Archived: Dr Aman Raja Also known as Parklane Medical & Surgical Services

Updated 27 October 2016

Dr Aman Raja (also known as Park Lane Medical & Surgical Services) is located near Turnpike Lane in the London Borough of Haringey, North London. The practice has a patient list of approximately 1,200. Twenty percent of patients are aged under 18 and 5% are 65 or older. Forty one percent of patients have a long- standing health condition, whilst approximately 5% had carer responsibilities.

The services provided by the practice include child health care, ante and post natal care, immunisations, sexual health and contraception advice and management of long term conditions. The staff team comprises one male GP (eight sessions per week), a long term locum GP who provided cover when the provider was on planned, long term leave, one female practice nurse locum appointed in March 2016 (one session per week), a practice manager and administrative/reception staff. At the time of our inspection, the practice held a General Medical Service (GMS) contract with NHS England. This is a contract between general practices and NHS England for delivering primary care services to local communities.

The practice’s opening hours are:

• Monday, Wednesday and Friday 9:30am -7.00pm

• Tuesday: 9am-6.30pm

• Thursday 9.00am -11.30am

• Saturday: 11:30am-1:30pm.

Appointments are available at the following times:

Monday, Wednesday, and Friday: 9:30am-11:30am and 4pm-6pm

Tuesday: 9.00am -11.30am and 4pm -6:30pm

Thursday 9.00am -11.30am

Saturday: 11.30am - 1.30pm

Outside of these times, we were told that cover is provided by an out of hours provider.

The practice is registered to provide the following regulated activities which we inspected: treatment of disease, disorder or injury, diagnostic and screening procedures, surgical procedures, family planning, maternity and midwifery services.

Updated 27 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Aman Raja (also known as Park Lane Medical & Surgical Services) on 2 June 2016. Overall the practice is rated as requires improvement.

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

• Some risks to patients were assessed and managed. However, those relating to infection control and emergency oxygen were not.
• Reasonable adjustments had not been made to remove barriers to people accessing the service. For example, the reception desk did not have a lowered section to accommodate wheel chair users. This area of concern had been highlighted at our last inspection.
• We did not see evidence that the practice was obtaining the views of people who used the service.

• Governance arrangements did not always operate effectively. For example, infection prevention and control risks were not well managed.

• We saw evidence that the GP assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Patients said they were treated with compassion, dignity and respect.
• Patients 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 areas where the provider must make improvements are:

• Introduce a system for checking emergency oxygen.

• Ensure that there are appropriately signed patient group directions (PGDs) on file to enable the practice’s locum nurse to legally administer medicines.

• Ensure that staff receive annual basic life support training.

• Review processes to ensure reasonable adjustments are made for disabled people under the Equality Act 2010.

In addition the provider should:

• Review its systems for identifying and providing support to carers.

• Ensure there are processes for identifying where improvements in clinical care can be made and monitored.

• Review policies and procedures to ensure they are fit for purpose.

This service was placed in special measures in January 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe services. Shortly after our inspection, the provider notified the CQC that they were retiring and applied to cancel their registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 27 October 2016

The provider was rated as inadequate for providing safe services and was rated as requires improvement for providing effective, responsive and well led services. The issues we identified affected all patients including this population group.

• 97% of patients with diabetes had had a foot examination in the previous 12 months.

• Longer appointments and home visits were available when needed.

• For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 27 October 2016

The provider was rated as inadequate for providing safe services and was rated as requires improvement for providing effective, responsive and well led services. The issues we identified affected all patients including this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Immunisation rates were relatively high for all standard childhood immunisations.

• Latest unverified 2015/16 QOF results provided by the practice showed that 80% of patients on the practice’s asthma register had had an asthma review in the preceding 12 months. Published, comparative national data, CCG data and exception reporting data were not available.

• 84% of women aged 25-64 had had a cervical screening test performed in the preceding 5 years compared with 82% nationally.

• Appointments were available outside of school hours.

Updated 27 October 2016

The provider was rated as inadequate for providing safe services and was rated as requires improvement for providing effective, responsive and well led services. The issues we identified affected all patients including this population group.

• 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.

Updated 27 October 2016

The provider was rated as inadequate for providing safe services and was rated as requires improvement for providing effective, responsive and well led services. The issues we identified affected all patients including this population group.

• 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 offered a full range of health promotion and screening that reflects the needs for this age group.

Updated 27 October 2016

The provider was rated as inadequate for providing safe services and was rated as requires improvement for providing effective, responsive and well led services. The issues we identified affected all patients including this population group.

• The latest unverified QOF results provided by the practice (2015/16) showed that 91patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. At the time of our inspection, national comparative data and exception reporting data had not yet been published for this time period.

• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had a system in place to help patients experiencing poor mental health access various support groups and voluntary organisations.

Updated 27 October 2016

The provider was rated as inadequate for providing safe services and was rated as requires improvement for providing effective, responsive and well led services. The issues we identified affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including those 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.