Archived: Dr A Karim's Practice

Updated 29 June 2016

Dr A Karim's Practice, also known as Ladygate Lane Surgery, provides GP led primary care services through a Primary Medical Services (PMS) contract to around 2,100 patients living in the surrounding areas of Ruislip. PMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS Hillingdon Clinical Commissioning Group (CCG).

The practice staff comprise of a GP principal (female); two salaried GPs (male and female); a practice nurse; a practice manager; and a small team of reception/administrative staff. The GPs collectively provide nine clinical sessions per week, and the nurse works 12 hours per week.

The practice is located in a converted residential property with two consulting/treatment rooms on the ground floor, and office space on the first floor. A third consulting room on the ground floor is not currently being used for clinical purposes. The ground floor of the premises is accessible by wheelchair.

The practice is open from 08:30 to 18:30 every weekday except Thursday afternoon when it closes at 13:00. Extended opening hours are available on Monday, Tuesday, and Friday evenings from 18:30 to 19:00. If patients telephone the practice from 08:00 to 08:30 they are directed to an out-of-hours provider, who would contact the GP principal in emergency cases. Appointments can be booked in advance over the telephone, online or in person. The practice opted out of providing out-of-hours services to their patients. Outside of normal opening hours patients are directed to an out-of-hours GP, or the NHS 111 service.

The percentage of patients aged zero to four (4%), aged five to 14 (12%) and under 18 (20%) is similar to national averages (6%, 11% and 21% respectively). Patients aged 65+ represent 15% of the practice population, patients aged 75+ represent 6%, and patients aged 85+ represent 1% (national averages 17%, 8% and 2% respectively).

The percentage of people with a long standing health condition (42%) is below local and national averages (50% and 54% respectively). The average life expectancy for the practice is 81 years for males (CCG average 79, national 79) and 85 years for females (CCG average 84, national 83).

The service is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease, disorder and injury; maternity and midwifery services; and surgical procedures.

Updated 29 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr A Karim's Practice, also known as Ladygate Lane Surgery, on 9 March 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, complaints relating to clinical incidents were not investigated as significant events.
• Most risks to patients were assessed and well managed, with the exception of those relating to prescribing high risk medicines.
• 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.
• Data from the national GP patient survey showed that patient satisfaction with accessing care was mostly below average. Although, patients we spoke to said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day. The practice had taken action to improve access to care and treatment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

• Review the protocols for managing patients on high risk medicines and ensure adequate safety checks are undertaken prior to prescribing these medicines.
• Review exception reporting data and recall procedures to improve the management of patients with long-term conditions.
• Ensure there is a system in place to monitor the use of prescription pads.
• Ensure the practice actively identifies and supports patients who are also carers.
• Review patient feedback, particularly from the national GP patient survey.
• Advertise that translation services are available to patients on request.
• Ensure staff are aware of the vision and strategy for the practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 June 2016

The practice is rated as requires improvement for the care of people with long-term conditions. There were, however, examples of good practice.

• The percentage of patients at the practice with a long standing health condition (42%) was lower than the national average (54%).
• Patients at risk of hospital admission were identified as a priority and discussed at clinical and multidisciplinary team meetings.
• All these patients had a named GP and were invited for structured annual review to check that 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.
• Patients were reviewed following discharge from hospital and referrals to support services were made to prevent readmissions.
• Longer appointments and home visits were available when needed.
• However, adequate checks were not undertaken prior to prescribing patients certain high risk medicines. The practice also had higher than average exception reporting rates for many long-term conditions. This meant that whilst they were identifying patients with long-term conditions, the management of these patients may not have been effective.

Updated 29 June 2016

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

• The percentage of patients aged zero to four (4%), aged five to 14 (12%) and under 18 (20%) was similar to national averages (6%, 11% and 21% respectively).
• 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 were invited for an appointment.
• Urgent access appointments were available for children and pregnant women who were unwell.
• 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 we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered shared antenatal and postnatal services.

Updated 29 June 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.
• The percentage of older patients registered at the practice was similar to national averages. Patients over the age of 75 represented 6% (national average 8%), and patients over the age of 85 represented 1% (national average 2%).
• All patients over the age of 75 had a named GP who was responsible for their care.
• The practice offered a range of enhanced services which included the shingles and flu vaccinations, and avoiding unplanned admissions to hospital.
• The practice was responsive to the needs of older people, and offered longer appointments, home visits and urgent appointments for those with enhanced needs.
• Monthly multidisciplinary team meetings were used to review care plans and discuss those with enhanced needs.
• The practice was part of a local integrated care programme to improve services for vulnerable adults over the age of 65, who required GP care over the weekend.
• Patients were reviewed following discharge from hospital and referrals to support services were made to prevent readmissions. For example, to social services and occupational therapy. Patients were also told how to access support services.

Updated 29 June 2016

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

• The number of patients in paid work or full-time education was the same as the national average (62%).
• 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 had a website and facilities to book appointments and order repeat prescriptions online.
• Telephone consultations were offered for patients who could not attend the practice. Late appointments were available from 18:30 to 19:00 on Monday, Tuesday and Friday evenings. These appointments were prioritised for working patients.
• There was a range of health promotion and screening that reflected the needs for this age group, including NHS health checks for patients aged 40 to 74.
• The practice’s uptake for the cervical screening programme was 73%, which was below the CCG average of 78% and national average of 82%.

Updated 29 June 2016

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

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• Patients could be referred to an in-house counsellor and those with memory problems were screened and referred to a memory clinic for further assessment.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs, including during times of crisis.

Updated 29 June 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 housebound patients, carers, those with a learning disability, and patients receiving end of life care.
• Housebound patients and those who could not access the practice were supported via home visits.
• 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. Patients could also be referred to an in-house counsellor.
• 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.