Archived: Dr NK Agrawal and Partner

Updated 6 April 2016

Dr NK Agrawal and Partner also known as The Surgery, provides primary medical services to approximately 5500 patients in the local community. The practice is a partnership between two GPs (1 male and 1 female). A new GP is joining the current partnership and this is currently being formalised. The new partner is also a GP provider of another nearby location. Until recently the practice also had two salaried GPs. However, one of the salaried GP had left and regular locums GPs are employed. The practice is located on Clifton lane, Stone Cross, west Bromwich. There is a branch surgery known as Victoria Health Centre, Suffrage Street, Smethwick. We did not visit the branch site during our inspection.

The GPs are supported by two practice nurses one of whom was a long term locum. One nurse worked 30 hours a week and the other nurse worked one day a week. At the time of the inspection the nurse who worked 30 hours a week was on long tern leave and many of their responsibilities were being carried out by the GP partners. The practice also employed a specialist nurse in Chronic Obstructive Pulmonary Disease (COPD) who attended the practice weekly from a local hospital. COPD is the name for a collection of lung diseases, including chronic bronchitis and emphysema.

The non-clinical team consists of a practice manager, a deputy practice manager, a secretary and a team of reception staff.

The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management such as diabetes and end of life care. The practice also provides some directed enhanced services such as minor surgery (joint injections only), childhood vaccination and immunisation schemes. Enhanced services require an enhanced level of service provision above what is normally required under the core GP contract.

The practice opening times are 8.30am to 6.30pm Monday to Fridays except Thursdays when it closed at 3pm. Morning surgery times were from 9am to 11.30am Mondays to Fridays. Afternoon surgery times were from 4pm to 6pm Mondays to Fridays except Thursdays when it was closed.

The branch surgery is open from 9.30am to 6.30pm Mondays to Fridays. Morning appointments are available from 9.30am to 11.30am Mondays to Fridays. In the afternoon, appointments are available form 4.30pm to 6.30pm Mondays to Fridays.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by an external out-of-hours service provider when closed.

We reviewed the most recent data available to us from Public Health England which showed that the practice is located in an area of high deprivation score compared to other practices nationally. Data showed that the practice has a higher than average practice population aged between 0 and 50 years in comparison to other practices nationally. The practice also has a lower than the national average number of patients aged 50 years and over.

Updated 6 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr NK Agrawal and Partner on 26 January 2016. Overall the practice is rated as requires improvement.

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, all significant events were not recorded and shared appropriately.
• Most risks to patients were assessed and well managed. However, we found that the practice did not have a defibrillator so that it could adequately respond to a medical emergency. A risk assessment had not completed to provide a rationale for this.
• 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.
• Most patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had the facilities and had most equipment to treat patients and meet their needs. However, there was no Automatic External Defibrillator (AED) and no risk assessment was in place to determine if one was needed.
• There was a leadership structure and staff felt supported by management. A new GP partner was joining the current partnership and they assuming some leadership responsibilities. However, due to this transition of responsibilities governance processes in respect to recruitment of some staff were not as robust.
• The practice was looking to establish a Patient Participation Group (PPG) so that it could seek feedback from patients.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvement are:

• All Patient Group Directions (PGDs) must be available and appropriately signed.

• Appropriate recruitment checks must be in place before staff begin working at the practice.

• The practice must determine if an Automatic External Defibrillator (AED) is required.

The areas where the provider should make improvement are:

• Ensure method for recording all incidents and significant events is consistent.

• Ensure risk assessments such as control of substances hazardous to health (COSHH) are carried out.

• All risk assessment to protect patients, staff and visitor should be in place and reviewed regularly.

• The practice should ensure staff appraisals are carried out regularly.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 April 2016

The provider was rated as require improvement for safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is rated as require improvement for the care of people with long-term conditions. Data showed that the practice’s achievement for the management of long term conditions was better than local and national average. One of the nurses was away on long term leave and the GP partners had taken on the responsibility to review patients with long term conditions. Longer appointments and home visits were available when needed. Appropriate patients had a named GP lead and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice had purchased the services of a specialist nurse from the local hospital in order to run a weekly COPD clinic. A specialist diabetes nurse along with a consultant from the local hospital held monthly clinics for complex cases.

Updated 6 April 2016

The provider was rated as require improvement for safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is rated as require improvement 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 accident and emergency (A&E) attendances. One of the GP partner was the lead for child safeguarding for the practice and the CCG. All consultation rooms were on the ground floor which made the practice accessible for pushchairs and appointments were available outside of school hours. The GP offered immunisations to children when needed as one of the nurses was on long term leave. The immunisation rates were comparable to local and national averages. The practice had reviewed 85% of patients diagnosed with asthma, in the last 12 months. This was this was 10% above local and 9% above national averages. The practice had stopped offering extended hours appointments. However, appointments were available outside of school hours and the premises were suitable for children and babies. We saw school children had attended the practice for appointments after school on the day of our inspection.

Updated 6 April 2016

The provider was rated as require improvement for safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is rated as require improvement for the care of older people. Nationally reported data showed that outcomes for patients were good for many conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 6 April 2016

The provider was rated as require improvement for safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is rated as require improvement for the care of working-age people (including those recently retired and students). The practice offered online services through its website. The practice also had arrangements for patients to have telephone consultations with a GP. The practice was proactive in offering a full range of health promotion and screening that reflected the needs of this age group. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. This included health checks for patients aged 40 to 70 years of age. The practice referred patients to services promoting healthy living such as weight management.

Updated 6 April 2016

The provider was rated as require improvement for safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is rated as require improvement for the care of people experiencing poor mental health (including people with dementia). Latest data we looked at showed that 88% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was 4% above local and national averages. The data we looked at also showed that 96% of patients with schizophrenia, bipolar affective disorder and other psychoses had had a comprehensive care plan documented in the record, in the preceding 12 months. This was 10% above local and 8% above national averages. The practice had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

Updated 6 April 2016

The provider was rated as require improvement for safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is rated as require improvement for the care of people whose circumstances may make them vulnerable. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Home visits were carried out to patients who were housebound and to other patients on the day that had a need. 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. Regular clinics with a specialist diabetes nurse and a consultant in from a local hospital was held.