Archived: Dr Ravinder Kooner

Updated 11 January 2018

Dr Ravinder Kooner, also known as Cole Park Surgery, is located in the London Borough of Richmond Upon Thames and is a member practice of Hounslow Clinical Commissioning Group (CCG). The practice has a patient list size of approximately 3300 patients. The practice is situated in an area which is classified as the fourth most deprived decile. The majority of the patients within the practice are either young or of working age. A small percentage of patients are aged between 65 and 85.

The practice is located on the ground and first floor of a converted residential property with wheelchair access. There are five consulting rooms and a room for baby consultations. There are three toilets; two for patients with disabled access, on each floor and another for staff.

Clinical staffing includes the lead GP and partner, one salaried GP, two regular locum GPs, a locum nurse practitioner and two regular locum nurses. The team also includes two health care assistants. The clinical team are supported by four reception staff, a secretary and a part-time practice manager

The practice is open between 08:30am – 6:00pm Monday – Thursday. Appointments are available from 8:30am – 6:00pm.The practice is open between 8:30am –4:30pm, on Friday; appointments are available from 8:30am – 4:30pm.Extended surgery hours are offered from 6:00pm – 8:30pm every Tuesday. When the practice is, closed patients can call NHS 111 in an emergency or a local out of hour’s service.

The service is registered with the Care Quality Commission to provide regulated activities of diagnostics and screening services, treatment of disease, disorder or injury, surgical procedures, maternity and midwifery services and family planning.

The service is planned to integrate with another local GP practice in Hounslow CCG from 1 January 2018, so the premises will be vacated and staff and patients will transfer to the new provider. The current provider will no longer be registered with the Care Quality Commission.

Updated 11 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Ravinder Kooner on 24 March 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. This was because the provider did not have a defibrillator available at the practice or an appropriate risk assessment to indicate how they would deal with a medical emergency; there was no practice policy or clear system in relation to safeguarding vulnerable adults and the practice did not have a range of health and safety risk assessments for the premises.

The full comprehensive report can be found by selecting the ‘all reports’ link for Dr Ravinder Kooner on our website at www.cqc.org.uk.

This inspection was an announced focussed inspection carried out on 5 December 2017 to confirm that the practice had met the legal requirements in relation to the breach in regulation 12 that we identified in our previous inspection on 24 March 2016. No action plan was sent following the breach in legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made.

Overall the practice is rated as good. However, the practice was still found to be requires improvement for providing safe services.

Our key findings were as follows:

• The practice had access to an automated external defibrillator (AED) for use in medical emergencies.

• The practice had a policy for safeguarding vulnerable adults, but the process for escalating concerns was unclear. Non-clinical staff had received training appropriate to their roles, but three GPs had not undertaken safeguarding adults training to the required level 2.

• The practice had completed a fire risk assessment but actions had not been completed.

• The practice did not have other appropriate risk assessments to keep people safe; including health and safety of the premises, hazardous substances and legionella.

• Quality and Outcomes Framework (QOF) exception reporting rates for patients with mental health and dementia had improved. Results for 2016/17 demonstrated exception reporting was in line with local and national averages.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 27 July 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 81% of patients with diabetes on the register had their blood sugar recorded as well controlled, compared to the national average of 78%.

• 94% of patients with diabetes on the register had a recorded foot examination and risk classification; this was comparable to the national average of 88%.The

• 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 27 July 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 comparable to the local average for all standard childhood immunisations.

• 90% of patients diagnosed with asthma had an asthma review in the last 12 months; this was higher than the national average of 75%.  The exception reporting rate was 1%.

• 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.

• 82% of women aged 25-64 had it recorded on their notes that a cervical screening test has been performed in the preceding five years; this was comparable to the national average of 82%.The

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

Updated 27 July 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.

• 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 27 July 2016

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

• 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.

• The practice offered a ‘Commuter’s Clinic’ on Tuesday evening until 8.30pm for working patients who could not attend during normal opening hours.

Updated 27 July 2016

The practice is rated as good for the care of people experiencing poor mental health.

• 100% of patients diagnosed with dementia had a recorded review in a face to face meeting in the last 12 months compared to the national average of 84%.  This was lower than the national average as the exception reporting rate was 46%.
• 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months, compared to the national average of 88%. This was lower than the national average as the exception reporting rate was 17%.

• 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.

• 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 understood how to support patients with mental health needs and dementia.

Updated 27 July 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, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in 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.

• Staff were not aware of recognising signs of abuse in vulnerable adults. They were not aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies out of normal working hours.