Archived: Dr D Varma

Updated 13 December 2016

Dr D Varma, also known as Brayford Square Surgery is one of the member GP practices in the Tower Hamlets Clinical Commissioning Group (CCG). The practice is also a member of the Stepney and Whitechapel Network, a CCG sub-group of four GP surgeries in the local area.

The practice provides GP primary care services to approximately 3,400 people living in Stepney, London Borough of Tower Hamlets. Services are provided under a General Medical Services (GMS) contract with NHS England. A General Medical Services (GMS) contract is the contract between general practices and NHS England for delivering primary care services to local communities. The practice is located in a single storey building and all rooms are fully accessible.

Information published by Public Health England indicates the practice is located in one of the most deprived parts of England. For example, Income Deprivation Affecting Older People (IDAOPI) is 59% (compared to the CCG average of 49% and the national average of 16%). Income Deprivation Affecting Children (IDACI) is 39% (CCG average 39%, national average 20%). At 76 years, male life expectancy is lower than the England average of 79 years; and at 82 years, female life expectancy is lower than the England average of 83 years. The practice population is predominantly of Asian ethnicity, with patients of Bengali ethnic origin being the largest ethnic group at 70%.

One of the partners had recently left the practice and the provider was in the process of amending its registration status from partnership to sole provider. The practice is registered to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder or injury, maternity and midwifery services and family planning.

There are currently two GPs, one female and one male, both of whom are part-time and provide a combined total of 16 GP sessions per week. The clinical team is completed by a locum nurse who works part time and one health care assistant. There is also a practice manager and two reception staff. The health care assistant and practice manager are trained as phlebotomists. (Phlebotomists are specialist healthcare assistants who take blood samples from patients for testing in laboratories).

The practice opening hours are:

Monday 8:00am to 8:00pm

Tuesday 8:00am to 6:00pm

Wednesday 8:00am to 6:00pm

Thursday 8:00am to 1:00pm

Friday 8:00am to 6:00pm

Saturday Closed

Sunday Closed

Telephones are answered between 8:00am and 6:30pm daily except Thursdays when the surgery closes at 1:00pm. Patients are directed to Tower Hamlets CCG Out Of Hours GP service (OOH) outside these times, including Thursday afternoons. The details of the how to access the OOH service are communicated in a recorded message accessed by calling the practice when it is closed and details can also be found on the practice website.

Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to four weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.

The practice had not previously been inspected.

Updated 13 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr D Varma on 20 October 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients 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.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The practice should take steps to ensure that safety checks of electrical equipment are carried out regularly.
• The practice should consider reviewing its complaints process to ensure that all complaints are being recorded, including those made verbally, so that trends and patterns can be identified and learning points can be used to bring about improvements.

• The practice should continue to pro-actively identify and support patients who are also carers.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 13 December 2016

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

• GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The health care assistant had been trained to provide day to day support for patients with long term conditions.
• 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 13 December 2016

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. Immunisation rates were relatively high for all standard childhood immunisations.
• 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.
• The practice’s uptake for the cervical screening programme was 85%, which was comparable to the CCG average of 79% and the national average of 82%.
• Outcomes for patients with asthma were above CCG and national averages. For instance, 94% had had an asthma review in the preceding 12 months using a nationally recognised assessment tool.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with local GP practices and health visitors and engagement with local community networks.

Updated 13 December 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Outcomes for conditions often associated with older people were comparable to or above local and national averages. For instance, 98% of patients with hypertension had well controlled blood pressure compared to the CCG average of 88% and the national average of 84%.
• Home visits for NHS health checks for older people could be arranged with the practice health care assistant and this had been risk assessed for the safety of the staff member as well as for the patient.

Updated 13 December 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.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• Two members of staff had trained as phlebotomists so that working patients who found it difficult to attend specialist phlebotomy clinics for blood tests, could arrange to have them done at the surgery during the extended surgery hours.

Updated 13 December 2016

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

• All patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 84%.
• 92 % of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 13 December 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 homeless people and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• All staff had been trained in learning disability awareness and used this training to provide suitable support to patients who needed it, for instance, by allowing greater flexibility around appointments.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary 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 normal working hours and out of hours.
• The practice had collaborated with three local GP practices to produce a series of information and health promotion videos and these were available in Bengali which was the most common language spoken amongst the practice population.