Archived: Dr Khashayar Ghaharian

Updated 1 September 2016

Dr Khashayar Ghaharian provides primary medical services to approximately 2700 patients through a general medical services contract (GMS). The practice is located in the Wollaton Vale area of Nottingham. There is car parking available and the practice is accessible by public transport.

The level of deprivation within the practice population is below the national average. Income deprivation affecting children and older people is similar to the national average.

The clinical team comprises one GP (male) and a practice nurse (female). The clinical team is supported by a full time practice manager, a secretary, a head receptionist and two receptionists.

The practice opens from 8.30am to 6.30pm Monday to Friday. Generally appointments are from 9am to 11.30am each morning and from 3.30pm to 5.30pm each afternoon. Extended hours appointments are offered on Wednesday mornings from 8am and on Friday evenings until 8pm. In addition to pre-bookable appointments that can be booked up to two weeks in advance, urgent appointments are available on the day for people that require them. Urgent appointments are released twice a day at 8.30am and at 2.30pm. Due to the GP being a single handed practitioner, there is some variation in appointment times to facilitate clinics such as the baby clinic.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by NEMS.  

Updated 1 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Khashayar Ghaharian on 18 May 2016 and 15 June 2016. Overall the practice is rated as good.

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

• The practice had systems in place to enable staff to effectively report and record significant events. Learning from significant events was shared internally and externally.
• Risks to patients were assessed and managed. The practice worked with the health centre management to review risks on an ongoing basis to ensure patients and staff were kept safe.
• Staff delivered care and treatment in line with evidence based guidance and local guidelines. Training had been provided for staff to ensure they had the skills and knowledge required to deliver effective care and treatment for patients.
• Feedback from patients was that they were treated with kindness, dignity and respect and were involved in decisions about their care.
• Information about services and how to complain was available and easy to understand. Complaints were dealt with promptly and the practice demonstrated they were keen to meet with complainants to ensure issues were resolved as quickly as possible.
• Patients said they generally found it easy to make an urgent appointment but that they sometimes had to wait to see a named GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Adjustments had been made to the premises to ensure these were suitable for patients with a disability.
• There was a clear leadership structure which all staff were aware of. Staff told us they felt supported by the lead GP and the practice manager. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice worked closely with their patient participation group (PPG) to identify areas for improvement. The practice was responsive to suggestions from their PPG and was working with them to reduce the number of patient attendances at A&E.

However, there are areas where the practice should make improvements:

• The practice should ensure they continue to work to increase the number of identified carers

• The practice should ensure robust arrangements are in place to monitor and review stock levels of required emergency medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 September 2016

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

• Patients with long terms conditions who were identified as being at risk of admission to hospital were identified as a priority and had care plans in place. Monthly meetings were held with the multidisciplinary team to plan and deliver care for patients most at risk.

• Performance for diabetes related indicators was 100% which was 20.9% above the CCG average and 10.8% above the national average. The exception reporting rate for diabetes indicators was 2.7% which was below the CCG average of 9.8% and the national average of 10.8%.

• Longer appointments and home visits were available when needed to facilitate access for these patients.

• All these patients were offered regular reviews to check their health and medicines needs were being met.

Updated 1 September 2016

The practice is rated as good for the care of families, children and young people.

• Systems were in place to identify children at risk. The practice had a dedicated child safeguarding lead and staff were aware of who this was.

• Staff had received training in child safeguarding at a level relevant to their role.

• Extended hours appointments were offered outside of school hours to facilitate access for this population group.

• The practice website had a dedicated section for young people with age specific health information.

• Vaccination rates for childhood immunisations were in line local averages.

Updated 1 September 2016

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

• Personalised care was offered by the practice to meet the needs of its older population. The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Longer appointments were also provided for older people on request.

• Specialist clinics were provided from the practice to help meet the needs of this population group. For example, a regular falls and bones clinic was provided at the practice. Patients who needed to access the services of the specialist nurse would be invited into the practice of visited at home.

• The practice had care plans in place for 114 older people. Regular meetings were held with the multidisciplinary team to discuss patients at risk of admission to hospital and to review care plans.

Updated 1 September 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 offered services which were accessible and flexible. For example extended hours appointments were offered on Friday evenings until 8pm.

• The practice was proactive in offering online services including appointment booking and online prescription services.

• A range of health promotion and screening services were offered and promoted that reflected the needs of this age group. Uptake rates for cervical cancer screening, bowel cancer screening and breast cancer screening were above local and national averages.

• A range of services were offered at the practice to facilitate patient access including minor surgery.

Updated 1 September 2016

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

• Performance for mental health related indicators was 100% which was 11.3% above the CCG average and 7.2% above the national average. The exception reporting rate for mental health related indicators was 4.7% which was below the CCG average of 10.5% and above the national average of 11.1%.

• 90.5% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 6.6% above the CCG average and 6.5% above the national average. This exception reporting rate for this indicator was 0% which was below the CCG average of 8.5% and the national average of 8.3%.

• Monthly multidisciplinary meetings were held within the practice to ensure the needs of these patients were being met.

• 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 1 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Information was available which informed vulnerable patients about how to access local and national support groups and voluntary organisations.

• Translation services were provided where these were required and various pieces of information and signage were available in more than one language. A number of staff within the practice spoke more than one language.

• In order to effectively support vulnerable patients, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• 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.

• Longer appointments were available for these patients where required.