Archived: Dr Ammar Ahmad Also known as The Elms Surgery

Updated 11 April 2017

The Elms Surgery provides a range of primary medical services from its town centre location at The Avenue, Watford, Hertfordshire. The practice area covers mainly Central Watford but extends to North Watford, Garston & Bushey.

The practice serves a population of approximately 4,796 patients with considerably higher than average populations in the 0 to 4 years and 25 to 39 years age range and slightly lower than average population of patients aged 5 to 19 years and 45 to 74 years. The practice population is largely White British with a small mixed ethnic population and a recent increase in patients from Eastern Europe. National data indicates the area is one of low deprivation and low unemployment in comparison to England as a whole.

The clinical team consists of the lead GP (male), a female salaried GP, two practice nurses and two health care assistants. The team is supported by a practice manager and a team of reception and administration staff.

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

The practice operates from a two storey converted house and patient consultations and treatments take place on both the ground and first floors. There is a small car park outside the surgery with additional parking available close by permitting one hour free parking.

The Elms Surgery is open between 8am and 6.30pm Monday to Friday and appointments are available during these times daily. Extended hours appointments are offered on Tuesday evenings until 8pm.

The practice is part of the Watford Care Alliance (WCA). The Watford Care Alliance was formed in 2014 with funding from the Prime Ministers Challenge Fund, initially a group of 11 GP practices who came together to collectively consider improved primary care services and access for patients, other local practices have since joined. WCA offers extended access to appointments in the evenings and at weekends and also provides an integrated health and social care team, doctor and a phlebotomy service that operates at weekends.

The out of hours service is provided by Herts Urgent Care and can be accessed via the practice telephone number. Information about this is available in the practice and on the practice website and telephone line.

Updated 11 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ammar Ahmad on 19 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.
• The practice undertook appropriate recruitment checks including references and professional registration checks.
• The practice had a comprehensive business continuity plan in place for major incidents.

• 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 easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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 practice offered extended hours appointments, including weekend appointments through the Watford Care Alliance.

The areas where the provider should improvements are:

• Continue to identify and support carers in their patient population.

• Ensure improvement to childhood immunisations and cervical screening rates.
• Continue to monitor and ensure improvement to the results from the national GP patient survey.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 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.
• Patients requiring end of life care received support from GPs who worked in close liaison with community support teams to ensure patients needs were met.
• One of the GPs carried out regular visits to the local hospice and worked closely with staff managing palliative patients.

• Early screening was undertaken for long term conditions including pre-diabetes screening and NHS Health Checks.

• Longer appointments and home visits were available 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.

Updated 11 April 2017

The practice is rated as requires improvement 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.
• Immunisation rates for the standard childhood immunisations were low. For example, rates for the vaccinations given to under two year olds ranged from 79% and 86% (national average 90%) and five year olds from 63% to 70% (CCG averages, 94% to 95%, national averages 88% to 94%).
• 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 percentage of women aged 25-64 years whose notes recorded that a cervical screening test had been performed in the preceding five years was 72%, which was comparable to the CCG average of 82% and the national average of 81%. The practice was actively encouraging patients to attend cancer screening appointments and there were posters in the waiting area.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors. The community midwife held weekly clinics at the practice.
• Safeguarding information regarding children was shared with health visitors and the local authority for children who may be at risk.
• Following A&E attendance, parents and guardians of children aged 0 to 4 years were contacted by a GP to review the reasons for attendance.

Updated 11 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.
• The practice worked with other health and social care professionals to understand and meet the range and complexity of older patients’ needs and to assess and plan ongoing care and treatment. This included when patients moved between services, including when they were referred, or after they were discharged from hospital.
• Meetings took place with other health care professionals on a monthly basis when care plans were routinely reviewed and updated for patients in this group.

Updated 11 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 proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• 52% of patients aged 60-69 years had been screened for bowel cancer in the preceding 30 months, where the CCG average was 57% and the national average was 58%.
• 73% of female patients aged 50 to 70 years had been screened for breast cancer in the preceding 3 years, where the CCG and national averages were 72%.
• There were a number of access routes to the practice, for example, the use of the online booking system for appointments including those outside of normal surgery hours. Patients were also able to book a telephone appointment.
• Extended hours and evening telephone consultation appointments were available on Tuesdays until 8pm. Emergency telephone consultations were available daily.
• The practice offered the Men ACWY vaccine to young teenagers and first year students going to university to protect them against meningitis (an inflammation of the lining of the brain) and septicaemia (blood poisoning).
• 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.
• An in- house physiotherapy clinic operated twice each week.

Updated 11 April 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 number of patients with diagnosed psychoses who had a comprehensive agreed care plan was 94%, above the CCG average of 92% and the national average of 89%.
• Patients with mental ill health were routinely monitored and an annual health review was offered.
• Patients who had more complex psychological or mental health illnesses were offered an extended appointment.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. Information was available in the waiting area in the form of leaflets and posters along with links to videos and national groups on the practice website.
• 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.
• 92% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, above the CCG average of 85% and the national average of 84%.
• 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.

Updated 11 April 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice had a register of patients with learning disabilities and at the time of inspection there were 12 patients registered.
• Patients with learning disabilities were offered annual reviews which included a health assessment, medication review and an up to date health plan, 10 patients had received a health check in the last 12 months.
• 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.
• 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 held a register of carers, at the time of the inspection there were 24 patients on the register, approximately 0.5% of the total practice list size.
• A monthly Carers ‘Drop in’ session was offered to all patients.
• Vulnerable patients were highlighted on the clinical system. GPs monitored the status of these patients and any further risk factors they encountered and if identified as high risk, their details were passed on to the local safeguarding team.