Archived: Dr.Laliwala and Partners Also known as Parnwell Medical Centre

Updated 7 January 2016

Parnwell Medical Practice provides general medical services to approximately 1800 patients living in Parnwell, Peterborough and the surrounding area. The premises are purpose built and all treatment and consultation rooms are situated at ground level, ensuring level access for people with disabilities. Parking is available.

The practice has a team of four GPs, one female and three male, to meet patients’ needs. Three GPs are partners, with one as lead partner, meaning they hold managerial and financial responsibility for the practice; there is one salaried GP. Three practice nurses were employed.There is a practice manager who is supported by a team of five non-clinical administrative, secretarial and reception staff, who share a range of roles. The practice also hosts other services, for example community midwives run weekly sessions at the practice.

The practice is currently under a care taking contract, as agreed with NHS England, undertaken by the GP partners who also run Ailsworth Medical Practice in Peterborough. This has been in place since 2012 and is due to expire in September 2016.The practice provides a range of clinics and services, most of which are detailed in this report, and operates generally between the hours of 08:30 and 13:00, Monday to Friday. On Wednesday the practice is also open between the hours of 15:00 and 19:15. During times that Parnwell Medical Practice is closed patients can be seen at Ailsworth Medical Practice in Peterborough, approximately six miles away.

At Parnwell Medical Practice pre-bookable appointments could be booked up to two weeks in advance and urgent appointments were available on the day for people that needed them. If later in the day, requests for urgent appointments underwent a telephone triage process to ascertain the most appropriate course of action for the patient.

Outside of these hours, medical care is provided by Cambridgeshire Community Services NHS Trust. Primary medical services are accessed through the NHS 111 service.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parnwell Medical Practice on 7 October 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, responsive and well led services. It also required improvement for providing services for older patients, patients with long term conditions, patients in vulnerable circumstances, families, children and young patients, working age patients and patients experiencing poor mental health. It was good for providing an effective and caring service.

Our key findings were as follows:

• The practice had a good understanding of the needs of the practice population but these could not always be met due to reduced opening times.

• The practice had significant event and complaints procedures but an increased understanding was needed by staff around what constituted a significant event.

• Feedback from patients and observations throughout our inspection showed the staff were kind, caring and helpful. The clinical staff at the practice provided effective consultations, care and treatment in line with recommended guidance.

• New staff received appropriate inductions into their role.

• Although practice leadership was part time, they were visible and staff felt supported by the management and were involved in the vision of providing high quality care and treatment to patients.

• Information about services and how to complain was available and easy to understand.

• Urgent appointments were usually available on the day they were requested.

• The practice had a number of policies and procedures to govern activity.

However there were several areas of practice where the provider needs to make improvements. Importantly the provider should:

• Improve access for patients in line with the practice’s understanding of patients’ needs.

• Improve its understanding around what constitutes a significant event in order that staff can identify, report and investigate these in a consistent way.

• Ensure there are effective systems or processes in place to access, monitor and improve the quality and safety of the services provided. This should include health and safety risk management and regular fire drills.

• Improve the complaints process so that patients’ verbal concerns and complaints are monitored and any actions taken as a result of them are followed up.

• Ensure that clinical audit cycles are completed.

Professor Steve Field

CBE FRCP FFPH FRCGP Chief Inspector of General Practice

Updated 7 January 2016

Although the practice is rated as good for providing effective and caring services, they are rated as requires improvement for safe, responsive and well- led services. The concerns which led to these ratings apply to all population groups including this one.

GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, staff worked with relevant health and care professionals to co-ordinate and deliver a multidisciplinary package of care.

Updated 7 January 2016

Although the practice is rated as good for providing effective and caring services, they are rated as requires improvement for safe, responsive and well- led services. The concerns which led to these ratings apply to all population groups including this one.

There were systems in place to identify and follow up children who were at risk, for example, children and young people on the safeguarding register. Immunisation rates were in line with local averages 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.

Appointments were not always available outside of school hours. The premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors.

Updated 7 January 2016

Although the practice is rated as good for providing effective and caring services, they are rated as requires improvement for safe, responsive and well- led services. The concerns which led to these ratings apply to all population groups including this one.

Nationally reported data showed that outcomes for patients were good for 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 end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 7 January 2016

Although the practice is rated as good for providing effective and caring services, they are rated as requires improvement for safe, responsive and well- led services. The concerns which led to these ratings apply to all population groups including this one.

The needs of the working age population, those recently retired and students had been identified but the practice had not sufficiently adjusted the services it offered to ensure these were flexible and offered continuity of care. Accessibility proved a challenge for working age people as the practice had limited opening hours with only one afternoon and evening until 1930hrs per week. A telephone triage system allowed some flexibility for working patients and appointments could be arranged to suit the patient. The practice also offered online appointment bookings and prescription requests. Health screening and advice was provided and this included health checks for patients aged over 40, smoking cessation and counselling services.

Updated 7 January 2016

Although the practice is rated as good for providing effective and caring services, they are rated as requires improvement for safe, responsive and well- led services. The concerns which led to these ratings apply to all population groups including this one.

Annual physical health checks were offered to patients with long term mental health needs. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. A range of information with patients experiencing poor mental health on how to access support groups and voluntary organisations was available in the practice. Patients could also access counselling or support from advisory services. Patients who required urgent assessment and support were prioritised and seen the same day if required.

Updated 7 January 2016

Although the practice is rated as good for providing effective and caring services, they are rated as requires improvement for safe, responsive and well- led services. The concerns which led to these ratings apply to all population groups including this one.

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. It provided care to a local traveller population and had carried out annual health checks for people with a learning disability. It offered longer appointments for people with a learning disability or others requiring this. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.