Dr Kumudini Khare Also known as Dr Khare Medical Practice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as requires improvement. At this assessment, the rating has remained as requires improvement.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service mostly made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs.

The provider had some systems in place to identify people with previously undiagnosed conditions. However, our remote clinical searches identified 30 people with a potentially missed diagnosis of chronic kidney disease stages 3 to 5.

Our clinical searches found potential risks to patients regarding the actioning legacy patient safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).

Some patients with long term conditions such as asthma following an exacerbation of their symptoms had not been issued with a steroid card or been in receipt of a follow up review appointment. We found there were asthma alerts on the electronic systems which did not appear to have been addressed.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. Reception staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present.

Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing.

Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. This was completed in line with legislation and current evidence-based good practice and standards. However, our clinical searches had identified some gaps. These gaps included for example, a system for legacy patient safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA), identification of patients with the potential for chronic kidney disease stages 3-5, and the follow up of some patients with long term conditions on medicines requiring regular monitoring.

The records reviewed for people who received treatment following an exacerbation of their asthma did not always demonstrate follow up within 48 hours or evidence of safety netting advice. Our clinical searches found there were asthma alerts which did not appear to have been addressed, and from the records we sampled not all had been in receipt of a steroid card.

The service worked well across teams and services to support people. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services, such as via secondary care referrals.

Staff were positive about how the service worked well across teams and services to support people. There was evidence of working with the wider health care teams though multi-disciplinary teams (MDT) meetings. People had access to services provided by the Mercian Primary Care Network (PCN), including social prescribers. The service had worked with their patient participation group to make improvements.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, most patients at risk of developing a long-term condition and those with caring responsibilities. Staff told us they supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity. People could be referred for a range of support and guidance for example, Everyone Health Stop Smoking Service and Everyone Heath Adult Weight Management via Staffordshire County Council.

Our clinical searches identified gaps in the service’s routine monitoring of people’s care and treatment, in order for the service to continuously improve it. For example, the follow up of some patients with long term conditions on medicines requiring regular monitoring. There were some systems in place to ensure that people with long-term conditions were reviewed regularly. This included an annual review appointment for patients with long term conditions within their birth month. If patients did not attend, they received follow up invitations to encourage attendance.

The percentage of children aged 5 who had received immunisation for measles, mumps and rubella (two doses of MMR) between 2023- 24 was 84.6% which was below the World Health Organisation based target for uptake target of 95.0%. There was no strategy in place to improve uptake, however the practice following our feedback contacted and booked appointments for those that had failed to attend .

Data from the UK Health Security Agency showed that cervical screening uptake in 2024 had included 305 patients of the 425 eligible patients, 71.8%. This was below the 80% target. The service advised that patients who declined the cervical screening uptake offer were documented and re-offered screening in the future. Persistent non-attenders received follow-up contact and information leaflets on the benefits and risks. The practice leadership confirmed that they had focused recently on non-attenders and had contacted all these patients.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. The do not attempt cardiopulmonary resuscitation (DNACPR) decisions we looked at were appropriate and were made in line with relevant legislation.

The provider told us that although they were notified about DNACPR decisions through discharge letters from secondary care. This was recorded in the electronic record; however, they did not always receive a copy of the Recommended Summary Plan for Emergency Care and Treatment form (ReSPECT) or details of the discussion. A ReSPECT form is a personalised plan created through conversations between the individual, their family, and healthcare professionals, detailing what treatments the person would or would not want in an emergency when they may not be able to communicate their wishes. The lead GP advised they reviewed all patients in receipt of a ReSPECT form following their discharge, which enabled them to employ a system whereby they held a copy of the form as well as being held by the patient. The lead GP provider was aware of the future introduction of the digital ReSPECT form.