Archived: Dr Tahalani and Partners

Updated 3 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Talahani and Partners on the 18 February 2015. The practice was rated as requires improvement for providing effective care. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to ensure the care they provided was effective and met the standard required by CQC.

We undertook this focussed inspection on 27 July 2016 to check that the practice had followed their plan and to confirm that they were now providing effective care. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Talahani and Partners on our website at www.cqc.org.uk.

Overall the practice was rated as Good.

Following the focussed inspection we found the practice to be good for providing effective care.

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

• All staff that act as chaperones had received chaperone training.

• The practice had purchased an automated external defibrillator (used to attempt to restart a person’s heart in an emergency).

• All staff had received training on infection control.

• The practice had completed one complete clinical audit cycle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 August 2015

The practice was signed up to City and Hackney long term conditions enhanced service for conditions such as diabetes, asthma and COPD. This encompassed both prevalence targets and management targets. The GPs felt that combined with QOF this meant they had to be proactive in identifying patients with long-term conditions and optimising their care. They had a recall system set up where each lead clinician was allocated a specific administrator who recalled patients for annual reviews. Recall lists are printed off weekly and recalls were managed via phone, letters and texts. All attempts at contact was documented in the patients records. Non-responders are followed up opportunistically. In some cases, repeat medication can be changed to ‘Acute’ with a prescription reminder to both patient and pharmacist to encourage review with a GP. Diabetes specialist nurse clinics were held twice per week, together with diabetes dietician clinics, and a heart failure specialist nurse who visited patients at their homes. In addition, practice nurses and HCAs regularly undertook reviews for Asthma, COPD, hypertension and diabetes.

Updated 6 August 2015

We saw evidence that the practice have monthly health visitor meetings where they discussed children in need and complex cases. They maintained a register of vulnerable patients and see walk-in emergencies at both sites and in every clinical session. The GPs demonstrated an understanding of Gillick competency and we saw evidence of them seeing the under 16’s in their clinics. The practice worked closely with the sexual health clinic, the Ivy centre, which was based in the same site as one of their branch surgery. The nurse prescriber had additional training in contraception and gave advice to women and was able to give repeat prescriptions for contraception. This removed the need for patients to have a GP appointment.

There were weekly immunisation baby clinics and last year’s performance for child immunisations at age 12 months was approximately 95% which was higher than the CCG area average of 85%.

Appointments were available outside of school hours and the premises were suitable for children and babies. Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health. Clinicians offered family planning advice, fitted IUDs and prescribed the contraceptive pill.

Updated 6 August 2015

The practice used a risk profiling tool which enabled GPs to identify a range of at-risk patients and detect and prevent unwanted outcomes for patients. The practice was signed up to both the Avoiding Unplanned Admissions (AUA) enhanced service and a ‘frail home visiting ‘enhanced service. The aim of both of these services was to target care to those most at risk of hospital admissions. Both services identify vulnerable, elderly patients and necessitate enabling named clinician-led care, developing a care plan, proactive management and home visiting of elderly patients. The practice kept a register of elderly patients whose care needed to be prioritised. This register was accessible to reception staff and enables them to be proactive in providing care for these patients. The practice had been allocated a ‘Care coordinator’ to help to meet the non-medical needs of this group of patients by liaising with external agencies and dealing with issues such as housing and finance. Multi-disciplinary monthly meetings were held to review complex cases. These were attended by community matron, district nurses and the care coordinators. The GP’s told us this approach helped to promote holistic patient care.

Updated 6 August 2015

The practice is rated as good for the population group of the 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. They had extended opening three days a week and online services for ordering repeat prescriptions, booking appointments and getting test results were available. They also offered phone consultations for patients who could not attend the surgery. The practice offered an extensive range of health promotion and invited patients over 40 years of age to have an NHS health check

Updated 6 August 2015

The practice worked closely with link consultants from the local Community Mental Health team (CMHT) who attend the practice quarterly to discuss clinical cases, namely people who had been transferred back to primary care from secondary care. We saw notes from these meetings were typed directly into patient’s records. The practice had an allocated mental health liaison nurse who assesses appropriate patients in the practice and also attends the CMHT meetings. We saw the practice works very closely with primary care psychology services – IAPT and they refer patients to the Tavistock clinic, who provides in-house psychotherapy services when needed.

We saw evidence that both clinical and administrative staff have had Mental Capacity Act and dementia awareness training. QOF data showed the practice had scored 100% for conditions commonly found amongst older people such as dementia.

Updated 6 August 2015

The practice’s two surgeries are located in areas where a large amount of their patients are socially deprived and have difficulty accessing both medical and social support. The practice therefore offers services to meet their patients ‘holistic’ needs, such as a weekly benefits advisor attends the practice on Friday mornings and a family action counsellor’ attends on Thursday mornings. We saw their system diary which confirmed these sessions were well attended.

One of the GPs was the lead for vulnerable adults and reception staff had a list of vulnerable patients to ensure they were prioritised for appointments. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector organisations. 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 and out of hours.

Practice staff had access to an interpreter and translation service via language line to ensure that those patients whose first language was not English could access the service. The practice was accessible to disabled patients