Archived: Dr Pushpa Chopra

Updated 7 January 2016

Dr Pushpa Chopra i s located in Upminster in the London Borough of Havering. It is one of the 52 member GP practices of Havering Clinical Commissioning Group.

The practice serves a predominantly White population, with 95.6% of people in the local area identifying as White, 1.8% as Asian / Asian British, 1.6% as Mixed / Multiple Ethnic Groups, 0.9% as Black / African / Caribbean / Black British, and 0.1% as Other Ethnic Groups. The practice has approximately 1,600 registered patients. The practice is located in the tenth less deprived decile of areas in England. Life expectancy in the area is close to the England average.

Services are provided by Dr Pushpa Chopra under a Personal Medical Services (PMS) contract with NHS England. Dr Pushpa Chopra is registered with the CQC as an Individual.

When we first inspected the practice in September 2013 the practice was meeting standards in relation to Respecting and involving people who use services, Care and welfare of people who use services, Safeguarding people who use services from abuse, Cleanliness and infection control, and Complaints.

We inspected the practice again over two days in June and July 2014 and found improvements were required in relation to Care and welfare of people who use services, Cleanliness and infection control, Supporting workers, and Assessing and monitoring the quality of service. We issued a Warning Notice in respect of the shortfalls identified in relation to Care and welfare of people who use services. The practice was meeting standards in relation to Consent to care and treatment.

The last time we inspected the practice was in September 2014. The practice had made progress, but further improvement was required in respect of Care and welfare of people who use services.

At our inspection on 02 November 2015 shortfalls we had identified at previous inspections had been remedied. Other shortfalls were identified, however.

The practice opening times are:

Monday, Tuesday, Wednesday and Friday - 8.00am to 7.00pm

Thursday – 8.00am to 1.00pm

Routine appointments are available at the following times:

Monday and Tuesday – 9.30am to 10.30am and 5.30pm to 7.00pm

Wednesday and Friday - 9.30am to 10.30am and 5.30pm to 6.30pm

Thursday – 9.30am to 10.30am

Clinical services are provided by Dr Pushpa Chopra for all sessions except for the Wednesday and Friday afternoon sessions which are provided by a male GP working on a sessional basis. A third GP, also male, provides locum cover for Dr Chopra on a regular basis. Patients have the choice of seeing a female or male GP. There are two part time Practice Nurses. Non clinical staff include a part time Practice Manager and a team of four secretarial, administrative and reception part time staff.

Patients are cared for by an external out of hours GP service when the practice is closed.

Dr Pushpa Chopra is registered with the Care Quality Commission to carry on the following regulated activities at 75 Sunnyside Gardens, Upminster, Upminster, Essex RM14 3DP: Treatment of disease, disorder or injury; Diagnostic and screening procedures; and Maternity and midwifery services.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Pushpa Chopra on 02 November 2015 and conducted further staff interviews by phone on 05 November 2015. Overall the practice is rated as requires improvement.

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

• Shortfalls we identified at previous inspections of the practice in June/July 2014 and in September 2014 had been remedied. Other shortfalls were identified at this inspection however.

• There was an open and transparent approach to safety and a system was in place for reporting and recording significant events.

• Risks to patients were assessed, with the exception of those relating to legionella.

• The practice achieved 62.1% of the total Quality and Outcomes Framework (QOF) points available, compared with the Havering Clinical Commissioning Group average of 92.2%. The GP had made an active decision not to participate in the QOF programme. The GP had not put in place alternative audits to demonstrate how the practice was improving outcomes for patients.

• Clinical audits demonstrated quality improvement, however they were few in number.

• The majority of patients said they were treated with compassion, dignity and respect, and were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were available the same day.

• 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 had proactively sought feedback from patients.

The areas where the provider must make improvements are:

• Ensure systems are in place to monitor and improve patient outcomes.

• Ensure patient records fully document the care and treatment that has been provided.

• Ensure processes are in place so that national guidelines for the monitoring of long term conditions are followed.

• Ensure all staff who act as chaperones have received a disclosure and barring service (DBS) check.

• Ensure protocols for repeat prescribing are adhered to.

• Ensure a legionella risk assessment is in place.

In addition the provider should:

• Check regularly that prescription pads and Statement of Fitness for Work forms are stored securely at all times to prevent their misuse.

• Put a system in place so that all patients with a current or past diagnosis of depression have a coded entry that appears on their medical summary and informs a register of patients with current or past depression.

• Record clearly using appropriate coded entries in the notes where a patient has made an informed choice not to have a recommended treatment.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected within six months after the report is published. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The provider was rated as inadequate for providing effective care and requires improvement for providing safe and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• Steps were taken to identify and support patients at risk to prevent avoidable admission to hospital.

• Longer appointments and home visits were available when needed.

• Most patients with long term conditions had a structured annual review to check that their health and medicines needs were being met. The review was often carried out by another provider, for example the pharmacist, hospital or community team.

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

• Nursing staff had lead roles in diabetes and chronic obstructive pulmonary disease (COPD) management.

Updated 7 January 2016

The provider was rated as inadequate for providing effective care and requires improvement for providing safe and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• 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 was comparable to the national average of 81.9%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 7 January 2016

The provider was rated as inadequate for providing effective care and requires improvement for providing safe and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 7 January 2016

The provider was rated as inadequate for providing effective care and requires improvement for providing safe and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• 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 reflected the needs of this age group.

Updated 7 January 2016

The provider was rated as inadequate for providing effective care and requires improvement for providing safe and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

• People diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.

• People experiencing poor mental health had a structured annual review to check that their health and medicines needs were being met. This was most often carried out by the hospital or community mental health team.

• The practice regularly worked with multi-disciplinary teams in the case management of people 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.

Updated 7 January 2016

The provider was rated as inadequate for providing effective care and requires improvement for providing safe and well-led care. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were, however, some examples of good practice.

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

• It offered longer appointments for people with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• It had told 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.