Dr B. Saheecha and Dr N. Saheecha

Updated 6 April 2017

Drs N A Kuchhai and Dr B S Saheecha is a two-site GP service. Services are provided from following main location and the branch practice, and patients can attend any of the two practice premises. We visited the main location during this inspection:

The Health Centre (the main practice)

Gooshays Drive

Harold Hill

Romford

RM3 9SU

Heaton Avenue Surgery (the branch practice)

1 Heaton Avenue

Straight Road

Romford

RM3 7HR

The main practice is based in a shared purpose-built heath centre that has parking spaces available, step-free access to all clinical areas and an on-site pharmacy.

Drs N A Kuchhai and Dr B S Saheecha is one of a number of GP practices commissioned by Havering Clinical Commissioning Group (CCG). It has a practice list of 7039 registered patients. Havering is in the third most deprived decile out of 10 on the national deprivation scale. The practice has a lower percentage of unemployed patients (2%) compared to the local average of 4% and national average of 5%.

The practice staff includes two male GP partners and three regular locum GPs who are also male. The nursing team consists of three practice nurses. The clinical team provided 28 sessions per week. The administration team include a full time practice manager and a team of 12 reception and administrative staff. A cleaner and gardener were also employed by the practice.

The practice is open during the following hours:

Monday - 8am to 8pm

Tuesday - 8am to 7pm

Wednesday - 8am to 1pm

Thursday - 8am to 7pm

Friday – 8am to 7pm

Appointments are available during the following hours:

Monday - 8am to 7pm

Tuesday - 8.30am to 6.30pm

Wednesday - 8.30am to 1pm

Thursday - 8.30am to 6.30pm

Friday – 8.30am to 6.30pm

Out of these hours, cover was provided by the local cooperative GP service and the NHS 111 service.

We had previously carried out an inspection at this practice in September 2013 and found it be compliant with the regulated areas we looked at.

Updated 6 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs N A Kuchhai and Dr B S Saheecha on 3 January 2017. Overall the practice is rated as good.

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

• Staff used an effective system report and investigate significant events and the working culture encouraged openness and honesty to highlight areas for improvement.
• Risks to patients were assessed and well managed, including through medicines management and safeguarding processes.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• There was evidence of multidisciplinary working to meet the complex needs of patients, including vulnerable young people and those who received palliative care.
• Patients provided positive feedback about the caring nature of staff and said they took the time to listen to their concerns. We saw staff treated people with compassion, dignity and respect and involved them in care planning and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients that walked in without an appointment were seen on the same day. The practice operated a policy that no patient would be turned away without being seen.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure learning from significant events is embedded in practice processes and staff professional development.
• Implement a structured system that enables staff to track updates and changes to national clinical and best practice guidance.
• Ensure appraisals are consistent and include evidence of on-going professional development.
• Ensure risk assessments are in place for non-clinical staff who do not have a Disclosure and Barring Service check.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 April 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• A practice nurse contacted patients who attended hospital unexpectedly to support them in managing their condition.
• Performance for diabetes related indicators was variable compared with the national average. For example the percentage of patients with diabetes in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 92% compared to the CCG and national averages of 78%. However the percentage of patients in the same period in whom the last measured total cholesterol was 5mmol/l or less was 75% compared with the CCG average of 74% and national average of 80%. Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, a named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 6 April 2017

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

• There were systems in place to identify and support children living in disadvantaged circumstances. This included those who were at risk such as children and young people who had a high number of emergency hospital attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 83% which was comparable to the CCG average of 82% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice provided specialised care and support for children with needs relating to behaviour, Asperger’s syndrome and attention deficit hyperactivity disorder through a shared care arrangement.
• Child development clinics were offered at six to eight weeks old.
• We saw positive examples of joint working with midwives and health visitors.

Updated 6 April 2017

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice invited all patients over 75 years to attend a 30 minute annual health check which included a blood test, medicine review and advice regarding diet, nutrients, exercise and available benefits they may be able to claim.
• Staff offered dementia screening and referrals to a memory clinic as well as assessments using a frailty pathway. This helped to ensure patients received care that met their changing needs.

Updated 6 April 2017

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 was proactive in offering online services as well as a range of health promotion and screening that reflected the needs of this age group, including electronic prescribing and sexual health.
• The practice offered extended hours to support those could not attend appointments during standard working hours.
• The patient representative group was actively promoting recruitment to this age group to improve their representation at practice development meetings.

Updated 6 April 2017

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

• 90% of patients diagnosed with dementia 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 exception reported 12% compared to the national average of 7%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had a designated dementia support lead who was responsible for overseeing the treatment of all diagnosed patients.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• A GP partner had a special interest in psychology and provided additional specialist services for this patient population group, including in relation to depression, anxiety and substance use.

Updated 6 April 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, those over 75 years of age living alone and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed 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.
• Patients who were considered vulnerable were given same day priority appointments.
• The practice had identified 1.5% of its patient list were carers.