Archived: Drs Kumar, Nanu, Croft & Rana Also known as Dr Kumar & Partners

Updated 25 November 2016

The practice shares a health centre with another GP practice. They occupy the ground floor of a three storey building. All consulting and treatment rooms are therefore accessible to patients who have difficulty managing stairs. The practice has undergone, and is still going through, a significant change in the team of GPs. Two GP partners retired in 2015 and 2016 and one is in the process of leaving the practice. A new partner joined the practice in 2015 and was in the process of applying to CQC to be registered as a partner.

The main practice is near to the centre of Reading with bus links passing close by.

The practice is in the process of closing their branch surgery in Tilehurst. This is due to close in November 2016. Currently the practice has a registered patient population of approximately 6,800. The practice expectation is that upon the closure of the branch surgery the registered population will fall to around 4,600. This is because some patients currently registered, who live in the Tilehurst area, will register with other practices closer to their home.

The age profile of the practice is predominantly younger than the average for practice in England. There are more patients aged between 0 and 9 and 25 to 39 years old than average. There are fewer patients between 40 and 69 years of age. Income deprivation is an issue amongst the population. National statistics show the practice in the sixth rank in a 10 point scale of deprivation. There is an ethnic mix amongst the registered population with over 10% from backgrounds other than white British.

The practice is staffed by the two part time GP partners (both male) and a team of four regular locum GPs. They make up the equivalent of 3.2 whole time GPs. Three GPs are male and three are female. There is an outgoing GP partner who was not working at the time of our inspection. An experienced GP from the practice that shares the health centre is joining the team of partners on a part time basis. Their appointment is imminent. There are two practice nurses and two health care assistants. Day to day management and administration is undertaken by a Deputy Practice Manager and a team of nine reception and administration staff. The practice manager left the practice one month before the inspection and the practice is in the process of reorganising their management functions. Discussions with the other practice that occupies the health centre to share management and other support resources are at an advanced stage.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am every morning and 3pm to 6pm daily. Extended hours appointments are offered on a Friday morning from 7am and up to 7.30pm on a Monday evening. A Saturday morning clinic is held every week between 9am and 12pm. The practice provides services via a Personal Medical Services (PMS) contract. (A PMS contract is a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract. The practice has opted out of providing out of hours services to their patients. Out of hours services are provided by Westcall. The out of hours service is accessed by calling 111. There are arrangements in place for services to be provided when the surgery is closed and these are displayed at the practice and in the practice information leaflet.

Currently service are provided from;

Milman Road Health Centre, Milman Road, Reading, Berkshire, RG2 0AR and

Tilehurst Medical Centre, 5-7 Norcot Road, Tilehurst, Reading, RG30 6BP (Due to close as a branch surgery in November 2016)

We did not visit the branch surgery during our inspection due to the pending closure of services at that site.

A number of registration changes are required of the practice to ensure they remain legally registered in accordance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The partner who joined in 2015 must be registered as a partner. The outgoing partner is required to cancel their registration as both a partner and registered manager for the service. The incoming partner will be required to submit an application to be added as a partner and apply to become the registered manager.

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Kumar, Nanu Croft and Rana on 6 October 2016. Overall the practice is rated as requires improvement.

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

• The main practice had recently undergone extensive refurbishment to improve facilities in treatment and consulting rooms for patients.
• Services were to be concentrated in the main practice with the branch practice due to close in November 2016. GP and nursing resources could then be focussed upon meeting the care needs of the registered population.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Most risks to patients were assessed and managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Information about how to complain was available. 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 GP and there was continuity of care, with urgent appointments available the same day.
• The provider was aware of and complied with the requirements of the duty of candour.
• Information about services was available but not everybody would be able to understand or access it. For example, there were no information leaflets available in south Asian languages despite there being a large number of patients from south Asia on the practice list.
• The practice did not demonstrate that audit was driving improvement in clinical outcomes. There was no audit strategy in place to meet the needs of the registered population.
• Feedback from patients for some aspects of care was below national average.
• There was a leadership structure and staff felt supported by management. However, leadership capacity was limited at the time of inspection by having two part time GP partners in post and reliance upon locum GP cover.

