Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kaushikkumar Karia on 28 July 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.

• 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.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below average compared to the national average particularly those for diabetes and hypertension.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However, patient satisfaction with nurse consultations was below average.
• Information about services and how to complain was available and easy to understand. However, the procedure was not displayed inside the practice to empower patients to make a complaint if they so wished. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they could make an appointment with a named GP within a reasonable time and there was continuity of care, with urgent appointments available the same day.
• The practice had adequate facilities and was 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.

The areas where the provider should make improvement are:

• Advertise the complaints procedure in the patient waiting room.
• Consider ways of supporting patients with hearing difficulties.
• Carry out appraisals for non-clinical staff.
• Encourage more patients to attend national programmes for bowel and breast cancer screening.
• Improve outcomes for patients with long-term conditions particularly diabetes and hypertension as evidenced by poor QOF achievement.
• Improve on the identification of patients with Chronic Obstructive Pulmonary Disorder (COPD).
• Consider ways to improve patient satisfaction with nurse consultations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating August 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced inspection at Dr Kaushikkumar Karia as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

Patient on-line Registration Success. The practice increased online registrations from 2.4% in June 2016 to 23.1% in April 2017 which was significantly above the NHS England target of 10%. The practice was contacted by NHSE as they were looking to use the practice as a case study seeking permission to showcase the practice achievement and how they managed the success. In addition, since April 2017 online registration had increased further to 45% and we saw evidence that patients had made increasing use of the online service to order repeat prescriptions, access their care records and better manage their health.

The areas where the provider should make improvements are:

• Continue to improve Quality and Outcomes Framework (QOF) performance particularly in relation to diabetes and hypertension indicators.
• Continue to improve cervical screening and childhood immunisation uptake to bring in line with national targets.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.