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Archived: Dr A Sinha and Dr G De Good

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 25 June 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sinha and Dr De (Cromwell Road Surgery) on 27 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive services that were well-led and met the needs of the population it served.

The practice was outstanding for the care of older people.

Our key findings were as follows:

  • Patients who used the service were kept safe and protected from avoidable harm. The building was well maintained and clean.

  • All the patients we spoke with were positive about the care and treatment they received. The CQC comment cards and results of patient surveys showed that patients were consistently pleased with the service they received.

  • There was good collaborative working between the practice and other health and social care agencies that ensured patients received the best outcomes. Clinical decisions followed best practice guidelines.

  • The practice met with the local Clinical Commissioning Group (CCG) to discuss service performance and improvement issues.

  • There were good governance and risk management measures in place. The leadership team were visible and staff we spoke with said they found them very approachable.

We saw an area of outstanding practice:

  • The practice employed a care co-ordinator whose role was to review and co-ordinate the care of older people and to signpost them to available services when needed. This was to ensure they had a care plan in place and were receiving care and treatment which would reduce the risk of unplanned admissions to hospital. There had been an improvement in the rate of unplanned admissions from 339 in 2013/14 to 291 in 2014/15.

However there were areas of practice where the provider needs to make improvements

Importantly the provider should:

  • Ensure records were kept to confirm vaccines were maintained at the required temperature when being transported between practice sites.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 June 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were enough staff to keep patients safe.

Effective

Good

Updated 25 June 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were above the local CCG average for 14 out of 20 clinical indicators. Care and treatment was being considered in line with current guidelines and legislation. This included assessing capacity and promoting good health. Patient’s needs were consistently met and referrals to other services were made in a timely manner. Staff worked with multidisciplinary teams. The practice undertook clinical audit and monitored the performance of staff. Staff had received training appropriate to their roles.

Caring

Good

Updated 25 June 2015

The practice is rated as good for providing caring services. Data showed that patients rated the practice higher than others in the local CCG area for several aspects of care. Feedback from patients about their care and treatment was positive. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 25 June 2015

The practice is rated as good for providing responsive services. It reviewed the needs of its local population and engaged with the NHS Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. Patients said they were able to make an appointment with a named GP which supported continuity of care. Urgent appointments were available on the same day requested. The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and the practice responded to complaints and comments appropriately.

Well-led

Good

Updated 25 June 2015

The practice is rated as good for being well-led. The leadership team was visible and it had a clear vision and purpose. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. Governance arrangements were in place and there were systems for identifying and managing risks. Staff were committed to maintaining and improving standards of care. Key staff were identified as leads for different areas in the practice and they encouraged good working relationships amongst the practice staff. Staff were well supported by the GPs and practice manager.

Checks on specific services

People with long term conditions

Good

Updated 25 June 2015

The practice is rated as good for the care of people with long-term conditions. Staff had a good understanding of the care and treatment needs of these patients. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice closely monitored the needs of this patient group. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medication needs were being met. There was a recall programme in place to make sure no patient missed their regular reviews for conditions, such as diabetes, respiratory and cardiovascular problems. We heard from patients that staff invited them for routine checks and reviews. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice was working with the local advanced community care team on a pilot scheme looking at patients with complex chronic disease needs who were at higher risk of admission or attendance at the hospital.

Families, children and young people

Good

Updated 25 June 2015

The practice is rated as good for the care of families, children and young people. 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 offered comprehensive vaccination programmes which were managed effectively. Immunisation rates were relatively high for all standard childhood immunisations. The practice monitored any non-attendance of babies and children at vaccination clinics and worked with the health visiting service to follow up any concerns. Appointments were available outside of school hours and the premises were suitable for children and babies. All of the staff were responsive to parents’ concerns and ensured children who were unwell could be seen quickly by the GP.

New mums were offered a six week post natal face to face appointment along with the baby check.

Older people

Outstanding

Updated 25 June 2015

The practice is rated as outstanding for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service and actively reviewed the care and treatment needs of these patients. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. Patients over the age of 75 had a named GP. These patients had on-going reviews every three months or sooner if necessary.

The practice employed a care co-ordinator whose role was to review and co-ordinate the care of older people and to signpost them to available services when needed. This was to ensure they had a care plan in place and were receiving care and treatment which would reduce the risk of unplanned admissions to hospital. There had been an improvement in the rate of unplanned admissions from 339 in 2013/14 to 291 in 2014/15.

Each patient over 70 received a ‘Happy Birthday’ letter each year offering them a review by the practice; any chronic diseases were reviewed at this visit.

The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 25 June 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of this population group 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 provided a range of options for patients to consult with the GP and nurse. On-line access was available for patients to book appointments and to order repeat prescriptions. Late night clinics were available one evening a week. Patients were contacted on the telephone to discuss results, medication and to offer advice after normal working hours.

A full range of health promotion and screening was available that reflected the needs of this population group.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 June 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients who experienced mental health problems including dementia. The register supported clinical staff to offer patients an annual appointment for a health check and a medicines review. Data for 2013/2014 showed the practice performed above the local CCG average for the percentage of patients diagnosed with dementia that had received a face to face review in the previous 12 months. The practice was also in line with the local CCG average for documented care plans that had been completed for patients with other mental health problems such as schizophrenia, bipolar affective disorder and other psychoses.

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Information was available for patients on counselling services and support groups.

People whose circumstances may make them vulnerable

Good

Updated 25 June 2015

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, travellers and those with a learning disability. It offered patients on the practice learning disability register an annual health check. The patients on the practice register had received an annual health check in 2014. The practice offered these patients longer appointments. We found that all of the staff had a very good understanding of what services were available within their catchment area, such as supported living services, care homes and support for people with carer responsibilities.

The practice provided a substance misuse service to vulnerable patients. The service was GP led and had the support of a counsellor and nursing staff. This enabled the service to support the families and children of patients who were substance misusers.

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. They had access to the practices’ policy and procedures and discussed vulnerable patients at the clinical meetings.