Dr Khalid Mirza

Updated 20 April 2017

Dr Khalid Mirza’s practice is also known as Woodhall Farm Medical Centre and provides a range of primary medical services to the residents of Hemel Hempstead and surrounding area. The practice is based in a purpose built medical centre at Valley Green, Hemel Hempstead HP2 7RJ.

The practice population has a higher than average number of patients below under nine years of age, for example 8% of the practice population is under four years of age, where CCG and England average is 6%. The practice also had noticeably fewer female patients over the age of 45 years of age. National data indicates the area falls in the fourth less deprived decile and is therefore one of lower than average deprivation. The practice has approximately 2,701 patients with services provided under a General Medical Services (GMS) contract, a nationally agreed contract with NHS England.

The clinical team includes one male principal GP, one female salaried GP, one nurse practitioner and one nurse prescriber. There is a team of reception and administrative staff led by a practice manager. 

The practice is open from 8.30am to 6.30pm Monday to Friday and offers extended opening hours until 7.30pm Monday evenings. At the time of the inspection the practice closed for lunch from 1pm to 2pm, an emergency mobile telephone number was available to the residential care home and learning disability home serviced by the practice and certain patients. The practice told us this arrangement was however under review.

When the practice is closed, out-of-hours services are provided by accessing NHS 111. Information was provided on the practice website and on posters and leaflets available in the practice.

Updated 20 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Khalid Mirza on 24 January 2017. 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.
• Feedback received from patients from the completed CQC comment cards was consistently positive. Patients told us they were impressed by the professional attitude and caring approach of the staff.
• The practice had identified less than 1% of patients as carers and had achieved the Carers in Hertfordshire Silver Award.
• Members of the patient participation group (PPG) we spoke with were positive about the practice and the care provided.
• The practice met regularly with the PPG and responded positively to proposals for improvements.
• 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.
• 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 improvements are:

• Work to increase the number of patients recognised as carers should continue.
• In line with the practice complaints policy ensure patients receive a written response to any complaint.
• Continue to take steps to ensure that in future National GP Patient Surveys the practice’s areas of below local and national average performance are monitored and improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2017

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.
• Performance for diabetes related indicators was similar to the local and national averages. For example, the percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification was 84% compared to the CCG and the national average of 89%.
• The principal GP at the practice is diabetic lead for the locality.
• Longer appointments and home visits were available for these patients 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.
• Nurse led clinics ensured annual reviews and regular checks for patients with asthma and chronic obstructive pulmonary disorder (COPD) were in place. The practice had clear objectives to reduce hospital admissions for respiratory conditions.
• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The practice regularly reviewed their QOF achievement to identify if there were any areas which required additional focus, particularly for those patients with long-term conditions. These reviews were led by one of the nurse practitioners with the support of the practice manger and discussed at the practice clinical meetings.

Updated 20 April 2017

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.
• 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 provided appointments outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• Childhood immunisation rates for the vaccinations given were higher than CCG and national averages. For example, the practice achieved a 99% target for childhood immunisation rates for the vaccinations given to under two year olds compared to the national average score of 91%.
• The practice’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 82% and the national average of 81%.
• We saw positive examples of joint working with midwives and health visitors.

Updated 20 April 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.
• A vaccination programme was in place for older people including, seasonal flu jabs, shingles and pneumococcal vaccinations.
• Patients aged over 75 years were offered an annual health check.
• The practice holds a Gold Standard Framework meeting monthly with staff from the palliative care nursing team from a local hospice and the District Nursing Team.

Updated 20 April 2017

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 open 8.30am to 6.30pm Monday to Friday with extended hours from 6.30pm to 7.30pm on Monday evenings. This was especially useful for working patients who could not attend during normal opening hours.
• 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. For example, smoking cessation and weight management.
• 60% of females, aged 50-70 years, were screened for breast cancer in last 36 months compared to the CCG and the national average of 72%.
• 45% of patients, aged 60-69 years, were screened for bowel cancer in last 30 months compared to the CCG average of 57% and the national average of 58%.
• Patients who had not attended for screening opportunities were offered an appointment at the practice to discuss the service and its benefits to increase awareness and acceptance of the screening.

Updated 20 April 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with 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 carried out advance care planning for patients with dementia and provided advice and support for patients experiencing poor mental health about how to access support groups and voluntary organisations.
• Performance for mental health related indicators was similar to the local and national averages. 100% of patients diagnosed with dementia who had their care reviewed in a face-to-face meeting in the last 12 months, compared to the CCG average of 85% and the national average of 84%.
• Referrals were made to the IAPT team (Improving Access to Psychological Therapies) and the Holistic Care team based in the practice building.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01 April 2015 to 31 March 2016) was 92%, compared against the local CCG average of 92% and the national average of 89%.
• The practice had a system in place to follow up patients who had attended accident and emergency 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. Staff were in the process of completing Dementia Awareness training.

Updated 20 April 2017

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

• The practice had identified 17 patients as carers and offered them flexible appointment booking, health checks and flu vaccinations. The carers lead offered assistance and advice on the different type of support available.

• The practice held a register of patients living in vulnerable circumstances including travellers, homeless people and those with a learning disability.
• The practice was able to recognise how services should be adapted to support the patient’s lifestyle.
• The practice provided dedicated GP services to residents at a learning disabled home. The practice offered longer appointments for patients with a learning disability. The practice had 14 patients registered with learning difficulties and 13 of these patients had received a health check in 2015/2016
• 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 support groups and voluntary 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 normal working hours and out of hours.
• The practice provided services to a group of travellers registered with the practice.