Archived: Dr Khalid Choudhry

Updated 10 August 2016

Dr Khalid Choudhry provides primary medical services to approximately 3,728 patients in Leicester City. At the time of our inspection, the practice list size had increased by approximately 500 additional patients within a period of approximately eight weeks due to the recent close of two local GP practices. This had put increased demand on access to appointments for patients however the practice were continually monitoring availability of appointments and waiting times.

It is registered with the Care Quality Commission to provide the regulated activities of; the treatment of disease, disorder and injury; diagnostic and screening procedures; family planning and maternity and midwifery services.

At the time of our inspection the practice employed a practice manager, a supporting practice manager, a GP, two locum GPs, one practice nurse, 1 health care assistant, three receptionists and one apprentice receptionist.

The practice is located at 91 St Peter’s Road, Leicester, LE2 1DJ and is open from 9am until 6.30pm Monday to Friday. The practice provides extended opening hours on a Monday, Wednesday and Friday evening until 7pm. The practice is part of a pilot scheme within Leicester City which offers patients an evening and weekend appointment with either a GP or advanced nurse practitioner at one of four healthcare hub centres. Appointments are available from 6.30pm until 10pm Monday to Friday and from 9am until 10pm on weekends and bank holidays. Appointments are available by walk in, telephone booking or direct referral from NHS 111.

The practice has a General Medical Services (GMS) contract. The GMS contract is the contract between general practices and NHS England for delivering care services to local communities.

The practice has an active patient participation group (PPG) which has been in place for four years who meet on a bi-monthly basis.

The practice has a higher population of patients between the ages of 20-34 years of age. 54.8% of the patient population have a long standing health condition.

The practice offers on-line services for patients including ordering repeat prescriptions and booking routine appointments.

The practice lies within the NHS Leicester City Clinical Commissioning Group (CCG). A CCG is an organisation that brings together local GPs and experienced health professionals to take on commissioning responsibilities for local health services.

Updated 10 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Khalid Choudhry on 29 March 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.

• 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.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they did not always find 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 practice had an active patient participation group in place who met on a regular basis.

• Risks to patients were assessed and well managed with the exception of those relating to Legionella.

• There was no process in place to ensure appropriate checks were undertaken to ensure members of the nursing team were registered with the Nursing and Midwifery Council (NMC).

• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure a process is in place to assess and monitor risks in relation to Legionella.

• Review governance arrangements to ensure systems and processes are in place for gaining assurance that members of the nursing team are registered with the Nursing and Midwifery Council (NMC).

The areas where the provider should make improvement are:

• Ensure all policies and procedures are reviewed and updated.

• Ensure all members of staff complete the appropriate level of safeguarding training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 August 2016

The provider is rated as requires improvement for the care of people with long-term conditions. The provider was rated as good for being effective, caring, responsive and well led. However it was rated as requires improvement for providing safe care. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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

• Performance for diabetes related indicators was 37% which was worse than the national average of 89.2%. Exception reporting rate was 5.15% which was lower than CCG and national averages. Performance during 2015-16 had shown significant improvement compared to 2014-15 results. A practice nurse had been employed who specialised in Diabetes management, this had improved services provided for diabetes patients and led to improvement in performance during 2015-16.

• 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.

• The practice participated in an admissions avoidance scheme and delivered personalised care plans and regular reviews for patients with a long term condition with a view to deliver more personalised care and to reduce emergency or unplanned hospital admissions.

Updated 10 August 2016

The provider is rated as good for the care of families, children and young people. The provider was rated as good for being effective, caring, responsive and well led. However it was rated as requires improvement for providing safe care. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 for some of the vaccinations given were lower than local and national averages. The practice sub-contracted services for childhood immunisations to local health visiting teams to improve immunisations uptake for babies and children.

• The practice provided childhood immunisation clinics.

• 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 75%, which was comparable to the CCG average of 69% and the national average of 82%.

• 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, health visitors and school nurses.

• The practice provided weekly midwifery led clinics.

Updated 10 August 2016

The provider is rated as good for the care of older people. The provider was rated as good for being effective, caring, responsive and well led. However it was rated as requires improvement for providing safe care. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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.

Updated 10 August 2016

The provider is rated as good for the care of working-age people (including those recently retired and students). The provider was rated as good for being effective, caring, responsive and well led. However it was rated as requires improvement for providing safe care. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• 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 telephone consultations for patients who were unable to attend for an appointment.

• The practice provided extended hours appointments until 7pm on a Monday, Wednesday and Friday.

Updated 10 August 2016

The provider is rated as good for the care of people experiencing poor mental health (including people with dementia). The provider was rated as good for being effective, caring, responsive and well led. However it was rated as requires improvement for providing safe care. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• Data provided for 2014-15 showed that only 9% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, however data provided for 2015-16 showed that this had significantly improved and at the time of our inspection performance was 88.8% which was higher than the national average of 84.01%.

• Performance for mental health related indicators was 34.6% which was worse than the national average of 92.8%. Exception reporting rate was 4.1% which was significantly lower than CCG and national averages. Performance during 2015-16 had shown significant improvement and results were in line with local and national averages.

• 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.

• 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.

Updated 10 August 2016

The provider is rated as good for the care of people whose circumstances may make them vulnerable. The provider was rated as good for being effective, caring, responsive and well led. However it was rated as requires improvement for providing safe care. The concerns which led to these ratings apply to everyone using the practice, including this population group.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. Care plans were in place and reviewed on a regular basis for patients which included those who suffered with a learning disability.

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

• 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.