Archived: Dr Jyotsna Patel Also known as Chamberlayne Road Surgery

Updated 1 July 2016

Dr Jyotsna Patel provides NHS primary medical services to around 2500 patients in the Kensal Rise area of London through a 'general medical services' contract. The service is run from one surgery.

The current practice clinical team comprises a principal GP (female), a locum GP (male), a part-time locum practice nurse, two health care assistants and a phlebotomist. The practice also employs a practice manager and receptionists and administrators.

The practice is open from 9.00am until 1.00pm every weekday although telephone lines are only open between 9.00am and 11.00am. Afternoon opening times vary, with the practice open from 4.00pm until 6.30pm on Monday, Wednesday and Friday and from 4.00pm until 8.00pm on Tuesday. The practice is closed on Thursday afternoon.

Appointments can be made between 9.00am and 11.00am in the morning and between 4.00pm and 6.00pm on Monday, Wednesday and Friday and between 5.00pm and 8.00pm on Tuesday.

The practice offers online appointment booking and an electronic prescription service. The GPs make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, the website and on a recorded telephone message.

The practice has a high proportion of adults under 45 and relatively few children and patients aged over 65. The practice population is ethnically diverse with significant number of patients originating for example, from Indian, Caribbean and Eastern European backgrounds. Practice staff can speak a range of languages.

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

Updated 1 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chamberlayne Road Surgery on 12 February 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 an effective system in place for reporting and recording significant events. The provider was aware of and complied with the requirements of the duty of candour.
• Risks to patients were assessed and well managed.
• 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. Staff had been trained and their competencies assessed to carry out their roles.
• 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 found it easy to make an appointment with a named GP and urgent appointments were available the same day.
• The practice was well equipped to treat patients and meet their needs and was accessible to patients with disabilities.
• 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.

We saw one area of outstanding practice:

• The practice ensured that low-risk patients were able to get a repeat prescription for the contraceptive pill without delay. The practice had designed a short self-complete risk assessment for women who required a repeat prescription. Women were asked to take their own blood pressure (a blood pressure machine was available in the practice) and include the results with their completed form. This ensured that women at low-risk of complications were not delayed by having to wait for an appointment with a doctor to receive a repeat prescription, increasing the risk of unplanned pregnancy. 

The areas where the provider should make improvement are:

• The practice should recruit or hire a nurse to provide more practice nurse sessions. This would make better use of the clinical team's skills and resources.
• The practice should monitor patients' telephone access to the service and appointment booking system. We noted that patient feedback about telephone access was positive, but the telephone line was typically only operational for 4.5 hours a day. Patients ringing outside of these hours, even when the practice was open, were directed to attend local urgent care centres, the NHS '111' service or the practice deputising service if they were experiencing an urgent problem. 

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 1 July 2016

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

• The practice maintained registers of patients with particular long-term conditions.
• Practice performance for diabetes related indicators tended to be better than the national average. For example, the percentage of diabetic patients whose blood sugar levels were well controlled (that is, their most recent HbA1c measurement was 64 mmol/mol or below) was 79% compared to the national average of 78%. The percentage of diabetic patients whose last blood pressure reading was in the normal range was 91% compared to the national average of 78%. Ninety-six per cent of the practice’s diabetic patients had a recorded foot examination within the last year which was higher than the national average of 88%.
• Patients with a long-term condition had a named GP and a structured annual review to check their health and medicines needs were being met. Longer appointments and home visits were available when needed.

• 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. The practice participated in the Brent Integrated Care initiative and coordinated care with other community and social services teams and professionals as appropriate.

Updated 1 July 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.
• Immunisation rates were high for all standard childhood immunisations. Children were invited proactively for immunisations by text messages to parents. Non-attenders were followed up.
• Children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with health visitors, for example to follow up children who had not attended for immunisation. Staff had contact details for the local midwives and school nurses.

• The practice provided antenatal care and a weekly baby clinic.
• The practice provided contraception services and chlamydia screening for patients aged 16-25. 

Updated 1 July 2016

The practice is rated good for the care of older people.

• Around 3% of practice patients were aged 75 years or over. The practice was responsive to the needs of older patients and offered home visits to older patients unable to travel to the surgery.
• The practice had regular communication and coordination with other providers of care for older patients with complex needs including regular contact with the community nurses and, for patients coming to the end of life, the palliative care nurse.
• The practice sent older patients an advance reminder of their appointments.
• Older patients were offered annual health checks covering health promotion, dietary advice and exercises appropriate for this age group. Older patients were assessed for falls and referred for occupational therapy if appropriate.
• Older patients were signposted to other sources of advice and support for example, local befriending services and day centres.
• The practice offered the flu, shingles and pneumococcal vaccines to eligible older patients.

• All emergency admission discharges were followed up to avoid readmission with referral to the local rapid response service when appropriate.

Updated 1 July 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.
• The practice offered evening opening hours one day a week. Pre-bookable and emergency appointments were available and face to face or telephone consultations.
• There was an online appointment booking and cancellation facility and electronic prescription service. Online services were becoming increasingly popular with patients.
• The practice offered a range of health promotion and screening services reflecting the needs for this age group. For example the practice had participated in the meningitis C vaccination programme targeting students.
• The practice provided contraceptive services. The practice encouraged younger patients who were sexually active to be tested for chlamydia.
• The practice’s coverage for the cervical screening programme was 83%, which was comparable to the national average of 82%.
• Patients presenting with work-related stress were supported and could be referred to the local Improving Access to Psychological Therapies service (IAPT) or the online 'Big white wall' service as appropriate.

Updated 1 July 2016

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

• The practice had a small numbers of patients over 75 and very few patients with a diagnosis of dementia. All had attended a face to face review of their care in the last year including a review of their medicines. The practice had a case finding approach to dementia and screened patients at risk, for example, following a stroke.
• The practice proactively reminded patients with dementia of their appointments.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice advised patients experiencing poor mental health how to access various support groups and voluntary organisations and referred patients experiencing stress and less severe mental health problems to the local IAPT programme and the online 'Big White Wall' service.
• 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. Patient feedback we received confirmed that the practice was quick to recognise and provide support for patients experiencing crisis.

Updated 1 July 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 people with a learning disability, patients at risk of a fall, and carers.
• The practice offered longer appointments for patients who needed this for example patients with a learning disability. The practice routinely booked interpreters for patients who did not speak English well.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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. The practice added alerts to the patient electronic record system identifying patients at risk.
• The practice staff told us that as a small practice they knew many of their patients well. They provided examples where they had alerted the GP to concerns when a patient known to them seemed to be in distress, behaving out of character or experiencing other difficulties.
• The practice invited patients with a learning disability for an annual health check and liaised with  the community learning disability nurse and dementia nurse. Care plans we reviewed included evidence that patients and carers were involved.
• The practice kept a register of patients who were carers and signposted them to additional sources of support. The practice had identified 3% of the practice population as carers.