Archived: Dr Rina Miah Also known as Harbottle SurgeryCa

Updated 15 October 2015

Dr Rina Miah is a busy rural practice providing care and treatment to 815 patients of all ages, based on a Personal Medical Services (PMS) contract agreement for general practice. The practice is part of NHS Northumberland Clinical Commissioning Group (CCG) and provides care and treatment to patients living in the Upper Rede and Coquet Valleys of central Northumberland, including the Powburn, Harbottle, Longhorsley and Otterburn areas. The practice serves an area where deprivation is lower than the England average, but 18.2% of children live in poverty. Life expectancy for both men and women is lower than the England average.

The main surgery was based in Harbottle village hall and there were small branches located in the Rothbury and Otterburn areas. We visited the following locations as part of inspection:

The Harbottle surgery, The Village Hall, Harbottle, Morpeth, Northumberland, NE65 7DG.

The Rothbury branch surgery, The Community Hospital, Whitton Bank Road, Rothbury, Morpeth, Northumberland, NE65 7RW.

The Otterburn branch surgery, The Otterburn Village Hall, Otterburn, Northumberland, NE19 1NR.

The main premises are located in the Harbottle Village Hall and these have been adapted to provide fully accessible treatment and consultation rooms for patients with mobility needs. Both branch surgeries also provided disabled access.

Dr Rina Miah provides a range of services and clinics including, for example, services for patients with asthma, diabetes and coronary heart disease. The practice consists of two GPs (one male and one female), a practice manager, a practice nurse, a dispenser and a trainee dispenser, and a small team of administrative and reception staff. The male GP was a locum doctor who had worked for the practice for a considerable number of years. However, they were shortly due to leave the practice. The GP provider held some sessions at the Harbottle surgery, but also worked at another practice in the Durham area for which they were registered with the Care Quality Commission. When the practice is closed patients can access out-of-hours care via Northern Doctors, and the NHS 111 service.

The Harbottle surgery opening hours were: Monday: 8:30am to 5pm; Tuesday: 8:30am to 6pm; Wednesday: 8:30am to 12:30pm; Thursday: 8:30am to 12:30pm and Friday: 8:30am to 5pm.

The Harbottle surgery GP appointment times were:

Monday: 2pm to 4.15pm, and nurse appointment times ran from 8:30am to 11am;

Tuesday: 2pm to 6pm, and nurse appointment times ran from 8:30am to 11am and between 3pm to 5pm;

Wednesday: 9am to 11:15am;

Friday: 9am to 11:15am, and nurse appointment times ran from 10:15am to 11:15am and between 3pm to 5pm.

The Otterburn branch surgery appointment times were:

Monday: 9am to 10:45am;

Friday: 2:45pm to 4:30pm.

The Rothbury branch surgery appointment times were:

Thursday : 9am to 10am: following an agreement reached with the former primary care trust, staff attended a weekly multi-disciplinary meeting at this time which also involved staff from another local practice as well as community based health staff;

Thursday: 10am to 12:15pm.

Friday: the nurse appointment times ran from 7:30am to 9:30am.

The practice manager told us emergency telephone triage was provided by Northern Doctors each Wednesday and Thursday between 12:30pm and 6:30pm so patients could access the care and treatment they needed. Although extended hours surgeries were not offered, staff told us every effort would be made to offer patients an appointment time which met their needs, even if this meant seeing them before or after a planned surgery session.

Updated 15 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rina Miah (Harbottle surgery) on 28 July 2015. Overall the practice is rated as good.

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. However, assessments had not been carried out in relation to all risks to the safety of patients and staff;
• Overall, the main practice and its branch surgeries had good facilities and were well equipped to treat patients and meet their needs. However, the absence of a defibrillator and oxygen supply at the Otterburn surgery could make it difficult to provide emergency treatment to patients should they become seriously ill at the surgery;
• Most systems and processes for managing medicines were satisfactory. However, the practice had failed to make sure that prescription forms were always stored at the Otterburn surgery in accordance with national guidance;
• Information about how to complain was available and easy to understand;
• Most patients told us they were treated with compassion, dignity and respect and were involved in making decisions about their care and treatment. Information was provided to help patients understand the care available to them;
• The practice worked closely with other organisations to help deliver a wider range of services so they could better meet the needs of patients who lived in a rural, isolated setting and who were dispersed over a large geographical area;
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received most of the training appropriate to their roles, although we did identify some gaps;
• Results from the National GP Patient Survey of the practice, published in July 2015, showed that patient satisfaction with access to care and treatment was higher when compared to local and national averages. The majority of patients we spoke to on the day of the inspection, as well as those who completed Care Quality Commission (CQC) comment cards and contacted us before the inspection, were satisfied with access to appointments.

