Archived: Dr V Chawla's practice

Updated 3 January 2017

Dr V Chawla’s Practice is also known as Wingerworth Surgery. The practice  is managed by a partnership of two GPs, and provides primary medical services to approximately 4500 patients, through a personal medical services (PMS) contract.

The main practice is in Wingerworth in Derbyshire, with a branch surgery in North Wingfield. The level of deprivation within the practice area is below the national average.

The clinical team includes two GP partners (one male, one female), three salaried GPs (two male, one female), a practice nurse and a healthcare assistant. The clinical staff are supported by a practice manager and a team of reception and administrative staff.

The practice is open from 8am to 7pm Monday to Friday. The morning appointment times for GPs, include a sit and wait service which guarantees every patient who attends the practice is seen. This runs between 8.30am to 10.30am. Afternoon appointments vary to ensure adequate access throughout the week. The practice provides extended hours on a Monday evening until 8pm.

The practice has opted out of providing out-of-hours services to its patients. This service is provided by Derbyshire Health United. When the practice is closed, calls redirect to the out-of-hours service. 

Updated 3 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr V Chawla's practice on 30 March 2016. During that inspection we found that the practice had not followed effective recruitment procedures, in regards to obtaining a Disclosure and Barring Service (DBS) check for two clinical members of staff prior to them working at the surgery. 

Overall the practice was rated as good with are services safe requiring improvement in view of the above.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr V Chawla's practice on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice told us what action they had taken to meet the legal requirement in relation to the breach.

We undertook a desk based review on 28 November 2016 to check that the provider had completed the required action. We did not visit the practice as part of this inspection. This report covers our findings in relation to the requirement.

This inspection found that the provider had taken appropriate action to meet the legal requirement.

• Effective recruitment procedures were followed. Required checks were obtained prior to new staff working at the practice, to ensure they were suitable to carry out their work. 
• We received assurances that a DBS check was obtained for relevant clinical staff immediately following the comprehensive inspection.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 July 2016

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

• The practice was in line with results for the care of patients with long-term conditions. For example:
  • The percentage of patients with a lung disease who had a review undertaken in the preceding 12 months was 95% compared to a national average of 90%.
• The practice had invested in 24 hour blood pressure monitors and equipment to diagnose lung disease in the practice reducing the need to refer patients to hospital.
• Longer appointments and home visits were available when needed.
• The practice had worked with the clinical commissioning group (CCG) to develop pathways to provide prompt home visits by the out of hours provider to patients at risk of deteriorating due to their long term condition.

Updated 26 July 2016

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

• The practice had achieved 100% childhood immunisations in 2013 and continued to work with families and health visiting teams to maintain a high level of immunisation.
• Immunisation rates, for 2015, were above the CCG average for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to two year olds ranged between 98% and 100%, compared to a CCG range of between 96% and 98%
• 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. Urgent appointments were always available on the day, and nursing appointments were available one evening a week until 6.30pm.

Updated 26 July 2016

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

• We were given many examples of situations where the GPs had gone the extra mile for patients, often in their own time, to ensure there was adequate care in place for patients at short notice. For example; they had proactively organised equipment at a patients house when they met them in the local shop and realised they required further assistance to maintain mobility. We were given many examples of situations where the GPs had gone the extra mile for patients, often in their own time, to ensure there was adequate care in place for patients at short notice. For example; GPs remained in the practice outside normal hours to make sure a patient was seen on a Friday evening rather than travel to the local hospital, often with a follow up over the weekend to ensure enough had been done to prevent admission.
• The practice offered proactive, personalised care to meet the needs of older people in its population.
• Staff were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• They worked effectively with multi-disciplinary teams to identify patients at risk of admission to hospital and to ensure their needs were met.
• Fortnightly meetings were held between the practice, district nursing team, physiotherapists, social services and community matron to ensure a full multi-disciplinary approach to patient care.
• Additional care and support was managed, in conjunction with the GPs and nursing staff, by the care coordinator. This enabled regular support and care to be monitored and care plans quickly revised when patients’ conditions deteriorated.
• One GP session a week was dedicated to visiting a local care home providing routine appointments and health review.

Updated 26 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 and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. This included access to telephone appointments, and the availability of extended hours appointments.
• The practice offered online services such as electronic prescriptions, and GP appointments were offered through the online booking system.
• Health promotion and screening was provided that reflected the needs for this age group. The practice was consistently at the top of the CCG for health checks. For example, the practice had screened 70% of patients aged between 60-69 for bowel cancer, which was above the CCG average of 60%. The practice’s uptake for the cervical screening programme was 90% which was significantly higher than the national average of 81%.

Updated 26 July 2016

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

• Performance for dementia related indicators was 100% which was 8% above the CCG average and 6% above the national average. This was attained with an exception rate of 0%, 8% below the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• A text message service was used to remind patients that their medicines were due; this had positive effects for patients who previously did not take all their medicines due to the nature of their illness or disability.
• Reception called patients with a diagnosis of dementia to remind them of their appointment in the morning, if they had previously missed an appointment.
• The care co-ordinator was also a dementia friends champion and had done a presentation about dementia to staff and PPG members to increase awareness and increase the number of ‘dementia friends’ associated with the practice.
• Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 26 July 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• Patients told us that additional time had been allocated during appointments when difficult decisions had to be made or complex care plans developed. This was often in addition to telephone conversations to make sure there was appropriate understanding and suitable care in place for patients.
• Practice staff were trained to recognise domestic violence and understood how to go about initiating the conversation leading to support for those patients who may be victims.
• The practice offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments. Health checks were offered to patients with a learning disability and 81% of patients had been reviewed in the past year.
• The practice and safeguarding lead regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice had access to a four wheel drive car to provide home visits during severe weather conditions, ensuring continuity of care.
• 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 proactively identified carers and 140 carers were on their register which equated to 3% of the patient list.