Dr Layth Delaimy Also known as Ashley Medical Practice

Updated 29 January 2018

Dr Layth Delaimy (also known as Ashley Medical Practice) is located in Walton-on-Thames in a converted residential property, with all patient areas on the ground floor, and is a training practice. (A training practice has GP trainees who are qualified doctors completing a specialisation in general practice).

At the time of our inspection there were approximately 3,100 patients on the practice list. Statistics show very little income deprivation among the registered population. The registered population is lower than average for 15-29 and 50-84 year olds, and higher than average for those aged from birth to nine years old and 30-49 year olds.

The practice is owned by a single principal GP who works with one salaried GP (both male). The GPs are supported by locum nurses, a healthcare assistant, a manager and four administrative staff. There are often GP trainees attached to the practice; at the time of our inspection one GP trainee (female) was attached to the practice.

The practice is open between 8.30am and 6pm Monday to Friday. A phlebotomy clinic is offered on Saturday mornings. When the practice is closed patients are advised, through the practice website, patient leaflet and recorded telephone message, to contact NHS 111 where they can be redirected to the most appropriate external out of hours service.

The practice has a General Medical Services (GMS) contract with NHS England (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice offers enhanced services for example; childhood immunisations.

Services are provided from the following location:-

1a Crutchfield Lane

Walton-on-Thames

Surrey

KT12 2QY

Updated 29 January 2018

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr Layth Delaimy on 25 January 2017. The overall rating for the practice was good and the practice was rated requires improvement for providing safe services. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Layth Delaimy on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 25 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good and is now rated good for providing safe services.

Our key findings were as follows:

• Infection control was being monitored within the practice and where risks were identified action was taken.
• The temperature of the fridge used for storage of vaccines was monitored and appropriate action taken when concerns arose.
• A risk assessment for lone working had been completed.
• Recruitment checks had been completed for staff employed since our last inspection.

In addition we saw evidence of:

• Information advising patients that chaperones were available was clearly displayed in the waiting area.
• The practice was monitoring management of long term conditions including improvement to the system used for contacting patients about their annual reviews. A healthcare assistant had been trained to help with long term condition management.
• Improvements were made to the quality of care as a result of additionally reviewing informal and verbal complaints and concerns.
• However, there is also one area of practice where the provider needs to make improvements.

The provider should:

• Review polices and protocols to ensure that they are practice specific and reflect current practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 March 2017

Our inspection in January 2016 identified issues which resulted in the practice being rated requires improvement overall. This affected all patients including this population group and the practice was rated as requires improvement for the care of people with long-term conditions.

At the inspection in January 2017 we saw significant improvement and the practice is now rated as good overall. 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 the health care assistant was receiving training to increase the scope of the role to support the monitoring of long term conditions.
• Patients at risk of hospital admission were identified as a priority.
• The practice was performing in line with the local and national averages for QOF clinical indicators. However exception reporting was still higher than clinical commissioning group (CCG) and national averages.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and patients were invited to attend the practice for a structured annual review to check that their health and care needs were being met.
• Staff told us that when patients were diagnosed with a serious or long term condition after the consultation with the GP they were sent a letter outlining their condition along with possible actions or treatments.

Updated 23 March 2017

Our inspection in January 2016 identified issues which resulted in the practice being rated requires improvement overall. This affected all patients including this population group and the practice was rated as requires improvement for the care of families, children and young people.

At the inspection in January 2017 we saw significant improvement and the practice is now rated as good overall. The practice is now 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 for the standard childhood immunisations were mixed. For example; the national expected standard of 90% coverage was only reached in one out of four indicators for two year olds, but the percentage of five year olds receiving measles, mumps and rubella (MMR) vaccines was comparable with local and national averages.
• 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.
• 67% of eligible female patients’ notes recorded that a cervical screening test had been performed in the preceding five years which was lower than the clinical commissioning group (CCG) average of 80% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies, with baby change facilities provided and private rooms made available for breast feeding.
• We saw positive examples of joint working with midwives and health visitors.

Updated 23 March 2017

Our inspection in January 2016 identified issues which resulted in the practice being rated requires improvement overall. This affected all patients including this population group and the practice was rated as requires improvement for the care of older people.

At the inspection in January 2017 we saw significant improvement and the practice is now rated as good overall. The practice is rated as good for the care of older people.

• The practice offered personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice offered electronic prescribing which enabled patients to collect their prescriptions from the pharmacists of their choice which was more convenient for the patients.

Updated 23 March 2017

Our inspection in January 2016 identified issues which resulted in the practice being rated requires improvement overall. This affected all patients including this population group and the practice was rated as requires improvement for the care of working age people.

At the inspection in January 2017 we saw significant improvement and the practice is now rated as good overall. The practice is rated as good for the care of working age people.

• 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 electronic prescribing which enabled patients to collect their prescriptions from the pharmacists of their choice which could be close to their place of work.
• The practice did not offer extended hours GP appointments but did offer a Saturday morning phlebotomy clinic for patients who found it difficult to attend during normal surgery hours.

Updated 23 March 2017

Our inspection in January 2016 identified issues which resulted in the practice being rated requires improvement overall. This affected all patients including this population group and the practice was rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).

At the inspection in January 2017 we saw significant improvement and the practice is now rated as good overall. The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients with dementia, and in appropriate cases this was shared with other local services such as the ambulance service.
• Clinical staff we spoke with had a good understanding of how to support patients with mental health needs and dementia and had completed training regarding the Mental Capacity Act 2005.
• All staff we spoke with demonstrated a clear understanding of patient consent.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice promoted the use of patient experts and put patients in touch with other patients experiencing the same disease or illness after gaining mutual consent.

Updated 23 March 2017

Our inspection in January 2016 identified issues which resulted in the practice being rated requires improvement overall. This affected all patients including this population group and the practice was rated as requires improvement for the care of people whose circumstances may make them vulnerable.

At the inspection in January 2017 we saw significant improvement and the practice is now rated as good overall. The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice provided GP services to the residents of a nearby hostel for homeless people.
• The practice ran a transport fund scheme which could be used in exceptional circumstances to provide transport for vulnerable patients to attend the practice safely.
• 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.