Dr Walji Colleagues practice aims to provide the highest quality of

Dr Walji & Colleagues practice aims to provide the highest quality of medical service. It enables patients primarily, but also all members and users of the practice, to discover a healthier life for themselves and others. Practice ensures every possible effort is made to guarantee that every patient receives the most beneficial service and optimum level of treatment specifically tailored to their individual needs.

Practice philosophy is for all staff members to work with close partnership with their patients to ensure that every individual empowered has their rights respected and their dignity protected.

To ensure practice is successful, clear and achievable goals must be set. Even though some objectives might change from time to time, the main objective to provide an excellent service for the patient must remain.

As well as the aims and practice philosophy as above, the goal is to generate as much income as possible by achieving the highest possible points for QOF, LIS & DES schemes; to complete clinical procedures/interventions which will generate essential funds.

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At the beginning of every financial year Dr Walji & Colleagues practice sets goals and objectives for the next 12 months. For example the goals for 2018-2019 year was to: 1. achieve 95% of QOF points; 2. 100% of required numbers for NHS health checks, 3. complete as many ECGs as possible to boost practice income, 4. achieve all required numbers for local improvement schemes (LIS) to qualify for 100% payment; 5. follow guidance from BSOL CCG medicine optimization team and reduce spending; 6. Adopt drug monitoring systems to ensure patient safety.

7. Increase numbers for breast, bowel & cervical cancer screenings.

In order to measure practice team performance, one must check practice achievements for the year 2018-2019 for each indicator.

1. QOF achievement: Dr Walji & Colleagues team effort was very effective for 2018-2019. Practice achieved 98% out of possible 100% which is above national and local CCG average.

2. Practice was required to complete 165 NHS health checks for 2018-2019 year; 41 checks per quarter. According to the monitoring figures practice failed to complete required number of in Q1 (35 checks completed). At this point retired practice nurse offered to do few sessions per week as a volunteer. She was asked to take charge of NHS checks. As a result the number spiked in Q2 to 56 checks completed. This did not reflect in Q3 as numbers plunged to 25 (see appendix 1 attached to email). To ensure the final target was met, practice manager request admin staff to make telephone invites. The practice managed to do 64 checks in Q4 which brought the final number to 180 (9% above required). Even though the practice managed to achieve the final target, it is clear that the system was failing during the year. Practice management decided to monitor NHS checks regularly and ensure enough patients are invited. So far 18 patients have had their NHS checks completed in Q1 of 2019-2020 year.

3. ECGs- there is no set target to complete ECG recordings for QOF or any other scheme. However practice gets paid per each completed recording at the end of each quarter. To ensure no opportunities are missed, designated ECG slots have been allocated on HCA and Practice Nurse Clinics, 5 slots per clinic. This brings the total number of 15 ECG recordings per week. During the year Practice manager identified that there were some missed or cancelled appointments missed out on ECG slots. This issue has been addressed at practice team meeting and staff are required to book another patient as soon as they cancel booked appointment. Additional checks have proved that this has been taken on board by all staff.

4. Traditionally Dr Walji & Colleagues practice does well for LIS schemes. However during the year monitoring identified that the practice was missing out of required COPD & Asthma exacerbation follow up reviews within requested time frame. To overcome this issue it has been discussed at the Practitioners meeting and the following decision was made: after every hospital admission or GP consultation for exacerbation as task is sent to Practice Manager or assistant Practice Manager to ensure the follow up appointment is arranged. This has proved to be effective as practice achieved 83% for asthma (required 80%) and 87% for COPD (required 70%) follow up reviews (see appendix 2). This has guaranteed possible 100% payment for RQIP LIS.

5. Practice prescribing Lead (Dr. M.R) has regular meetings with medicine optimization team from CCG. Every recommendation for 2018-2019 year has been discussed at the weekly Practitioners Meetings. Practice achievements: Capital Improvement Plan (CIP) for 2018-2019 was ?4041.58. The actual savings for the same year- ?4178.00 which is 103.4% achievement. The CIP budget for DLCV (drugs of limited value) was to save ?2599.17. The actual savings- ?5800.26. This is 223.2% achievement which saved practice ?3201.09 more than expected (see appendix 3).

6. To ensure patient safety practice follows strict drug monitoring policy. All patients on multiple medications are required to have at least 6 monthly medication reviews. Some medications need more frequent monitoring (eg. Methotrexate, Lithium, Anticoagulants, etc.). Practice adapted Emis searches provided by local CCG to monitor high-risk drugs. These searches are regularly discussed at weekly Practitioner Meetings to identify patients who are overdue for blood tests, BMI checks, etc. Practice performance for 2018-2019 has been proved to be very effective as practice achieved 100% for prescribing incentive LIS.

7. Historically Dr Walji & Colleagues practice used to achieve lower numbers than national & local average for screening projects. This is dues to inner city location, where a lot of patients refuse to participate in screening programmes due to language barrier, cultural or other reasons. To overcome this barrier practice has implemented few changes: a. For cervical cancer screening it was decided to have designated late evening clinic bi-monthly (3pm till 8pm on Wednesdays). This has increased practice numbers and for 2018-2019 practice achieved 81% compare to 80% requirement from public health (see appendix 4). Dr Walji & Colleagues continue to use the same strategy for this financial year. b. To improve uptake for breast cancer screening practice decided to dedicate an informational notice board to breast screening statistics. A bunting has been put across the waiting area with details like eligibility criteria, telephone numbers to contact to re-arrange missed/cancelled appointment and links for information on different languages. Practice nurses contact patients who missed their screening appointments to explain the importance of screening. This has boosted practice screening numbers so much that a screening nurse visited practice to take pictures of notice board to share experience with other practices. c. Practice has not managed to improve update for bowel cancer screening. Therefore, a new tactic has been introduced for the next financial year: practitioners notify a designated receptionist of all non-responders. This receptionist follows it up with a telephone call to the patient and a letter which includes a leaflet in different languages. The effectiveness of this will be assessed during the year.

To sum up Dr Walji & Colleagues effectiveness in performance has proved to be good in some areas but not effective in others. There are measures in place to improve performance in necessary areas. The management is committed to monitor the effectiveness during this year and implement necessary changes if/when required.