Archived: Dr Dhanumjaya Rao Chunduri

Updated 29 October 2015

Dr Dhanumjaya Rao Chunduri provides primary care services at the Balaji Surgery within Sparkbrook Medical Centre which is a large and modern health centre in Sparkbrook, an inner-city area in south-east Birmingham. The area is identified as having a higher proportion of people living there who are classed as deprived and have a greater need for health services.

The registered patient size is 2814 patients. Balaji Surgery has an inherently young population with almost twice the national average of 5 to 14 year olds (20.8% compared to 11.4%) and very low numbers of older patients. For example, the practice has 2.5% of patients aged 75 years or over registered at the practice compared to a national average of 7.6% and 0.2% of patients aged 85 years or over compared to a national average of 2.2%. The practice also has a high ethnic patient population, mainly from the Pakistani community and low levels of economic activity.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some enhanced services. Enhanced services require an enhanced level of service provision above what is normally required under the core GP contract.

The practice is open from Monday to Friday each week from 8.30am to 6.30pm and appointments are available on Monday 9am to 8pm, on Tuesday, Thursday and Friday 9am to 5.30pm and on Wednesday from 9am to 1pm. The practice does not provide an out-of-hours service but has alternative arrangements in place for patients to be seen when the practice is closed.

There is a principal GP, one regular locum, a female sessional GP, a practice manager, an assistant practice manager, a business development manager and a number of administrative and reception staff.

Updated 29 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Balaji Surgery on 24 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable and people experiencing poor mental health.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, including those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Information about services and how to complain was available and easy to understand.
• Most patients we spoke with and from patient feedback in CQC comment cards and patient satisfaction survey information told us that patients felt they were able to make an appointment with a named GP, there was continuity of care and urgent appointments available the same day. They also told us that they felt they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. This did not fully align with the national GP patient satisfaction survey (January 2015) which indicated that some patients had experienced difficulty making appointments and did not always feel involved in decisions about their care.
• The practice was above average for most areas of the quality outcomes framework (QOF) for 2014, however they were below average in relation to some diabetes indicators and cervical screening. We saw that the practice had taken steps to address this.

• 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.

There were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Provide more detailed information for carers to ensure that all avenues of support are open to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 October 2015

The practice is rated as good for the care of people with long-term conditions. Data showed that the percentage of patients with hypertension having regular blood pressure tests was 73.36% and similar to the national average of 83.13%. We found that 95% of patients with diabetes had received an annual review and a medication review in 2014/2015. There were areas for improvement for patients with diabetes for example, in relation to foot examinations, however we saw that the practice had employed a new healthcare assistant to address this issue.

Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 29 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 living in disadvantaged circumstances, for example, children and young people who were identified at risk of abuse. Immunisation rates were variable for all standard childhood immunisations. For example, half of childhood immunisation rates for the vaccinations given to under two year olds were above the CCG average and half were below. For five year olds, the childhood immunisation rates were above the CCG average. 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. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

Updated 29 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Flu vaccination rates for the over 65s were 91.43% which was above the national average and at risk groups were 41.35% which were comparable to the national average of 52.29%.

Updated 29 October 2015

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 offered extended hours on a Monday evening from 6.30pm until 8pm for working patients who could not attend during normal opening hours.

Updated 29 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). We found that seven out of eight patients with dementia had received an annual health check. We saw that performance for mental health related indicators was above the Clinical Commissioning Group (CCG) and national averages. For example, the patients with mental health illnesses such as bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 90% compared to the national average of 86.09%. Also the dementia diagnosis rate at the practice was 0.91% and above the CCG and national average of 0.54%.

The practice regularly worked with multi-disciplinary teams in the case management of people 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. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

Updated 29 October 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients who had a learning disability and19 out of 25 of these had received an annual health check so far this year. The practice also offered longer appointments for people with a learning disability.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various 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.