Archived: Dr Patrick Gonsalves Also known as Kingstanding Road Surgery

Updated 28 April 2016

Kingstanding Road Surgery has to date been a single-handed GP practice which provides primary medical serves under a general medical services (GMS) contract to a population of approximately 1,471 patients in the Kingstanding area of Birmingham. The registered provider Dr Gonsalves, has been absent from the practice since October 2015, since which time Modality Partnership had been caretaking the practice. In December 2015 Dr Gonsalves joined the Modality Partnership, although the registration details with the Care Quality Commission remained unchanged at the time of the inspection. However, the practice has now made an application to amend the registration details.

The practice has a slightly higher number of patients between the ages of 40-55 and 60 to 80 years. Data from Public Health England shows that the area is one with significantly lower levels of deprivation compared to the rest of England.

At the time of this inspection, in the absence of the GP provider the practice had clinical sessions provided from two male GPs from the Modality Partnership and a regular locum female GP, there was an interim practice manager also provided from Modality, a practice nurse, and four reception staff.

The practice is open Monday to Friday mornings from 8am to 1pm and afternoons from 3.30pm until 6.30pm, with the exception of Thursdays when the practice closes at 4.30 and Mondays when extended hours appointments are provided until 7.30pm.on Mondays. When the practice is closed between 1pm and 3.30 patients are given the number to call to access a doctor if they need one urgently. The practice has opted out of providing out-of-hours services for their own patients and this is provided by an external out of hours service. Patients are advised of how to contact the out of hours (OOH) service outside of practice opening hours via an answer phone message which also provides medical cover between 1pm and 3.30pm.

Updated 28 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced inspection at Kingstanding Road Surgery on 23 February 2015, when the practice was rated as inadequate and placed into special measures. This was followed up with an inspection on 21 October 2015 to determine if actions had been completed in response to warning notices issued as a result of the previous inspection.

We found on the inspection on 21 October 2015 that improvements had been made but the rating was not changed as a new comprehensive inspection was required in line with CQC process. Therefore, we carried out an announced comprehensive inspection at Kingstanding Road Surgery on 29 January 2016 to determine if sufficient improvements have been made to allow the practice to be taken out of special measures and review the practice rating.

Following the inspection carried out on 29 January 2016 the overall rating of the practice is 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 the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.
• The practice had adequate facilities and had the appropriate equipment and resources to treat patients and meet their needs.
• The practice had joined with Modality Partnership and were in the process of amending their CQC registration. This had resulted in a clear leadership structure and management model. Staff reported that they felt supported by management.
• The practice proactively sought feedback from staff and was seeking to engage with patients to gain their views and act on them. For example, by raising awareness in the waiting area regarding feedback. They were taking steps to re-establish the patient participation group.

The areas where the provider should make improvement are to:

• Carry out risk assessments regarding emergency equipment and contents of GPs bags.
• Continue to carry out audit to monitor and demonstrate improvement in patient outcomes.
• Proactively seek to identify carers in the practice.

I confirm that this practice has improved sufficiently to be rated ‘Good’ overall. The practice will be removed from special measures.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice  

Updated 28 April 2016

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

• The nurse and GP led care in chronic disease management and were well supported by reception staff who were proactive in calling patients who had been prioritised for review to increase attendance and uptake of the service offered.
• Longer appointments and home visits were available when needed.

All these patients had a named GP and structured annual reviews were being arranged to check their health and medicines needs were being met. For those patients with the most complex needs, the practice liaised with relevant health and care professionals to deliver a multidisciplinary package of care. 

Updated 28 April 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 high for all standard childhood immunisations.
• Children and young people were treated in an age-appropriate way and were recognised as individuals, and we spoke to a patients during our inspection who confirmed this.
• Cervical screening was offered to patients and a female doctor and nurse were available to encourage uptake, which was comparable with the national average.
• Appointments were available outside of school hours and patients told us the practice was responsive to childhood illness and always saw children urgently if necessary.
• The practice had taken steps to establish improved joint working with midwives, health visitors and other members of the primary health care team. They had made contact with community colleagues and put measures in place to continue contact if issues arose and ensure sharing of information.

Updated 28 April 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, such as screening for frailty to prevent falls.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Housebound patients who required a flu vaccination were visited at home by the practice nurse who also carried out a health review at that time.
• The practice were pro-actively identifying patients with heart failure to improve the way they structured their care.

Updated 28 April 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 services such as smoking cessation as well as a health assessments and new patient medical assessments.

Updated 28 April 2016

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

• The practice were working to improve the accuracy of all disease registers including that of patients diagnosed with dementia.
• They were developing relationships with the multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice told patients experiencing poor mental health about how to access various support groups and voluntary organisations such as IAPT and MIND.
• There was 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 and we saw that staff had undertaken dementia awareness training.

Updated 28 April 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 those with a learning disability and all patients in this group had been seen.
• The practice offered longer appointments for patients with a learning disability.
• The practice had made contact with members of the multi-disciplinary teams to make themselves known and encourage improved communication regarding the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations, such as alcohol abuse support.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. They 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.