Dr Kewal Krishan Also known as Mayfield Medical Practice

Updated 18 May 2016

Dr Kewal Krishan is located in a residential area of Wolverhampton. It is situated in a purpose built single storey building. The practice is located in an area of high deprivation and falls within the 20% most deprived in England. The practice provides medical service to approximately 6,546 patients over two sites. The main practice is based at Mayfield Medical Practice at 272 Willenhall Road, Wolverhampton WV1 2GZ and the branch practice is located at The Surgery, Cromwell Road, Bushbury, Wolverhampton WV10 8UT. Both practices are purpose built and provide ground floor facilities with disabled access and ample parking for patients. For this inspection a visit was made to both the main and branch practice.

The practice team consists of one lead GP and two salaried GPs (two male and one female), who provide services which equate to 2.5 whole time equivalent GPs. The practice also use GP locums to support the clinicians and meet the needs of patients at the practice. The clinical practice team includes two advanced nurse practitioners who are both independent prescribers, two practice nurses, a health care assistant and two phlebotomists. The clinical staff are supported by a practice manager, an assistant practice manager/IT manager and seven receptionists and administration staff. In total there are 19 staff employed either full or part time hours.

The practice is open Monday and Thursday between 8am and 7pm, Tuesday and Friday from 8am to 6.30pm and Wednesday 8am to 8.30pm. Extended surgery hours are available three evenings per week. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service Primecare, the NHS 111 service and the local Walk-in Centres.

The practice has a contract to provide Primary Medical Services (PMS) for patients. This is a contract for the practice to deliver primary medical services to the local community. They provide Directed Enhanced Services, such as the childhood vaccination and immunisation scheme and minor surgery. The practice provides a number of clinics for example long-term condition management including asthma, diabetes and high blood pressure.

Updated 18 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kewal Krishan on 9 February 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, recording and addressing significant events.
• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice employed an advanced nurse practitioner who had extended training in sexual health and contraception to meet the needs of its higher than average younger population group.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• There was a clear leadership structure and staff felt supported by the 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.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 18 May 2016

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Performance for diabetes assessment and care was similar to the national average (89.4% as compared to the national average of 89.2%). Performance for asthma assessment and care was higher than the national average (80.15% as compared to the national average of 75.35%). 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. The practice maintained a register of patients with long-term conditions who required a home visit.

Updated 18 May 2016

The practice is rated as good for the care of families, children and young people. The practice had a policy in place to ensure that any child under the age of three is seen immediately and any child under five is triaged and seen on the day. Immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. There were systems in place to identify and follow up children living in disadvantaged circumstances. One of the advanced nurse practitioners attended school meetings to provide clinical guidance for children and young people assessed as being at risk from harm. We saw positive examples of joint working with midwives. The practice employed an advanced nurse practitioner who had extended training in sexual health and contraception to meet the needs of its higher than average younger population group. The practice told us that they were the highest user of long-acting reversible contraceptives (LARC, methods of birth control that provide effective contraception for an extended period without requiring the patient to take any action). The practice’s uptake for the cervical screening programme was 83.1%, which was comparable to the national average of 81.83%.

Updated 18 May 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population. The practice offered home visits and the phlebotomists employed by the practice visited this group of patients to take blood when needed.  Urgent appointments were available for older patients with enhanced needs.

Updated 18 May 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. Students in higher education were supported to register and de-register with the practice with ease. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs of this age group. The practice appointment telephone line was open between 8.30am and 6.30pm and extended hours were offered three evenings per week.

Updated 18 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The data showed that 93.75% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This was comparable to the national average of 88.47%. The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia. It carried out advance care planning for patients with dementia. The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 80%, which was comparable to the national average of 84.01%. Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 18 May 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients with a learning disability and carried out annual health checks for these patients. An easy read (pictorial) letter was sent to patients with a learning disability inviting them to attend the practice for their annual health check.

Staff had been trained 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. The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.