Dr BK Jaiswal's Practice

Updated 16 May 2017

Dr Jaiswal’s Practice is located in a residential area of Dagenham. It provides primary medical services to approximately 4,445 people living in Barking and Dagenham. The practice holds a General Medical Services (GMS) contract and is commissioned by NHSE London. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures and treatment of disease, disorder or injury. Services are provided from the Julia Engwell Health Centre, Dagenham, RM9 4SR.

The practice is staffed by one GP partner and two locum GPs, one male and two females. They provide14 GP sessions cumulatively every week. The practice employs one part time female practice nurse prescriber and one female locum nurse. There is one practice manager, one assistant practice manager, four reception staff and one secretary.

The practice is open between 9.00am and 6.30pm Monday to Friday. The practice is open between 9.00am and 1.00pm on Wednesdays. Appointments are available between 9.30am to 1.00pm every morning and 4.30pm to 6.30pm every evening. Extended surgery hours are on Monday and Tuesday between 6.30pm and 8.00pm. Appointments can be booked over the phone, in person or online. The out of hours service is provided by Barking and Dagenham GP out of hours service which is accessed by telephoning the practice’s number. The details of this service are on the practice leaflet and on posters in the practice waiting area.

The practice has a higher than average population of patients aged 0 to 9 years and 25 to 39 years when compared to CCG and national average (as reported by Public Health England 2014). The average male life expectancy is one year less than the CCG average and two years less than the national average. The average female life expectancy is the same as CCG average and one year less than the national average. The number of patients suffering income deprivation is higher than the national average.

The practice was previously inspected under the Care Quality Commission’s current inspection regime.

Updated 16 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr BK Jaiswal’s Practice and on 28 February 2016. The overall rating for the practice was good. The full comprehensive report on 28 February 2016 inspection can be found by selecting the ‘all reports’ link for Dr BK Jaiswal’s Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 28 February 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our previous inspection on 28 February 2016, we rated the practice as requires improvement for providing safe services. Not all staff were had received mandatory training and the practice had not risk assessed not having a defibrillator. In addition, the practice did not provide us with evidence to demonstrate that medical equipment had been calibrated and annual internal infection control audits were carried out. At this inspection we found these issues had been satisfactorily addressed with the exception of infection control training and fire safety. However, we saw evidence that both these training had been booked. The practice is now rated as good for providing safe services.

Our key findings were as follows:

• The practice had a defibrillator available on the premises with adult and children’s pads and we saw records to confirm this had been checked daily.

• The practice provided us with evidence which demonstrated that all medical equipment had been calibrated by an external organisation.

• Annual internal infection control audits were implemented.

• We found that not all staff had completed mandatory training, for example, fire safety and infection control. However we saw evidence which confirmed this training had been booked for April 2017.

• Following the comprehensive inspection, the practice told us they took practical steps to ensure all patients had the opportunity to join the patient participation group (PPG).The PPG was brought to patient’s attention by way of the practice leaflet, repeat prescriptions and staff members who informed patients about it opportunistically.

• Policies we reviewed were all updated and practice specific. All practice policies were digitised, however they also had access to paper copies which were kept in a clearly labelled folder in a lockable room.

The area where the provider should make improvement is:

• Ensure mandatory training is completed timely and develop a more rigorous recording system to highlight training nearing expiration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2016

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

• All patient's with a long term condition had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP partner worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Longer appointments and home visits were available when needed.
• The practice was committed to improving performance. Performance for diabetes related indicators were better than CCG and national averages. For example, the percentage of patients with diabetes who had their blood pressure reading measured in the preceding 12 months of 140/80 mmHg or less was 85% (CCG and national average 78%).

• Clinical staff did not have lead roles in chronic disease management, however the clinicians ran regular asthma, diabetes and Chronic Obstructive Pulmonary Disease review clinics.
• The GP partner was responsible for identifying patients at risk of hospital admissions.

Updated 20 April 2016

The provider 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 and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• 71% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months, which was in line with the CCG (76%) and national average (75%)
• 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.
• The practice’s uptake for the cervical screening programme was 80% which was comparable to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 20 April 2016

The practice is rated 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 percentage of people aged 65 or over who received a seasonal flu vaccination was 76%, this was above the CCG average (72%) and national average (73%).

Updated 20 April 2016

The provider 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 full range of health promotion and screening that reflecteds the needs for this age group.
• The practice had carried out 18% of the NHS Health Checks for people aged 40 to 74 years, which was higher than CCG average (16%).

Updated 20 April 2016

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

• 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
• Performance for mental health related indicators was better than the CCG and national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 months is 100% (CCG average 91%, national average 90%).
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• 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.

Updated 20 April 2016

The provider 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.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.