Archived: Dr Kanwalpal Nandra Also known as Bulbanks Medical Centre

Updated 15 October 2015

Dr Kanwalpal Nandra’s practice, also known as Bulbanks Medical Centre, is in Erith in the London Borough of Bexley. The practice has one practice principle who manages the practice which is based at a single site. The practice is based in a converted house which has been modified to ensure that it is fit for clinical use.

The practice provides primary medical services to approximately 3,400 patients. The practice employs one salaried GP. The GP principle is lead for most areas in the practice. Both GPs in the practice are male. The practice also employed a practice nurse, a practice manager, a practice administrator and five part time receptionists. At the time of the inspection visit the practice was looking to recruit a part time healthcare assistant.

The practice is contracted to provide Personal Medical Services (PMS) and is registered with the CQC for the following regulated activities: treatment of disease, disorder or injury, maternity and midwifery services, family planning, surgical procedures, and diagnostic and screening procedures at one location.

The practice provides a number of enhanced services, including childhood vaccinations, extended opening hours, influenza immunisations, learning disabilities, minor surgery, and rotavirus and shingles Immunisation.

The practice is open from 8:00am until 7:30pm on Mondays, from 8:00am until 6:30pm on Tuesdays, Wednesdays and Fridays and from 8:00am until 1:00pm on Thursdays. A local Bexley co-operative provides services to patients who need to see a practitioner between 1:00pm and 6:30pm on Thursdays. Outside of normal opening hours the practice used a Bexley based out of hours provider.

Updated 15 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kanwalpal Nandra’s practice on 12 August 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. All opportunities for learning from internal and external incidents were maximised.

• The practice had identified risks and had implemented systems to mitigate risks.

• 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.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• We saw that outcomes for patients were in line with national standards.

• Regular multi-disciplinary team meetings were in place at the practice.

• The practice provided extended access on Monday evenings and had adapted the practice to meet the needs of all patients.

• 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.

• Governance arrangements were in place at the practice, but in some instances outcomes of meetings and policies and procedures were not documented.

The areas where the provider should make improvements are:

• Ensure that clinical meetings at the practice are minuted.

• The practice should ensure that all policies and guidance at the practice are specific to the practice.

• The practice should ensure that planned measures to change the flooring in the clinical rooms in the practice takes place as soon as possible.

• The practice should ensure that fire tests and drills are carried out and a record of these checks is maintained.

• The practice should ensure that it proactively seeks feedback from patients and that it meets regularly with the patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 October 2015

The practice is rated as good for providing care to people with long term conditions. The nurse led reviews of patients with long term conditions and there were recall systems in place to ensure that patients were reviewed on a yearly basis. Where appropriate care plans were developed at reviews. For those patients with multiple conditions, longer appointments were available. The practice worked closely with healthcare professionals in the community to provide care for these patients.

Updated 15 October 2015

The practice is rated as good for the care of families, children and young people. There were safeguarding processes in place at the practice and children who were potentially at risk could be identified. The practice provided immunisations and uptake was in line with national averages. Appointments were available for children outside of school hours and the premises were suitable for children. This included a play area in the waiting room for very young children. We saw good examples of joint working with healthcare providers in the community.

Updated 15 October 2015

The practice is rated as good for providing care for older people. The practice had named practitioners for all patients over the age of 75, and offered personalised care. It was responsive to the needs of older people and offered home visits. The practice had a policy of checking blood pressure and weight on a yearly basis. There was also an admissions avoidance plan in place at the practice which involved working with patients so that they could better care for themselves.

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 open later on a Monday evening to ensure that patients could attend out of hours. Telephone consultations were also available for this group. The practice website contained relevant information for patients in this group, and both appointments and prescriptions could be organised online.

Updated 15 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 86% of people experiencing poor mental health had received an annual physical health check. The practice had registers of patients experiencing poor mental health and those with dementia.

The practice had provided patients and carers with information about support groups, and details of these groups were advertised in the waiting room. A system was in place to recall any patients with poor mental health who had not attended appointments. Staff had received training on how to care for people with mental health needs and dementia.

Updated 15 October 2015

The practice is rated as good for the care of patients whose circumstance might make them vulnerable. The practice held registers of patients with learning disabilities and for patients who were housebound. Both groups of patients were reviewed on a yearly basis and in the past year the practice had provided health checks for all of its patients who had learning disabilities. Extended appointments were also offered. Homeless people and travellers could register at the practice.

The practice met every six weeks with district nurses, health visitors and the palliative care team to provide care for these patients. Staff that we spoke with 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.