Dr Kaura and Partners

Updated 6 February 2017

Dr Kaura and partners, Wrekenton Medical Group provides care and treatment to approximately 10,664 patients from the Deckham, Saltwell, Heworth, Windy Nook, Leam Lane, Sheriff Hill, Beacon Lough, Wrekenton, Springwell, Usworth, Donwell, Eighton Banks, Birtley, Harlow Green and Low Fell areas of Gateshead, Tyne and Wear. The practice is part of the NHS Newcastle Gateshead clinical commissioning group (CCG) and operates on a General Medical Services (GMS) contract.

The practice provides services from the following address:

Wrekenton Health Centre

Springwell Road

Gateshead

Tyne and Wear

NE9 7AD

The surgery is located in purpose built premises that are shared with external services. All reception and consultation rooms are fully accessible for patients with mobility issues. On-site car parking is available, which includes dedicated disabled car parking spaces.

The surgery is open from 7am to 6pm on a Monday to Friday and appointments are generally available from 8am to 5.40pm. However, extended hours appointments are available with a GP from 7.10am to 7.40am three mornings per week and with a nurse or health care assistant from 7.10am to 8am five mornings per week.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and GatDoc.

Dr Kaura and partners offers a range of services and clinic appointments including long term condition reviews, childhood immunisation service, contraception servicesm, smoking cessation and travel advice. The practice is also an approved training practice and involved in the training of qualified doctors wishing to gain experience of general practice.

The practice consists of:

• Three GP partners (one male and two female)
• Three salaried GPs (one male and two female)
• One nurse practitioner (female)
• Two practice nurses (female)
• Two health care assistants (female)
• A phlebotomist (female)
• Non-clinical members of staff including a practice manager, administration manager, reception, administration and secretarial staff

The area in which the practice is located is in the third (out of ten) most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The average life expectancy for the male practice population is 77 (CCG average 77 and national average 79) and for the female population 81 (CCG average 81 and national average 83).

Of the practice population, 61.8% were reported as having a long standing health condition (CCG average 56.9% and national average 54%). Generally a higher percentage can lead to an increased demand for GP services. At 69.5%, the percentage of the practice population recorded as being in paid work or full time education was higher than the CCG average of 60.5% and national average of 61.5%. Deprivation levels affecting children were comparable with the local average but higher than the national average. Deprivation levels effecting older people were higher than the local CCG and national averages.

Updated 6 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Kaura and Partners on 17 March 2016, which resulted in the practice being rated as good overall but as requiring improvement for providing effective services. The full comprehensive report can be found by selecting the ‘all reports’ link for Dr Kaura and Partners on our website at www.cqc.org.uk .

This inspection was a desk-based review carried out in December 2016 to confirm that the practice had carried out steps to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection in March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• Since our previous inspection staff had completed all mandatory training. A training matrix was in operation to help identify gaps or when updates were due.

• Unless specifically requested by the patient making the complaint, complaints information was not stored on a patients medical record.

• A system was now in place to ensure all meetings were minuted and minutes saved where they could easily be accessed by staff

• The practice had obtained documentary evidence confirming that NHS Property Services had carried out relevant Health and Safety checks. However, the last legionella risk assessment, carried out in July 2012, had highlighted some action points and the accompanying report, which was produced in July 2014 had recommended that a re assessment be carried out every two years. When this was pointed out to the practice during the inspection they contacted NHS Property Services to obtain a more up to date copy. However this was not received before finalising this report.

The practice should therefore:

• Put steps in place to monitor when health and safety checks are due to be completed by NHS Property Services, follow up on any delays or gaps and ensure they retain a copy on site of all up to date documentation.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 June 2016

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

• Patients at risk of hospital admission were identified as a priority for care and support by the practice.
• A locality based care navigator worked at the practice; they supported patients with long-term conditions, particularly those who are housebound.
• Nationally reported data showed the practice had achieved good outcomes in relation to most of the conditions commonly associated with this population group. For example, the practice had achieved 91% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 0.8% below the local CCG average and 2% above the national average.
• Longer appointments and home visits were available when needed.
• All patients with a long term condition had a named GP and were offered 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 provided an in-house smoking cessation service.

Updated 8 June 2016

The practice is rated as good the care of families, children and young people.

• There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• Arrangements had been made for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 90% to 98% (CCG average 81% to 97%) and for five year olds ranged from 82% to 98% (CCG average 90% to 98%).
• Urgent appointments for children were available on the same day.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
• Nationally reported data showed that outcomes for patients with asthma were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 3.4% above the local CCG average and 2.6% above the national average.
• The practice’s uptake for cervical screening was 81%, which was the same as the local CCG average of 81% and comparable to the national average of 82%.
• The practice provided contraceptive and sexual health services.

Updated 8 June 2016

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. The practice participated in the local unplanned admission scheme.
• All patients over the age of 75 had a named GP.
• Patients over the age of 75 and carers were offered an annual health check.
• The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 2.1% above the local clinical commissioning group (CCG) and national averages.
• The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Updated 8 June 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.
• Extended hours appointments with a GP were available three mornings a week from 7:10am until 7:40am. Extended hours appointments were available with a nurse or health care assistant five mornings a week from 7:10am until 8am.
• Patients could order repeat prescriptions and book appointments on-line.
• Telephone appointments were available with GPs and nurses.
• The practice offered a full range of health promotion and screening which reflected the needs for this age group.
• Additional services such as new patient health checks, health checks for patients aged between 40 and 74 and travel vaccinations were available at the practice.
• The practice website provided a wide range of health promotion advice and information.
• A minor surgery service was available at the practice.

Updated 8 June 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice held a register for patients experiencing poor mental health.
• Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 99% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 7% above the local CCG average and 6.9% above the national average.
• Nationally reported data showed that outcomes for patients with dementia were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 4.7% above local CCG average and 5.5% above the national average. 100% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which is above the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 about how to access various support groups and voluntary organisations.
• Patients could complete an online depression questionnaire on the practices’ website and an in-house counselling service was available.
• The practice invited patients to inform them if they were a military veteran with an online form.
• 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 8 June 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 living in vulnerable circumstances including those with a learning disability.
• Patients with learning disabilities were invited to attend the practice for an annual health check. At the time of the inspection the practice had identified 70 patients on the register, of these patients 77% had a health check completed. The practice offered longer appointments for patients with a learning disability if required.
• The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Telephone support was available if required.
• The practice website offered the facility to complete an online depression questionnaire.
• GPs at the practice provided drug and alcohol support services and worked with support services when appropriate.
• The practice had been active in creating a joint working protocol to ensure refugees who were located in the local area were effectively supported and best practice was shared between the services involved.
• 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. However, healthcare assistants and nursing staff had not undertaken the recommended level of safeguarding training that was appropriate for their role.
• Good arrangements were in place to support patients who were carers.