Archived: Dr JS Chandra

Updated 28 April 2017

Dr Chandra’s surgery is situated and the inspection was conducted at Hednesford Valley Health Centre, Station Road, Cannock, Staffordshire. The provider is registered with the Care Quality Commission to provide primary care services. The practice has a Personal Medical Services (PMS) contract with a registered list size of 2462 patients (at the time of inspection). The practice is based in the fifth least deprived areas when compared to other practices nationally.

The male life expectancy for the area is 78 years compared with the Clinical Commissiong Group (CCG) averages of 78 years and the national average of 79 years. The female life expectancy for the area is 83 years compared with the CCG averages of 82 years and the national average of 83 years.

There are four GPs, one is the lead GP whilst the remaining three are sessional Locum GPs and two practice nurses. Patients are able to see both male and female GPs. They are supported by a practice manager and administration staff.

The practice is located on one floor containing reception, waiting areas, consulting rooms, disabled toilet facilities, treatment rooms a training room and administration offices. There is step free access into the building and access for those in wheelchairs or with pushchairs.

The practice is open between 8am and 6.30pm Monday to Friday, the practice offers extended hours on Thursday until 7.45pm. GP appointments are available between 9.30am until 12.00pm and 4.30pm until 6.30pm. During extended hours appointments are available until 7.45pm. The practice is involved in the Cannock Network Project. A group of ten local GPs offer patients the service to book an on the day appointment through their own practice with a GP or nurse between 3.30pm and 8pm at the Network practice if appointments were not available at their own practice. Patients could also pre-book appointments on Saturday mornings between 9am and 12 noon.

The practice employs the use of the Staffordshire Doctors Urgent Care  to provide its out-of-hours service to patients. For example, if patients call the practice when it is closed, an answerphone message gives the telephone number they should ring depending on the circumstances.

Updated 28 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Chandra’s surgery on 18 January 2017. Overall the practice is rated as requires improvement.

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

• There was not always an effective system in place for the management of significant events.
• 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.
• 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 could make an appointment in advance 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, however emergency equipment was not easily accessible.
• The practice was registered incorrectly. We have asked the practice to update this so that they are complying with the registration regulations.
• There was a clear leadership structure and staff felt supported by management, although the practice did not have clear visions and values embedded.
• The practice did not act upon patient feedback provided in the GP patient survey.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Review and consider processes to ensure the proper management of emergency equipment.

• Improve the system for the management of significant events in relation to the identification of risks to patients.

• Review and consider GP patient survey results and ensure these are acted upon to make improvements to services for patients.

The areas where the provider should make improvement are:

• Review and consider the practice’s visions and values and ensure all staff are aware of these.

• Continue to encourage patients to attend bowel cancer screening programmes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 April 2017

The practice is rated as Requires Improvement for the care of people with long-term conditions. This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group. There were, however, examples of good practice.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was higher than national averages. For example: The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less (01/04/2015 to 31/03/2016) was 85% compared to the Clinical Commissioning Group (CCG) average of 82% and the national average of 78%.

• Longer appointments and home visits were available when needed.

• All these patients had a named (usual) GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 28 April 2017

The practice is rated as Requires Improvement for the care of families, children and young people. This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group. There were, however, examples of good practice.

• 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 accident and emergency (A&E) 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.

• 81% of female patients aged 25-64 attended cervical screening within the target period compared with the national average of 81%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• There was evidence of joint working with midwives, health visitors and school nurses.

Updated 28 April 2017

The practice is rated as Requires Improvement for the care of older people. This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group. There were, however, examples of good practice.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

• The practice kept up to date registers of patient’s health conditions and data reported nationally was that outcomes were comparable to that of other practices for conditions commonly found in older people.

The practice provided regular ward rounds at a number of nearby nursing and residential care homes.

Updated 28 April 2017

The practice is rated as Requires Improvement for the care of working-age people (including those recently retired and students). This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group. There were, however, examples of good practice.

• The needs of the working age population, those recently retired and students had been identified and the practice, however services had not been adjusted 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.

Updated 28 April 2017

The practice is rated as Requires Improvement for the care of people experiencing poor mental health (including people with dementia). This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group. There were, however, examples of good practice.

• The practice had reviewed the care for 91% clinical commissioning group of its patients diagnosed with dementia in a face to face meeting in the preceding 12 months, which was higher than the clinical commissioning group (CCG) average of 83% and the national average of 84%.

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

• The practice carried out advance care planning for patients with dementia.

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

• 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 28 April 2017

The practice is rated as Requires Improvement for the care of people whose circumstances may make them vulnerable. This is because the provider was rated as requires improvement overall. The concerns which led to those ratings apply to everyone using the practice, including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people who were encouraged to register using the practice as a home address 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.

• 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.