Archived: Dr V Agarwal's Practice Also known as The Mound Medical Centre

Updated 10 January 2017

Dr V Agarwal’s Practice (The Mound Surgery) is based in a single storey premises converted for the sole use as a surgery. The provider has been based in the property since 1990. It is one of a number of commercial units forming part of a residential housing estate owned by the local authority in the Royal Borough of Greenwich. It is located within a predominantly residential area of Eltham. The property includes two consulting rooms, one treatment room, an administration office, a reception area and a large waiting room. Greenwich Clinical Commissioning Group (CCG) are responsible for commissioning health services for the locality.

The practice is registered with the CQC as a Partnership. Services are delivered under a Personal Medical Services (PMS) contract. The practice is registered with the CQC to provide the regulated activities of family planning; maternity and midwifery services; treatment of disease, disorder and injury, surgical procedures and diagnostic and screening procedures.

The practice has 1644 registered patients with an age distribution similar to the national average. The surgery is based in an area with a deprivation score of 4 (with 1 being the most deprived and 10 being the least deprived).

GP services are provided by two GP partners (male and female) and a regular locum GP providing a total of nine GP sessions per week. The practice also employs a Practice Nurse providing 11.5 hours per week.

Administrative services are provided by six part-time members of staff including a Medical Secretary, Senior Receptionist and 4 receptionists/data clerks (2.7 wte).

The surgery reception is open from 8am to 7.30pm on Monday and from 8am and 6.30pm Tuesday to Friday. The surgery is closed at weekends.

Pre-booked and urgent appointments are available with a GP from 9.30am to 11.30am and 4.30pm to 7.30pm on Monday; from 9am to 11am and 4pm to 6pm on Tuesday and Wednesday; from 10am to 12.30pm on Thursday and from 9.30am to 11.30am and 4pm to 6pm on Friday.

Pre-booked appointments are available with the Practice Nurse from 11am to 2.30pm on Monday; from 4pm to 6pm on Wednesday and from 9am to 12.30pm on Thursday and Friday.

When the surgery is closed urgent GP services are available via NHS 111.

The provider has informed NHS England of their decision to close the practice on 31 March 2017. Initial plans were to close by November 2016 but the provider was encouraged to continue until the end of the current year. A Practice Manager had been employed by the practice until recently but they had found alternative employment in preparation for the original November closure date of the practice. In January 2017 NHS England will inform patients of the closure plans. 

Updated 10 January 2017

We carried out an announced comprehensive inspection at Dr V Agarwal’s Practice on 28 October 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.

• Risks to patients were assessed and well managed. However, there was no system in place to ensure results were received for all samples sent for the cervical screening programme or to monitor the inadequate sample rate for specimens sent for testing.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had identified only 14 patients as carers (0.85% of the practice list). Written information was available to direct carers to the support available to them.
• 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 there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

There are areas where the provider should make improvements:

• The provider should record batch numbers of blank electronic prescriptions placed in individual printers.

• The provider should implement a process to ensure that results were received for all samples sent for the cervical screening programme and to monitor the inadequate sample rate of specimens sent for testing.

• The provider should display notices in the waiting area informing patients that interpreting services were available for patients who do not have English as a first language.

• The provider should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to all carers registered with the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 10 January 2017

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

• The GPs worked closely with the practice nurse and community specialist nurses in the management of patients with long-term conditions.
• Patients at risk of hospital admission were identified as a priority.
• The practice performance rate for the Quality and Outcomes Framework (QOF) diabetes related indicators was comparable to the local and national average.
• Longer appointments and home visits were available when needed.
• 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. These patients were discussed at the quarterly multi-disciplinary team meetings where appropriate.

Updated 10 January 2017

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 who were at risk, for example, children and young people who had a high number of Accident and Emergency (A&E) attendances.
• Immunisation rates for all standard childhood immunisations were comparable to local and national averages.
• Patients told us that children and young people were treated in an age-appropriate way and we saw evidence to confirm this.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 10 January 2017

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.
• Quality and Outcomes Framework (QOF) performance indicators for conditions found in older people were comparable to local and national averages.
• The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.

Updated 10 January 2017

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 appointments were available at the surgery one evening a week.
• The practice was proactive in offering online services.

• A full range of health promotion and screening services were provided that reflected the needs for this age group.
• The percentage of women aged 25 to 64 years who had received a cervical screening test in the preceding five years was comparable to the local and national averages. However there was no failsafe system in place to ensure results were received for all samples sent for the cervical screening programme or to monitor the inadequate sample rate for specimens sent for testing.

Updated 10 January 2017

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 preceding 12 months. This was above the local average of 86% and national average of 84%.
• 91% of patients diagnosed with a mental health disorder had a comprehensive agreed care plan documented in the preceding 12 months. This was comparable to the local average of 83% and national average of 89%.
• 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 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 10 January 2017

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.
• The practice offered longer appointments and annual reviews 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 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.