Archived: Dr Nirvisha Kedia Also known as Coleridge House Medical Centre

Updated 18 August 2016

Dr Nirvisha Kedia (also known as Coleridge House Medical Centre) situated in Hemel Hempstead, Hertfordshire is a GP practice which provides primary medical care for approximately 2,100 patients living in Hemel Hempstead and surrounding areas.

Dr Nirvisha Kedia provides primary care services to local communities under a General Medical Services (GMS) contract, which is a nationally agreed contract between general practices and NHS England. Prior to 1 April 2016 the practice provided primary care services under a Personal Medical Services (PMS) contract, which is a contract between general practices and NHS England for delivering primary care services to local communities. The practice population is predominantly white British along with a small ethnic population of Asian Polish and other Eastern European origin. The practice has higher than average working age population.

The practice has one female principal GP. The practice regularly uses a male locum GP. There is a practice nurse supported by a health care assistant. There is a practice manager who is supported by a team of administrative and reception staff. The local NHS trust provides health visiting and community nursing services to patients at this practice.

There are two parking spaces outside the building as well as adequate roadside parking available. There is a reserved space outside the surgery for those patients with mobility issues.

The practice is open Monday Tuesday Thursday and Friday from 8.30am to 6.30pm except on Monday when the practice is open until 7.30pm. Telephone lines are however open from 8am. On Wednesday the practice is open from 8.30am till 1.30pm. The practice offers a variety of access routes including telephone appointments, on the day appointments and advance pre bookable appointments.

When the practice is closed services are provided by Herts Urgent Care via the 111 service.

Updated 18 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nirvisha Kedia (also known as Coleridge House Medical Centre) on 05 May 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.
• The practice had experience staffing issues during the past year which had impacted on their performance for delivering care to people with long term conditions. However we found remedial measures were in place to improve the performance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their 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 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:

• Continue to monitor the measures introduced to improve clinical performance.

• Continue to identify and support carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 August 2016

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

• The practice nurse and the principal GP had lead roles in chronic disease management such as diabetes, asthma, COPD (chronic obstructive pulmonary disease) and patients at risk of hospital admission were identified as a priority.

• The practice was taking steps to improve their performance for diabetes related indicators in the past year due to staff sickness and to recruitment of a practice nurse.

• 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 more complex needs, the principal GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 18 August 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 and Out of Hours service 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 70%, which was comparable to the CCG average of 75% and the national average of 74%.

• Early evening appointments were available outside school hours and the premises were suitable for children and babies.

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

• The practice provided a variety of health promotion information leaflets and resources for this population group for example the discreet provision of chlamydia testing kits.

Updated 18 August 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.

• All patients over 75 had a named GP.

• The practice offered over 75 years comprehensive health check which included an assessment of their physical mental social circumstances.

• The practice had identified older persons at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked with the Dacorum Holistic Health Care Team to coordinate their care.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Updated 18 August 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.

• The practice offered evening appointments between 6.30pm and 7.30pm every Monday for working patients and others who could not attend during normal opening hours.

• The practice offered pre bookable appointments up to 4 weeks in advance which could be booked in person by telephone or online.

• The practice offered telephone consultations Monday to Friday after 11am.

• The practice offered NHS Health checks smoking cessation advice and travel immunisations.

• The practice had enrolled in the Electronic Prescribing Service (EPS). This service enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 18 August 2016

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

• The practice offered annual reviews to all patients on the mental health register which included physical checks.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• 60% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to other practices in the local area.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice worked in conjunction with the local Improving Access to Psychological Therapies (IAPT) and Cognitive behavioural therapy (CBT) services and referred patients to these services as appropriate.

• The practice hosted the counselling service from the local mental health trust and patients and direct access to these services.

• The practice had a system in place to follow up patients who had attended A&E 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 18 August 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 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.

• The practice held regular review meetings involving district nurses, GP’s and the local palliative care nurses for people that require end of life care and those on the palliative care register.

• 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 identified patients who were also carers and signposted them to appropriate support.