The areas where the provider must make improvements are:

• Ensure the results and actions arising from clinical audit drive improvement in delivery of care and outcomes for patients. Ensure all relevant actions taken in response to national safety alerts are recorded as completed.

• Ensure the needs of the local population are fully identified and understood to plan delivery of services that are responsive to their needs. For example, in provision of information in appropriate languages and formats and reviewing whether accepting relatives as translators for patients who have difficulty communicating in English is appropriate. Also in the provision of accessible services for patients with both hearing and physical disabilities.

In addition the provider should:

• Review the practice processes to encourage more patients to attend national cancer screening programmes.
• Ensure a system is in place to provide annual health checks for patients diagnosed with a learning disability.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 November 2016

The practice is rated as requires improvement for provision of effective and responsive services. These ratings apply to all population groups.

• The care provided for this patient group was not driven by improvements identified from clinical audit.

There were some examples of good practice including:

• GPs were supported by nursing staff in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The percentage of patients diagnosed with diabetes who received a foot examination was 93% which was better than the CCG and national average of 88%.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met.
• 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. However, meetings with other health professionals were not always recorded.
• The practice care coordinator contacted patients with long term conditions who had been discharged from hospital. This enabled appropriate arrangements to be made for their follow up care and support.

Updated 25 November 2016

The practice is rated as requires improvement for provision of effective and responsive services. These ratings apply to all population groups.

• The cervical screening rate was 70% in the last three years. This was below the national average of 72% but better than the CCG average of 69%.
• One member of staff was unaware of the legal framework for accepting consent to treatment from patients under 16 years of age.

We saw some examples of good practice including:

• 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• One of the partners specialised in medicine for young patients and children. This meant that fewer patients in this group were referred to hospital for their care and treatment.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors. 

Updated 25 November 2016

The practice is rated as requires improvement for provision of effective and responsive services. These ratings apply to all population groups.

• Clinical audit was not driving improvement in patient care.

There were examples of good practice including:

• The care of older patients who were at risk of admission to hospital was kept under review and care planning was undertaken.
• There was a care coordinator who contacted older patients who had been discharged from hospital to ensure they received appropriate care and support.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

Updated 25 November 2016

The practice is rated as requires improvement for provision of effective and responsive services. These ratings apply to all population groups.

• Extended hours appointments were offered on two occasions on weekdays and every Saturday morning. This benefitted working patients who found it difficult to attend appointments during the working day.

• The needs of the working age population, those recently retired and students had been identified and the practice was in the process of adjusting the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, recruitment of an additional partner and a salaried GP was underway. These appointments would reduce the reliance on locum GP cover.
• The practice was proactive in offering online services as well as a full range of health promotion opportunities for this age group.

However,

• Take up of both bowel and breast cancer screening programmes was below national average.

Updated 25 November 2016

The practice is rated as requires improvement for provision of effective and responsive services. These ratings apply to all population groups.

However, we saw some examples of good practice including:

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was better than the CCG and national average of 84%.
• 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. Early screening for signs of dementia was promoted.
• 88% of patients diagnosed with long term mental health problems had an agreed care plan in place. This matched the national average of 89% but was below the CCG average of 90%. However, the practice exception rate from this indicator was 8% which was better than the CCG average of 10% and national average of 13%. Therefore, more patients were included in this target than local and national average.
• 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 accident and emergency where 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 25 November 2016

The practice is rated as requires improvement for provision of effective and responsive services. These ratings apply to all population groups.

• The practice held a register of patients diagnosed with a learning disability. Whilst these patients were identified the practice had undertaken only one annual health check in 20. This meant the remaining patients in this group were at higher risk of health problems going undiagnosed and left untreated.

We saw some examples of good practice including:

• The practice held a register of patients living in vulnerable circumstances including homeless people and travellers. People living in a local hostel for the homeless were able to register at the practice.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.