The areas where the provider should make improvements are:

• Ensure prescription forms are always stored in accordance with the national guidance;
• Carry out a risk assessment to assess any potential risks to staff when they are working by themselves, and take action to put appropriate support systems in place where these are needed;
• Carry out a review of the systems for delivering medicines to designated ‘pick up’ points to ensure they are safe and secure, including the carrying out of a risk assessment to identify and manage areas of risk associated with this.

We saw an area of outstanding practice:

Results from the National GP Patient Survey showed most patients were happy with how they were treated and the quality of the care and treatment they received. Patient satisfaction scores for GP and nurse consultations were above the local CCG and national averages. For example:

• 99% of patients said the GP was good at listening to them, compared to the local CCG average of 91% and the national average of 89%;
• 100% said the GP gave them enough time, compared to the local CCG average of 89% and the national average of 87%;
• 100% said they had confidence and trust in the last GP they saw, compared to the local CCG average of 96% and the national average of 95%;
• 99% said the last GP they spoke to was good at treating them with care and concern, compared to the local CCG average of 88% and the national average of 85%.

We are aware that since the inspection NHS England have terminated the contract and surgery has been closed. Had the surgery continue to function it may have been subject to a requirement notice with respect to the security arrangements for blank prescription pads at the branch surgery at Otterburn.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 15 October 2015

The practice is rated as good for the care of people with long-term conditions. Nationally reported data showed the practice had performed well in providing recommended care and treatment for most of the clinical conditions commonly associated with this population group. For example, the data showed the practice had achieved 100% of the total points available to them for providing the recommended care and treatment to patients with asthma. (This was 0.4% above the local CCG average and 2.8% above the England average). Where data showed the practice had performed less well with regards to some clinical indicators, we were provided with reasonable explanations for this. The practice nurse had a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All patients who had long-term conditions had a named GP and the practice nurse undertook regular reviews of their health to ensure any long-term conditions they had were being satisfactorily managed. The GP provider and their team worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 15 October 2015

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 who were at risk. For example, the practice maintained a register of vulnerable children and contacted families where children had failed to attend planned appointments. Where comparative data was available to us, this showed immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the Harbottle surgery site was suitable for children and babies. The practice offered sexual health screening and family planning services, which included the fitting of implants and coils. Safeguarding issues were discussed at monthly practice meetings. The practice had prepared a healthcare information leaflet aimed at younger people and had recently set up a Facebook page.

Updated 15 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed the practice had performed well in providing recommended care and treatment for the majority of the clinical conditions commonly associated with this population group. For example, the data showed the practice had achieved 100% of the total points available to them for providing the recommended care and treatment to patients with heart failure. (This was 0.1% above the local Clinical Commissioning Group (CCG) average and 2.9% above the England average). Staff offered proactive, personalised care to meet the needs of the older people. They were responsive to the needs of older people, and offered home visits and longer appointment times. Patient feedback about the quality of care and treatment provided was mostly very positive.

Updated 15 October 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group. A SMS text service was used to remind patients of any planned appointments. Practice staff used a number of mechanisms to communicate with patients. For example, the practice had a website, a Facebook page and produced quarterly newsletters. However, some patients told us staff could be better at communicating what was happening at the practice. The practice offered combined longer appointments for patients with multiple conditions to reduce the number of visits they required for their annual health reviews to be completed. The practice delivered a range of services so that patients could access them locally, rather than having to travel long distances. For example, the practice provided: Cryotherapy (use of low temperatures to treat benign and malignant tissue damage), a minor injury and minor surgery clinic, wound care, warfarin monitoring and diabetic eye and foot screening.

Updated 15 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Nationally reported data showed the practice had achieved 100% of the total points available to them for providing recommended care and treatment to patients with dementia. (This achievement was 3.1 % above the local CCG average and 6.6% above the England average.) Dementia screening and assessment was offered to patients at risk of Dementia. In August 2014, the practice dementia diagnosis rate was very low compared to the national target of 67%. By March 2015, this had increased significantly to 62.3%. Patients experiencing poor mental health had a care plan documented in their medical records. Patients experiencing poor mental health were provided with advice about how to access various support groups and voluntary organisations.

Updated 15 October 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice maintained a register of vulnerable adults, (including those patients with learning disabilities) and discussed these patients at the monthly practice meetings. Staff maintained a register of patients who were also carers, and offered these patients an annual healthcare check and, where appropriate, signposted them to other services that might be able to offer extra help. Nationally reported data showed the practice had obtained 100% of the points available to them for providing recommended care and treatment to patients with learning disabilities. (This achievement was 8.7% above the local CCG average and 15.9% above the England average.) Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, the recording of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.