Dr George Kamil Also known as Upper Halliford Medical Centre

Updated 6 July 2017

Dr George Kamil, also known as Upper Halliford Medical Centre, is a single handed GP practice providing primary medical services to approximately 3,020 patients in the Shepperton area of Middlesex. The practice occupies a building which was not originally designed for the delivery of medical services and access for patients who may use wheelchairs could be limited due to the width of corridors.

The principal GP (male) is supported by a male locum GP and a male healthcare assistant who works 20 hours a week. Both male and female locum GPs are used to cover the primary GP in their absence. The practice employs a part time nurse (female) for four hours a week. The practice is also supported by a full-time business manager and five part-time reception / administrative staff. The practice employs the services of a part time locum practice manager but they were not present at the time of the inspection.

All services are provided from:

270 Upper Halliford Road, Shepperton, Middlesex, TW17 8SY.

The practice is open from 8:30 to 6:30pm with the exception of Wednesday, when the practice closes at 1:30pm. There are extended hours every Monday 6.30pm – 7.00pm and Thursday 6.30pm -7.30pm.

Surgery hours are available between 9:30am and 11:30am and 4pm to 6pm Mondays Tuesdays, Thursday and Friday. On a Wednesday hours are 9:30am to 11:30am

During the hours of 8am to 8.30am and after 11.30pm on a Wednesday patients were able to speak with the GP in an emergency and details were provided on the practices answer phone message.

During the times when the practice is closed, the practice has arrangements for patients to access care from Care UK an Out of Hours provider. Information was provided to patients via the practice website and through an answer phone message.

Dr George Kamil was placed into special measures following an inspection in January 2016. In order to establish if the required improvements had been made we completed a further comprehensive inspection in September 2016. Improvements to the delivery of service were evident and the practice had made significant improvement since our previous inspection.

The practice population has a higher number of patients between 50-59 and 75+ years of age than the national and local Clinical Commissioning Group (CCG) average. For example, 37% of the practice population was over 65 years of age compared to the CCG and the national average of 27%. The practice provides a regular service to two nursing homes in the local area. The practice population also shows a slightly lower number of patients from birth to 34 years old than the national and local CCG average. There is a higher than average number of patients with long standing health conditions. The percentage of registered patients suffering deprivation (affecting both adults and children) was higher than the CCG average but lower than the average for England. Less than 10% of patients do not have English as their first language.

Updated 6 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr George Kamil on 29 September 2016. The practice was rated as requires improvement for providing responsive services and good for providing safe, effective, caring and well led services. The overall rating for the practice was good. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr George Kamil on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 12 June 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 29 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The practice had negotiated to increase the nurse working hours from 16 hours per month to 28 hours per month.
• The practice had secured a female locum GP to provide two regular sessions per month on alternate Mondays. They were still in the process of recruiting a more regular female GP.

In addition, the practice had improved patient engagement and had sought feedback from patients. The practice had actively promoted the patient participation group through a poster campaign in the waiting room. They had successfully recruited two new members to the PPG. The practice had undertaken a patient survey in January 2017 to gain feedback from patients. 100 forms were given out and the practice received 70 back. Patient feedback included;

• Increasing GP numbers to improve access to same day appointments.

• Request for text communication for appointment reminders and test results.

• Limited availability of a female GP.

In response to the feedback, the practice had secured retention funding for a GP for four sessions per week, to improve access to appointments. They were unable to offer text reminders with their current software system and were looking to recruit a female GP on a permanent contract.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of responsive services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 November 2016

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

• 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, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• Nationally reported data showed most patient outcomes were comparable with local and national averages. We noted two areas where the practice had scored low for diabetic care. The business manager and principal GP told us they had recognised the problems with the QOF scoring and had made improvements. We looked at the unverified data for the first seven months for 2016/2017 and saw that the results had improved.

• The practice offered diabetic foot screening. CQC data indicated that the practice achieved 80% for annual foot checks in patients with diabetes which was comparable to the national average of 88%.
• 70% of patients with asthma, on the register, had an asthma review, which was comparable with the CCG and national average of 75%

• Patients were supported to self manage their long term condition by using agreed care plans and by being encouraged to attend self-help groups

Updated 24 November 2016

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 and who were at risk, for example, children and young people who had a high number of A&E attendances.
• Immunisation rates had greatly improved from the inspection in January 2016 and were now around average for all standard childhood immunisations. For example, previous data showed that 54% of children under 24 months had received the MMR (measles, mumps and rubella) vaccine compared to the CCG average of 82%. Data used for this inspection showed that 90% of children under 24 months had received the MMR vaccine.
• 74% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years. This was comparable to the CCG average of 81% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Midwives linked to the practice ran weekly clinics.
• A pregnancy care planner was accessible online. This provided information in relation to pregnancy and labour and general pregnancy topics.
• Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse. Safeguarding policies and procedures were readily available to staff.
• The practice ensured that children needing emergency appointments would be seen on the day.
• Appointments were available at the practice with the GP until 6pm and on two afternoons a week until 7pm and 7.30pm.

Updated 24 November 2016

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.
• All older patients with complex care needs and those at risk of hospital admission had personalised care plans which were appropriately shared with local organisations to facilitate the continuity of care.
• We reviewed the minutes of multi-disciplinary meetings, held to discuss packages of care for patients with complex or palliative care needs.
• The practice supported patients who lived in two nursing homes by undertaking weekly home visits and providing advice over the telephone.
• The practice offered flu and pneumonia vaccination programmes.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were comparable to clinical commission group (CCG) and nation averages. For example, 85% patients with chronic obstructive pulmonary disease (COPD) had a review undertaken including an assessment of breathlessness. Which was comparable with the CCG and national average of 89%. Data also showed that 100% of patients with atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate) had been treated with anticoagulation drug therapy or an antiplatelet therapy. Which was comparable with the CCG and national average of 98%.

Updated 24 November 2016

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 full range of health promotion and screening that reflects the needs for this age group.
• Appointments were available at the practice with the GP until 6pm, with the exception of Wednesdays, and on two afternoons a week until 7pm and 7.30pm.
• Telephone consultations with the GP were available during working hours.
• Electronic Prescription Services (EPS) and a repeat prescription service helped patients to get their prescriptions easily.
• Travel health and vaccination appointments were available.

Updated 24 November 2016

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

• Patients were monitored as part of the Quality and Outcomes Framework ( QOF) to check that they had an up-to-date care plan. 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This compared well to a clinical commissioning group (CCG) average of 91% and a national average of 88%.
• 95% of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months. This was better than both the CCG average of 83% and national average of 84%.
• 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 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 24 November 2016

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.
• Patients with a learning disability or other disability were known to the practice. This meant staff could quickly identify when dealing with a patient, if they required additional assistance.
• 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. Minutes were recorded of meetings held.
• 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.
• The GP had received training in the Mental Capacity Act 2005, and could demonstrate an understanding of relevant consent and decision-making requirements of legislation and guidance.
• Carers and those patients who had carers, were flagged on the practice computer system and were signposted to the local carers support team.