Archived: Dr P Oza and Dr R Nam Also known as The Health Care Complex

Updated 21 June 2016

Dr P Oza and Dr R Nam provide primary medical services to approximately 4100 patients through a personal medical services (PMS) contract.

The practice is situated in a former mining community. The practice population live in one of the more deprived areas of the country and the number of children affected by income deprivation is higher than the national average.

The practice team comprises of two GP partners providing 20 clinical sessions per week. They are supported by a full time practice nurse and a part time healthcare assistant. The practice employs a part time practice manager and five reception staff.

The practice opens from 8.30am to 6pm Monday to Friday with telephone lines open from 8am. From 6pm to 6.30pm telephone lines are covered by NHS 111. Appointments with a doctor are available from 8.30am to 11.30am every morning and from 3.40pm to 5.40pm every afternoon. Extended hours surgeries were offered one evening per month and one Saturday per month in conjunction with other local practices.

The practice has opted out of providing out-of-hours services to its own patients. This service is provided by Central Nottinghamshire Clinical Services (CNCS) when the practice is closed.

A comprehensive inspection of this service was carried out in July 2015. The provider was found to be in breach of Regulation 12, Regulation 17 and Regulation 19 of the Health and Social Care Act 2008. This was due to identified concerns in the following areas; a lack of systems and processes to identify, assess and mitigate risks to patient and staff safety; a lack of effective recruitment procedures; absence of equipment to deal with certain emergencies and no assessment of the risk this presented; no effective systems to ensure medical consumables were used within expiry dates and a lack of effective systems to assess and prevent the risk of infections. Following this inspection the provider was issued with requirement notices and a warning notice.

Further inspections were undertaken in October and December 2015 to confirm that the provider had complied with warning notices.

Updated 21 June 2016

Letter from the Chief Inspector of General Practice

A comprehensive inspection of this service was carried out in July 2015. The provider was found to be in breach of Regulation 12, Regulation 17 and Regulation 19 of the Health and Social Care Act 2008. This was due to identified concerns in the following areas; a lack of systems and processes to identify, assess and mitigate risks to patient and staff safety; a lack of effective recruitment procedures; absence of equipment to deal with certain emergencies and no assessment of the risk this presented; no effective systems to ensure medical consumables were used within expiry dates and a lack of effective systems to assess and prevent the risk of infections. Following this inspection the provider was issued with requirement notices and a warning notice.

Further inspections were undertaken in October and December 2015 to confirm that the provider had complied with warning notices.

We carried out an announced comprehensive inspection at Dr P Oza and Dr R Nam on 24 March 2016. Overall the practice is rated as good.

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

• There were effective systems in place to report and record significant events. The practice demonstrated an open and transparent approach to safety.
• Risks to patients were assessed and well managed throughout the practice.
• Staff assessed the needs of patients and delivered care in line with current evidence based guidelines. Staff had received training to provide them with the skills, knowledge and experience to deliver care and treatment effectively.
• The practice had an understanding of their performance and had undertaken clinical audits to identify areas for improvement.
• Feedback from comments cards and from patients we spoke with demonstrated that they felt 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 as a result of complaints and concerns.
• Most patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

However, there were areas where the provider should make improvements. These are:

• The practice should continue to review, assess and monitor their management of patients experiencing poor mental health (including patients with dementia)
• The practice should consider formalising arrangements for nursing cover in the event of unexpected absence to ensure patients needing regular treatment are able to access care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 June 2016

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

• Clinical 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 87.3% which was 5.7% above the CCG average and 1.9% below the national average. The exception reporting rate for diabetes indicators was marginally below local and national averages.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met.
• For patients with the most complex needs, their named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Monthly multidisciplinary meetings were hosted by the practice.

Updated 21 June 2016

The practice is rated as good 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 A&E attendances. The GP lead for safeguarding liaised with other health and care professionals to discuss children at risk.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The community midwife attended the practice on a weekly basis to offer antenatal care for pregnant women.

Updated 21 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 practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• 70% of patients over 65 had received a flu vaccination compared which was marginally above the CCG average of 69%.
• The practice maintained a falls risk register.

Updated 21 June 2016

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

• 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.
• Extended hours services were offered in conjunction with other practices in the area to facilitate access for these patients.
• 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.
• NHS health checks were offered by the practice and data showed that the practice had exceeded their targets set by the CCG in respect of the number of offers made and checks completed.

Updated 21 June 2016

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national and local averages. However, this was achieved with a higher than average exception reporting rate.
• 73.9% of patients with a mental health condition had a comprehensive care plan in place in the last 12 months which was 11.1% below the CCG average and 14.4% below the national average.
• Areas for improvement had been identified in respect of mental health and the practice had undertaken a clinical audit. As a result of the audit recommendations had been made and the practice planned to repeat the audit in the near future.
• 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 A&E 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 21 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 those with a learning disability and those at risk of a fall.
• The practice offered longer appointments for patients with a learning disability and for those who required it.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. Monthly multidisciplinary meetings were hosted by the practice.
• 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.