Archived: Dr De & Dr A Ghosh Brace Street Health Centre Also known as Dr S De & Dr A Ghosh

Updated 31 March 2015

The practice provides General Medical Services to a population of approximately 3000 patients. It is located in a health centre which is shared with another GP practice and community based health services. The practice is situated in an area with high levels of deprivation and is in the most deprived areas nationally. The population is younger than the national average.

The practice is open Monday to Friday 9am to 6.30pm, with the exception of Wednesday afternoon. Extended opening hours are available on two evenings, Monday and Thursday, until 7.10pm. The practice has opted out of providing out-of-hours primary medical services to another provider.

Dr De is a female GP and Dr Ghosh a male GP. A practice nurse is also employed full time along with several administrative staff.

Updated 31 March 2015

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Dr De and Dr A Ghosh Brace Street Health Centre Practice on 20 October 2014. The practice is partnership of two GPs providing primary medical services for a population of approximately 3000 patients. The practice serves a diverse population in one of the most deprived areas in the country.

We found that the practice was responsive but needed to improve to deliver a safe, effective, caring and well-led service. We rated the practice overall as requires improvement.

Our key findings were as follows:

• Systems in place were not robust to ensure patients received a safe service. Potential risks to performance and patient safety (including those relating to health and safety, infection control, safe staffing, equipment and medicines) were not well managed.
• The practice did not have effective processes in place to drive service improvements and performance for patient outcomes.
• Feedback from patients about the service were mixed in their experiences of care and treatment received. Although most patients spoke positively of the service there was some scope for improvement. There had been efforts by the practice to improve the customer services aspect of care and maintain privacy which had been noticed by some patients.
• The practice was responsive to the needs of its patients. Patients expressed satisfaction with the appointment system. They were able to make an appointment easily and if needed could get urgent appointments the same day. The practice was accessible to patients with mobility difficulties.
• The practice did not demonstrate clear leadership and direction. The governance arrangements were not clearly defined so as to effectively manage risks and performance.

However, there were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure staff undertaking chaperoning duties have a clear understanding of their role and duties in order to appropriately support the patient during examination.
• Ensure that effective governance arrangements are in place for monitoring and managing potential risks to patients’ safety and performance relating to patient outcomes. This would include the issues relating to health and safety, staff recruitment and staffing levels, maintenance of equipment and medicines.

In addition the provider should:

• Strengthen the processes for managing information relating to patient safety and care. For example incidents, safety alerts, national guidance, audits complaints and comments and performance data to ensure that action needed is clearly identified and carried out to deliver improved patient outcomes.
• Introduce formal arrangements to ensure the needs of patients with complex and end of life care are discussed with relevant health and care professionals and co-ordinated care is delivered. This should include sharing information where appropriate with other providers such as the out of hours services to ensure patients receive continuity of care.
• Ensure staff understand their responsibilities under the Mental Capacity Act 2005 and their duties in fulfilling it.
• Establish systems to support patients who have recently suffered bereavement.
• Improve systems to support people who may be more vulnerable to access primary medical services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 31 March 2015

The practice is rated as requires improvement for the population group of people with long term conditions.

Patients with long term conditions were reviewed by the GPs and the practice nurses to assess and monitor their health condition. This enabled any changes in the patient’s condition to be managed as appropriate. Patients were invited to attend by telephone contact or opportunistically. Home visits were available if patients were unable to attend the surgery and urgent requests for appointments were triaged so that if the patient needed an appointment they would be seen. There had been two incidents in the last 12 months involving prescriptions not being available when needed but these had been addressed through training and staff demonstrated a good awareness of managing repeat prescriptions. The practice pharmacist undertook medicine reviews of more complex patients. Links to information on a range of conditions was available on the practice website.

The practice had difficulty providing information as to how it was performing in terms of outcomes for managing patients with long term conditions. The latest Quality Outcomes Framework (QOF) data (a national performance tool for patient outcomes) showed that performance varied according to condition. Diabetes was identified as an area where the practice performed less well. We were told this was a cultural issue and that notices had been put in place to encourage Asian diabetic patients to attend the surgery. The practice did not have multi-disciplinary team meetings or specific care plans in place to discuss and co-ordinate care for those with the most complex care needs.

Updated 31 March 2015

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

The practice had a higher than average proportion of younger patients than the national average. Young children were able to see a GP when they needed to and the practice was accessible to pushchairs. Appointments were available outside school hours on most evenings. Links were available to information on child and teenage health via the practice website.

There were systems in place for identifying children living in disadvantaged circumstances and who were at risk. Alerts on the patient record system enabled staff to identify and be extra vigilant of those who were at risk. All staff had received training in safeguarding children and had support from a lead GP for safeguarding so that appropriate action could be taken if they were concerned a child may be at risk of harm. The midwife and health visitor operated clinics once per week at the practice which enabled informal discussions to take place to share information or concerns.

Immunisation rates were lower than other practices in the Clinical Commissioning Group (CCG). The practice was unable to provide any updated information about immunisations but told us they had carried out additional clinics to follow up patients who had not attended.

Updated 31 March 2015

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

The practice had a lower than average proportion of patients over 75 years than the national average. The practice offered annual health checks for patients over 75 years and testing for dementia. This enabled the onset of health conditions to be detected and managed at the earliest opportunity. Elderly patients were able to see a GP when they needed to and the practice was accessible to patients with mobility difficulties.

The practice did not have any specific systems in place to identify older patients with multi-morbidities and complex health needs. There were no multi-disciplinary team meetings in place to ensure those with complex care needs, including patients at the end of life, were managed in a co-ordinated way.

Updated 31 March 2015

The practice opened extended hours on two evenings each week until 7.10pm to accommodate the needs of working age patients. Patients were able to book non urgent appointments in advance as well as on the day. Telephone consultations were available on request if the patient was unable to attend the practice. The practice had not yet introduced on-line booking for appointments and prescriptions but had plans to do so.

Students who were already registered with another practice were able to register as temporary residents if they needed to receive health care support. There were links to a range of health information relating to men and women on the practice website which patients could review at their convenience.

At the time of the inspection the practice did not offer NHS health checks. There were however plans to offer this service and clinical staff had received training in preparation to undertake these checks. Some screening programmes were offered at the practice but health promotion clinics such as smoking cessation and weight loss were not available.

Updated 31 March 2015

The practice is rated as requires improvement for the population group of people experiencing poor mental health (including people with dementia).

The practice used specific screening tools to identify patients with mental health problems and dementia so that patients could be appropriately referred. We saw evidence of health reviews for patients with poor mental health including reviews of their medicines. The practice had difficulty identifying the percentage of patients experiencing poor mental health who had received an annual physical health check. However, there were links to a range of information on mental health conditions on the practice website including details of various mental health support groups including MIND and SANE.

The practice did not specifically work with multi-disciplinary teams in the case management of patients experiencing poor mental health or have advanced care plans for patients with dementia.

Updated 31 March 2015

The practice is rated as requires improvement for the population group of people whose circumstances make them vulnerable.

The practice held a register for some vulnerable groups such as patients with learning disabilities and could identify patients who were at risk. Staff had received training and had an understanding of how to recognise and what action to take if they were concerned a patient may be at risk of harm.

Annual health checks were available for patients with learning disabilities but only one out of seven had been completed in the last 12 months. Multi-disciplinary team working to support vulnerable patients with complex care needs was limited. The practice required patients to have an address before they could register and were not able to confirm how they would manage a patient with no fixed abode as they had not come across this situation before.