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Dr Parvinder Garcha Good Also known as Hounslow Family Practice

Inspection Summary


Overall summary & rating

Good

Updated 2 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Parvinder Garcha, also known as Hounslow Family Practice, on 22 June 2016. The practice was rated as requires improvement for providing safe, effective, and well-led services, and good for providing caring and responsive services. Overall the practice was rated as requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Parvinder Garcha on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 11 September to check for improvements since our previous inspection. The practice is now rated as good for providing safe, effective, caring, responsive and well-led services. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • There was evidence of kind and compassionate care, with the GP principal providing his direct contact number to palliative care patients and their families. The GP also visited these patients in hospital and liaised with hospital staff to ensure continuity of care was maintained.
  • Results from the national GP patient survey showed patients 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with 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 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 the GPs and management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

  • Implement safety signage to indicate oxygen is stored on the premises.
  • Review the system to monitor and assess performance for the childhood immunisation programme.
  • Advertise that a translation service is available to patients on request.
  • Raise staff awareness of the practice’s updated complaints procedure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 October 2017

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • The practice used every opportunity to learn from internal and external incidents, to support improvement. Learning was based on an analysis and investigation.
  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents. Although, there was no safety signage to indicate where the oxygen was stored.

Effective

Good

Updated 2 October 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.
  • Staff were aware of current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for staff, with the exception of one non-clinical staff member whose appraisal had been scheduled.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice ensured that patients with complex needs, including those with life-limiting progressive conditions, were supported to receive coordinated care. For example, the GP principal visited palliative care patients admitted to hospital and liaised with hospital staff to ensure continuity of care was maintained.

Caring

Good

Updated 2 October 2017

The practice is rated as good for providing caring services.

  • We observed a strong patient-centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, the GP principal gave his direct contact number to palliative care patients and their families. The GP also visited these patients when they were admitted to hospital and liaised with hospital staff to ensure continuity of care was maintained.
  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 2 October 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Patients we spoke with 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 practice had good facilities and was well equipped to treat patients and meet their needs. Although, we did not see the translation service advertised.
  • Information about how to complain was available and evidence from examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 2 October 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by the GPs and management. The practice had policies and procedures to govern activity and held regular practice meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, and attended staff meetings and training opportunities. Most staff had received annual performance reviews.
  • The provider was aware of the requirements of the duty of candour. In examples we reviewed we saw evidence the practice complied with these requirements.
  • The GP principal encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • There was a focus on continuous learning and improvement at all levels.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.
Checks on specific services

People with long term conditions

Good

Updated 2 October 2017

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

  • GPs and nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • The practice had performed well on the Quality and Outcomes Framework (QOF) for managing long-term conditions. Unpublished and unverified data indicated that overall performance for diabetes related indicators had improved from 83% in 2015/16 to 96% in 2016/17.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for 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.

Families, children and young people

Good

Updated 2 October 2017

The practice is rated as good for the care of families, children and young people.

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
  • Immunisation rates were comparable to CCG averages and below national averages. The practice told us about administrative errors which may have contributed to the low figures.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
  • The practice had emergency processes for acutely ill children and young people.

Older people

Good

Updated 2 October 2017

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice shared summary care records with local care services.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
  • The practice worked collaboratively with other healthcare professionals in providing care and services to older people with complex needs. For example, utilising primary care coordinators to increase the quality in care planning and referring patients to community services.

Working age people (including those recently retired and students)

Good

Updated 2 October 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours from 6.30pm to 7pm on Monday and Thursday, 6.30pm to 7.30pm on Tuesday and Friday, and 7am to 8am on Wednesday. The GP principal also offered ad-hoc Saturday appointments at the practice, and pre-booked appointments in the evening and at weekends at the local primary care ‘hub’.
  • The practice was proactive in offering online services to book appointments and order repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs for this age group.
  • The practice planned to introduce virtual consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 October 2017

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

  • The practice held a register of patients living in vulnerable circumstances including those with a mental health illness.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice had signed up to the ‘common complex and serious mental health’ out of hospital service for monitoring and caring for patients with long-term depression and serious mental illness.
  • In 2015/16, 88% of patients with a diagnosed psychosis had a comprehensive care plan in their records, which was comparable to the CCG and national averages of 89%.
  • The practice carried out advance care planning for patients living with dementia. However, in 2015/16, 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months, which was below the CCG average of 86% 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 living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 2 October 2017

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, and those with a learning disability.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. The GP principal gave his direct contact number to palliative care patients and visited them when they were admitted to hospital.
  • 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.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 practice had signed up to the ‘caring for homeless patients’ out of hospital service, aimed at people who were homeless and had difficulty accessing general practice care. There were currently 20 patients on the practice’s homeless register. Staff were able to recognise the challenges faced by these patients in terms of access and communication with the practice, and offered a supportive and flexible approach when booking appointments and reviews. The GP principal was the locality lead for homelessness and worked closely with other health providers to offer care to homeless patients. The practice address could also be used by homeless patients for correspondence with the hospital or other care services.