Archived: Dr Vishnu Parmar

Updated 13 March 2018

Dr Vishnu Parmar also referred to as Overseal Surgery provides primary medical services to approximately 1 900 patients through a general medical services contract (GMS). The practice has been providing services since 1910 and is situated in the rural village of Overseal in Swandlincote, Derbyshire. Services are delivered from a detached and extended bungalow. The practice offers dispensing services to patients on the practice list who live more than one mile (1.6km) from their nearest pharmacy.

The number of older patients within the practice is above the local average and the number of children and young people is below the local average. The level of deprivation within the practice population is below the national average; with the practice population falling into the eighth most deprived decile. Income deprivation affecting children and older people is below the local and national averages.

Dr Vishnu Parmar (male GP) works closely with the clinical team which comprises of a salaried female GP (on  leave at the time of inspection), a female practice nurse and a practice employed pharmacist (part-time). The clinical team is supported by a practice manager and a team of reception staff who also have dual roles as dispensers.

The practice is open between 8am and 6.30pm Monday to Friday. GP appointments (pre-bookable) are available from 9am to 12pm every morning and 4pm to 6pm daily with the exception of Thursday afternoons. GP appointments are for on the day urgent appointments on Thursday afternoons.

The practice has opted out of providing out-of-hours services to its own patients. When the practice is closed patients are directed to Derbyshire Health United (DHU) via the 111 service.

We previously inspected this practice on 29 May 2013 and identified the practice was not meeting the required standards in relation to medicines, assessing and monitoring the quality of service provision.

We carried out a re-inspection on 14 November 2013 and found these standards had been met. A comprehensive inspection under the new methodology was carried out on 19 September 2016 and the practice was rated requires improvement.

Updated 13 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Vishnu Parmar on 19 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Vishnu Parmar on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 August 2017 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 19 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is now rated as good.

Our key findings were as follows:

• Staff delivered care and treatment in line with evidence based guidance and local guidelines. Most of the patient outcomes were generally in line with or above local and national averages.
• The practice had a comprehensive understanding of the practice performance including areas for improvement.
• Clinical audits were undertaken and showed improvements in the quality of care provided to patients.
• Feedback from patients was strongly positive about the care they had received, interactions with staff and access to the service. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 overarching governance framework had been strengthened to support the delivery of the practice vision and good quality care. Risks to patients were assessed and an action plan was in place to monitor improvements to the premises.

• The practice offered dispensing services to patients who lived more than one mile (1.6km) away from their nearest pharmacy. Arrangements for managing medicines in the practice minimised risks to patient safety.

There were also areas of practice where the provider needs to make improvements.

The areas where the provider should make improvement are:

• Continue to review and improve on the practice performance and patient outcomes.

• Continue to make improvements in childhood immunisation performance.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 March 2018

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

• Further improvements were still required in relation to some long term conditions such as heart failure and diabetes. Performance for diabetes related indicators was 82% which was below the CCG average of 94% and the national average of 91%. The level of exception reporting was lower than local and national averages.

• Clinical staff had lead roles in managing patients with long-term conditions and those patients identified as being at risk of hospital admission were identified as a priority.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For patients with the most complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

• Patients had good access to GP appointments and feedback from patients was consistently positive about their experience in obtaining an appointment quickly and a time that was convenient to them.

Updated 13 March 2018

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

• Immunisations were carried out in line with the national childhood vaccination programme. Published data showed the uptake rates for the vaccines given to under two year olds ranged from 63% to 94%. Lower values were achieved for three out of four vaccines - pneumococcal conjugate booster vaccine (62.5%), haemophilus influenza type b and meningitis C booster vaccine (87.5%) and measles, mumps and rubella (87.5%).

• A flexible appointment system ensured that children could be seen on the same day when this was indicated and outside of school hours.

• Patients we spoke with on the day and feedback received from our comment cards, showed young people were treated in an age-appropriate way and were recognised as individuals.

• The premises were suitable for children and baby changing facilities were provided.

Updated 13 March 2018

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

• The practice offered proactive and personalised care to meet the needs of the older patients in its population. Home visits and urgent appointments were available for those with enhanced needs.

• Monthly multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to plan and deliver care appropriate to their needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• We however noted that nationally reported data showed outcomes for conditions commonly found in older people, excluding rheumatoid arthritis remained below local and national averages.

Updated 13 March 2018

The practice is rated as good for the care of working-age people (including those recently retired and students).

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

• A range of health promotion and screening services were available to this age group. The uptake rates for cervical cancer screening, bowel cancer screening and breast cancer screening were in line with local and national averages.

• Additional services were offered to facilitate patient access including minor surgery and joint injections.

• Telephone consultations were available each day for those patients who had difficulty attending the practice due to work commitments for example.

Updated 13 March 2018

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

Published data showed:

• 100% of patients on the practice’s mental health register had a comprehensive care plan documented in their records compared to a CCG average of 92% and national average of 90%. However this was achieved with an exception reporting rate of 33%which was above the CCG average of 20% and national average of 13%.

• 76% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 9% below the CCG and national averages. Exception reporting rates were in line with CCG and national averages.

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

• Information was available for patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

Updated 13 March 2018

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 carers. The practice had identified 2% of their patient list as carers and offered support including annual flu vaccinations.

• The practice worked with multi-disciplinary teams in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. Patients were kept under close review by the practice in conjunction with the wider multi-disciplinary team

• Longer appointments could be booked to ensure sufficient time was available to discuss individual care and support needs.