test of how well you can breathe and can help in the diagnosis of different lung diseases such as chronic obstructive pulmonary disease (COPD).
• 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.

Updated 17 August 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. Vulnerable children, young people and vulnerable family groups were discussed and reviewed in a multidisciplinary meeting every month.
• Immunisation rates were relatively high 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. Children could be seen by the nurse outside of school hours until 6pm in the evening and the premises were suitable for children and babies.
• Patients at the practice could take advantage of the pharmacy first scheme. This allows people who receive free prescriptions to go straight to their pharmacist to receive treatment without needing to visit their GP first to get a prescription.
• The percentage of women who had undergone a cervical screening test was 88% which was higher than the CCG average of 77% and the national average of 82%.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice offered joint eight week baby checks where mothers and babies could be seen at the same time.

Updated 17 August 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.
• The practice was responsive to the needs of older people, and offered urgent appointments for those with enhanced needs.
• The practice offered home visits for older people and this was supported by a home visits protocol.
• Flu vaccinations were offered to older patients in their own homes by the practice nurse. The uptake for vaccinations in patients over 65 years old was 87%.

Updated 17 August 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 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.
• The practice would contact patients by telephone the day before they were due to attend the surgery and send an SMS text message to remind them of their appointment on the day.
• Telephone consultations were available for patients who could not attend the surgery.
• The practice offered an extended hours clinic until 7.30pm on a Monday. Patients could also access a GP at the two other BD8 group surgeries until 7.30pm on a Tuesday and Wednesday.

Updated 17 August 2016

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

• The GP patient survey showed that 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was slightly lower than the CCG and national average of 84%.
• Data showed that 100% of patients with a mental health issue had their smoking status recorded in their notes in the preceding 12 months, but only 75% of patients had an agreed and documented care plan.
• The practice nurse would opportunistically complete a short memory assessment with older patients and refer them to the GP if concerns were noted.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• The practice had a system in place to follow up patients who had attended accident and emergency when 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 17 August 2016

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

• The practice were aware of patients living in vulnerable circumstances including homeless people, travellers, carers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability, long term conditions or those who required an interpreter.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. The collaboration between the three practices enabled complex and vulnerable cases to be discussed confidentially and reviewed by clinicians with additional specialist knowledge in their monthly meetings.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Patients were able to access a benefits advisor at the surgery one morning per week.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. All the staff we spoke with on the day of inspection 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.
• High numbers of patients at the practice did not speak English as their first language and so were at risk of experiencing health inequalities. The diverse staff team were able to converse with patients in multiple languages and assist their access to health care.