Archived: Dr Surinder Babbar

Updated 20 October 2017

Dr Surinder Babbar, also known as The Courtland Surgery, is located at 62 Courtland Avenue, Ilford, Essex, IG1 3DP. The practice provides NHS primary care services to approximately 3,000 patients through a Personal Medical Services (PMS) contract (an alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract). The practice is part of NHS Redbridge Clinical Commissioning Group (CCG).

The practice is registered to carry out the following activities;

• Family planning

• Diagnostic and screening procedures

• Maternity and midwifery services

• Treatment of disease, disorder or injury

• Surgical procedures

The practice operates from a converted residential property with access to three consulting rooms on the ground floor. The first floor is accessed via stairs. All patient services were on the ground floor.

The practice has a larger than average proportion of adults on its patient list in the age ranges 0-4, and 25-39. The practice population is in the fifth most deprived decile in England (one being most deprived and 10 being least deprived). People living in more deprived areas tend to have a greater need for health services.

The practice is registered as an individual with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services; family planning and surgical procedures.

The practice staff comprises one principal male GP doing 10 sessions per week. The team is supported by a healthcare assistant (24 hours per week), a practice manager and two reception staff. The practice had recently employed a practice nurse to undertake the cervical screening programme approximately two hours per week.

The practice leaflet indicated that the premises are open from 9am to 6.30pm Monday to Friday. Extended hours are provided on Monday, Tuesday and Wednesday from 6.30pm to 7pm.

The practice provides a range of services including chronic disease management, smoking cessation, sexual health, cervical smears, childhood immunisations and travel advice and immunisations.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111.

Updated 20 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Surinder Babbar (The Courtland Surgery) on 18 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the 18 January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Surinder Babbar (The Courtland Surgery) on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 10 August 2017. Overall the practice is now rated as requires improvement. Prior to the publication of this report the practice submitted an application to cancel its registration which has been accepted by the CQC.

Our key findings 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 and had recently had all staff trained in safeguarding, chaperoning, infection control and fire training.
• All electrical equipment had been portable appliance tested (PAT), a new boiler had been installed, there had been recent Legionella and Control of Substances Hazardous to Health (COSHH) risk assessments.
• 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.
• 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, however long waiting times for appointments were mentioned on the day and in the national patient survey and the CQC comment cards.
• 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 not proactively acted feedback from patients, which it acted on.
• The provider was aware of the requirements of the duty of candour and they had recently trained all staff so they understood the requirements.

However if the provider had still been registered there were areas of practice where the provider needed to make improvements.

In addition the provider must:

• Continue to develop an ongoing programme that demonstrates continuous quality improvements to patient care in a range of clinical areas. This may include clinical audit.

• Consider developing a practice website.

• Assess, monitor and improve patient’s waiting times in view of the low patient survey results.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 October 2017

The provider is rated as requires improvement for effective, responsive, and good for safe and caring and well-led. The evidence which led to these ratings affected all patients including this population group. There were, however, examples of good care.

• The lead GP was the lead for chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 55% which was lower than the national average 78% with a practice exception reporting of 14% (national 12%).

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 73% (national average 78%) with a practice exception reporting of 9% (national 9%).

• 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 77% (national average 80%) with a practice exception reporting of 9% (national 13%).

• 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 20 October 2017

The provider is rated as requires improvement for effective, responsive, and good for safe and caring and well-led. The evidence which led to these ratings affected all patients including this population group. There were, however, examples of good care.

• 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.

• The practice told us that all children under the age of 16 would be able to access an appointment on the same day.

• The practice had achieved its target rate of 90% in one of four childhood immunisations and 87% in the remaining three and had achieved its target for childhood immunisation rates given to five year olds which ranged from 92% to 95% (CCG average ranged from 72% to 84% and national average from 88% to 94%).

• The practice’s uptake for the cervical screening programme was 79%, which was comparable to the CCG average of 78% and the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Patients had access to baby change facilities and a breast feeding room was available if requested.

Updated 20 October 2017

The provider is rated as requires improvement for effective, responsive, and good for safe and caring and well-led. The evidence which led to these ratings affected all patients including this population group. There were, however, examples of good care.

• 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 people, and offered home visits and urgent appointments for those with enhanced needs. The practice kept two, 20-minute appointments slots free per day specifically for the over 75 year olds.

• 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.
• 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 offered personalised care to meet the needs of the older people in its population. The healthcare assistant telephoned those patients over the age of 75 who were known to be vulnerable once a month to check on their care.

Updated 20 October 2017

The provider is rated as requires improvement for effective, responsive, and good for safe and caring and well-led. The evidence which led to these ratings affected all patients including this population group. There were, however, examples of good care.

• 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 ‘Commuter’s Clinic’ on Monday, Tuesday and Wednesday from 6.30pm to 7pm for working patients who could not attend during normal opening hours.
• Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for patients aged 40–74.
• The practice was proactive in offering appointments on-line and the patient we spoke with on the day told us this was easy and convenient.

Updated 20 October 2017

The provider is rated as requires improvement for effective, responsive, and good for safe and caring and well-led. The evidence which led to these ratings affected all patients including this population group. There were, however, examples of good care.

• The practice carried out advance care planning for patients living with dementia.

• The percentage of

• Performance for mental health related indicators was above the national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the preceding 12 months was 100% (national average 89%) with an exception reporting of zero percent; national 13%).

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption recorded in the preceding 12 months was 100% (national average 89%) with an exception reporting rate of zero percent (national 10%).

  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.

Updated 20 October 2017

The provider is rated as requires improvement for effective, responsive, and good for safe and caring and well-led. The evidence which led to these ratings affected all patients including this population group. There were, however, examples of good care.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers 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 practice was responsible for four care homes and held monthly meetings with care home managers to discuss patients on the unplanned admission register.

• 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.