Archived: Dr Ankur Chopra

Updated 14 November 2017

The Dr Ankur Chopra practice offers general medical services to people living in Hastings. There are 4000 registered patients. Approximately 2,300 patients come from rural areas, the rest are urban residents. The practice covers both deprived and affluent areas. Dr Ankur Chopra is currently registered as an individual provider, but has recently formed a partnership with three other clinicians, two GPs and an advanced nurse practitioner, who work from three other local surgeries. At the time of the inspection Dr Chopra was not carrying out clinical work at Roebuck House or Guesting Surgery but cover arrangements were in place with support from partner GPs, regular locums and a regular salaried GP. The regular salaried GP is supported by an advanced nurse practitioner who is one of the partners, two nurses, a phlebotomist and a team of receptionists and administration staff.

There is a practice manager and a deputy manager. A business manager is employed across four neighbouring practices who is overseeing improvements in the non-clinical governance of Dr Chopra’s practice.

The practice is open between 8.30am to 6.30pm Monday to Thursday and 8.30am to 5pm on Fridays. The practice worked with a neighbouring practice to ensure that there was a doctor available for emergencies between 8am and 6.30pm on a daily basis. Early morning appointments are available from 7.30am at Roebuck House on a Tuesday and at Guestling Surgery on Monday, Wednesday and Friday. The practice closes for lunch between 1pm and 2pm each day. In addition to pre-bookable appointments that could be booked up to four weeks in advance, urgent appointments are also available for patients that needed them.

The patient population includes a 2% lower proportion of children when compared with the local average and slightly more (1.4%) patients over the age of 75 than the national average. The practice had 12% less patients with a long standing health condition than the local average and lower than average unemployment. The practice runs a number of services for its patients including asthma clinics, child immunisation clinics, diabetes clinics, new patient checks, and weight management support. Services are provided from;

Roebuck House,

High Street,

Hastings,

East Sussex,

TN34 3EY

A branch surgery is located at;

Guestling Surgery,

Chapel Lane,

Guestling,

Hastings,

TN35 4HN

Outside normal surgery hours patients could access care from an Out of Hours provider IC24.

Updated 14 November 2017

Letter from the Chief Inspector of General Practice

The Dr Ankur Chopra practice was initially inspected in October 2015. It was rated inadequate for safe and well-led services and inadequate overall. It was placed into special measures and warning notices were issued. In March 2016 we carried out a focussed inspection of the areas covered by the warning notices and found that they had not been met. As a result a condition was imposed on the practice. During the period the practice was in special measures we took appropriate enforcement action.

We carried out an announced comprehensive inspection on 1 February 2017. On this occasion the practice was rated as requires improvement overall, inadequate in the well-led domain, requires improvement in the safe domain and good in the effective, caring and responsive domains. Additionally, further breaches of the legal requirements in relation to Good Governance were found and so we issued a warning notice. The practice therefore remained in special measures. On the 16 May 2017 we re-inspected the practice and found that they had met the requirements of the warning notice

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 4 October 2017.

Overall the practice is now 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 a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey were better than the national averages. They showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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. During the period of special measures the practice had employed external support to develop and implement improvement plans. It had worked with other local providers to improve services and outcomes for patients. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 November 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was significantly better than the national average. For example, 91% of patients with diabetes had an acceptable blood pressure reading in the preceding 12 months, compared with a CCG average of 81% and national average of 78%;
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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 14 November 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics...
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 14 November 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. There were ward rounds every other week to nursing homes where the practice had patients.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 14 November 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
• 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.

Updated 14 November 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.
• One hundred per cent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was better than the national average of 84%.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Performance for mental health related indicators was better than the national average. For example 95% of patients with schizophrenia bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the last 12 months compared with a national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 November 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.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability. These appointments were arranged at a quiet time to suit the patients
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.