Archived: Dr Dzung Nguyen Also known as Dr. Nguyen - Yellow Practice

Updated 3 May 2016

Dr Dzung Nguyen, also known as The Yellow Practice, is a surgery offering general medical services to the population of Walton-on-Thames, Surrey. There are approximately 4,700 registered patients.

At the time of the inspection the practice had only registered for three regulated activities. We noted that family planning services and surgical procedures were not included within the activities.

Dr Dzung Nguyen’s Practice is run by one principal GP. The principal GP has been trying to find a partner for the practice. The practice is also supported by one salaried GP, two long term Locum GPs, four practice nurses, a healthcare assistant, a phlebotomist, a team of administrative and reception staff, a clinical manager and a practice manager.

The clinical manager, phlebotomist, healthcare assistant and practice nurses are shared between the Yellow practice and the Red practice.

The practice runs a number of services for it patients including asthma clinics, child immunisation clinics, diabetes clinics and holiday vaccinations and advice.

Services are provided from one location:

The Yellow Practice, Walton Health Centre, Rodney Road, Walton-on-Thames, Surrey, KT12 3LB

Opening hours are Monday to Friday 8:30am to 6:30pm.

Appointments were available each morning from 8:30am to 12:30pm and 3pm to 6:30pm each afternoon. The practice also offered extended hours appointments between 7:30am and 8:00am each weekday and 6:30pm and 7pm Tuesday and Thursday evening.

During the times when the practice is closed arrangements are in place for patients to access care from an Out of Hours provider.

The practice shares its location with two other GP practices, the Red practice and White practice, along with other community health care staff.

The practice population has a higher number of patients between 0-4, 35-39, 45-49 and 85+ years of age than the national and local Clinical Commission Group (CCG) average. The practice population also shows a lower number of 10 - 29 year olds and 60-69 year olds than the national and local CCG average. There is a slightly higher number of patients with a long standing health condition and with a health care problem in daily life. The percentage of registered patients suffering deprivation (affecting both adults and children) is lower than the average for England.

Updated 3 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Dzung Nguyen (The Yellow Practice) on 28 January 2016. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, investigations and analysis were not documented in a way which showed they had been shared with staff. Patients did receive a verbal and written apology when things went wrong.
• Risks to patients were assessed and well managed, with the exception of those relating to the security of prescription pads.
• Clinical governance meetings were not attended by all clinical staff and the meetings were not minuted to ensure all staff were aware of discussions which took place.
• There were some gaps identified in staff training particularly for health and safety related subjects and governance.
• The majority of patients said they were treated with compassion, dignity and respect.
• 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, with urgent appointments 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 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 practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Ensure that mandatory training for staff is completed and monitored to ensure that time frames for renewal do not lapse. This includes ensuring staff have completed relevant training for fire safety, infection control, basic life support and information governance.

In addition the provider should:

• Review the systems in place for patients who have complained to ensure they receive further signposting to information should they wish to continue with their complaint.
• Ensure all staff are aware of the translation service available for patients who do not have English as a first language.
• Review the equipment available for use in medical emergencies, particularly for children.
• Consider the recording of minutes for meetings are maintained to assist in effective governance and ensure these are distributed to staff to inform better information sharing across all staff teams.
• Review the patient satisfaction results within the National GP Survey and consider what changes could be made to the areas that are lower than other practices so as to ensure greater satisfaction for patients.

.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 May 2016

The provider was rated as requires improvement for effective and for well-led and good for safe, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 97% compared to the local CCG average of 81% and the national average of 81%.
• 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.

Updated 3 May 2016

The provider was rated as requires improvement for effective and for well-led and good for safe, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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.
• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control was 93% compared to the local CCG average of 75% and the national average of 75%
• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 81% compared to the local CCG average of 80% and 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.
• The practice ensured that children needing emergency appointments would be seen on the day or were offered a same day telephone appointment to discuss any concerns.

Updated 3 May 2016

The provider was rated as requires improvement for effective and for well-led and good for safe, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 offered continuity of care with a named GP.
• The practice had a register of older patients with complex medical needs or who were at high risk of hospital admission.
• There was a weekly visit to a local residential home where the practice cared for approximately 50% of the residents.

Updated 3 May 2016

The provider was rated as requires improvement for effective and for well-led and good for safe, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, 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 reflects the needs for this age group.
• The practice offered telephone consultations on the same day which were usually dealt with during lunch-time or after evening surgery.
• Electronic Prescribing was available which enabled patients to order their medicine on line and to collect it from a pharmacy of their choice.
• The practice offered early morning appointments from 7:30am every day and also offered evening appointments until 7pm on Tuesday and Thursday to provide more flexible access to working patients and students.

Updated 3 May 2016

The provider was rated as requires improvement for effective and for well-led and good for safe, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is above both the local CCG average of 83% and the national average of 84%.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented inthe record, in the preceding 12 months was 90% compared to the local CCG average of 91% and the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 3 May 2016

The provider was rated as requires improvement for effective and for well-led and good for safe, caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 and carried out an annual health check.
• The practice regularly worked with multi-disciplinary teams 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.