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Inspection Summary


Overall summary & rating

Good

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Kaura and Partners on 17 March 2016, which resulted in the practice being rated as good overall but as requiring improvement for providing effective services. The full comprehensive report can be found by selecting the ‘all reports’ link for Dr Kaura and Partners on our website at

www.cqc.org.uk

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This inspection was a desk-based review carried out in December 2016 to confirm that the practice had carried out steps to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection in March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

  • Since our previous inspection staff had completed all mandatory training. A training matrix was in operation to help identify gaps or when updates were due.

  • Unless specifically requested by the patient making the complaint, complaints information was not stored on a patients medical record.

  • A system was now in place to ensure all meetings were minuted and minutes saved where they could easily be accessed by staff

  • The practice had obtained documentary evidence confirming that NHS Property Services had carried out relevant Health and Safety checks. However, the last legionella risk assessment, carried out in July 2012, had highlighted some action points and the accompanying report, which was produced in July 2014 had recommended that a re assessment be carried out every two years. When this was pointed out to the practice during the inspection they contacted NHS Property Services to obtain a more up to date copy. However this was not received before finalising this report.

The practice should therefore:

  • Put steps in place to monitor when health and safety checks are due to be completed by NHS Property Services, follow up on any delays or gaps and ensure they retain a copy on site of all up to date documentation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 February 2017

Effective

Good

Updated 6 February 2017

The practice is rated as good for providing effective services.

  • The provider had taken steps to ensure that all staff had undertaken recommended training since the previous inspection.

Caring

Good

Updated 6 February 2017

Responsive

Good

Updated 6 February 2017

Well-led

Good

Updated 6 February 2017

Checks on specific services

People with long term conditions

Good

Updated 8 June 2016

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

  • Patients at risk of hospital admission were identified as a priority for care and support by the practice.
  • A locality based care navigator worked at the practice; they supported patients with long-term conditions, particularly those who are housebound.
  • Nationally reported data showed the practice had achieved good outcomes in relation to most of the conditions commonly associated with this population group. For example, the practice had achieved 91% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 0.8% below the local CCG average and 2% above the national average.
  • Longer appointments and home visits were available when needed.
  • All patients with a long term condition had a named GP and were offered 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.
  • The practice provided an in-house smoking cessation service.

Families, children and young people

Good

Updated 8 June 2016

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

  • There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • Arrangements had been made for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 90% to 98% (CCG average 81% to 97%) and for five year olds ranged from 82% to 98% (CCG average 90% to 98%).
  • Urgent appointments for children were available on the same day.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
  • Nationally reported data showed that outcomes for patients with asthma were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 3.4% above the local CCG average and 2.6% above the national average.
  • The practice’s uptake for cervical screening was 81%, which was the same as the local CCG average of 81% and comparable to the national average of 82%.
  • The practice provided contraceptive and sexual health services.

Older people

Good

Updated 8 June 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. The practice participated in the local unplanned admission scheme.
  • All patients over the age of 75 had a named GP.
  • Patients over the age of 75 and carers were offered an annual health check.
  • The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs.
  • Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 2.1% above the local clinical commissioning group (CCG) and national averages.
  • The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Working age people (including those recently retired and students)

Good

Updated 8 June 2016

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

  • 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.
  • Extended hours appointments with a GP were available three mornings a week from 7:10am until 7:40am. Extended hours appointments were available with a nurse or health care assistant five mornings a week from 7:10am until 8am.
  • Patients could order repeat prescriptions and book appointments on-line.
  • Telephone appointments were available with GPs and nurses.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group.
  • Additional services such as new patient health checks, health checks for patients aged between 40 and 74 and travel vaccinations were available at the practice.
  • The practice website provided a wide range of health promotion advice and information.
  • A minor surgery service was available at the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 June 2016

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

  • The practice held a register for patients experiencing poor mental health.
  • Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 99% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 7% above the local CCG average and 6.9% above the national average.
  • Nationally reported data showed that outcomes for patients with dementia were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 4.7% above local CCG average and 5.5% above the national average. 100% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which is above the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.
  • Patients could complete an online depression questionnaire on the practices’ website and an in-house counselling service was available.
  • The practice invited patients to inform them if they were a military veteran with an online form.
  • 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.

People whose circumstances may make them vulnerable

Good

Updated 8 June 2016

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 those with a learning disability.
  • Patients with learning disabilities were invited to attend the practice for an annual health check. At the time of the inspection the practice had identified 70 patients on the register, of these patients 77% had a health check completed. The practice offered longer appointments for patients with a learning disability if required.
  • The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Telephone support was available if required.
  • The practice website offered the facility to complete an online depression questionnaire.
  • GPs at the practice provided drug and alcohol support services and worked with support services when appropriate.
  • The practice had been active in creating a joint working protocol to ensure refugees who were located in the local area were effectively supported and best practice was shared between the services involved.
  • 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. However, healthcare assistants and nursing staff had not undertaken the recommended level of safeguarding training that was appropriate for their role.
  • Good arrangements were in place to support patients who were carers.