Dr's P L & S Kaul and Dr G K Gill

Updated 7 November 2017

Dr's P L & S Kaul and Dr G K Gill Surgery also known as Harden Health Centre or Leamore Medical Centre is located in Walsall, West Midlands. The practice is situated in a multipurpose modern built NHS building, providing NHS services to the local community. Dr's P L & S Kaul and Dr G K Gill operate two practices both managed under separate General Medical Services (GMS) contracts with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

Based on data available from Public Health England, the levels of deprivation in the area served by Dr's P L & S Kaul and Dr G K Gill Surgery are below the national average, ranked at one out of 10, with 10 being the least deprived. Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds. The practice serves a higher than average patient population aged between zero to 34 and 40 to 54. The practice also has a below average number of patients aged 55 to 85 and over.

The registered patient list size is approximately 3,032. The surgery has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The practice is situated on the ground floor of a multipurpose building with two other practices. There is car parking available along with facilities for cyclists and patients who display a disabled blue badge. The practice has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staffing comprises of four GP partners (two male & two female), one independent nurse prescriber, one practice nurse, one practice manager, and a team of secretaries and receptionists. Practice staff work across both sites.

The practice is open between 8.30am and 6.30pm every day except Wednesday, which the practice closes at 1pm. Telephone lines are closed between 1.00pm and 2.00pm every day except Wednesday, when they are closed from 1pm until 6.30pm.

GP consulting hours are from 9.30am to 11.30am and 4pm to 6pm Mondays; 8.40am to 10.30am and 5pm to 7pm Tuesdays; 8.40am to 10.30am and 4pm to 6pm Wednesdays; 9.30am to 11.30am Thursdays; 9.30am to 11.30am and 3pm to 4pm Fridays. The practice has opted out of providing cover to patients in their out of hours period. During this time services are provided by NHS 111. When the practice is closed during core hours services are provided by WALDOC (Walsall doctors on call).

Updated 7 November 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr's P L & S Kaul and Dr G K Gill on 5 December 2016. The overall rating for the practice was good with the effective domain rated as requires improvement. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr's P L & S Kaul and Dr G K Gill on our website at www.cqc.org.uk.

This inspection was a desk based review carried out on 3 October 2017 to confirm that the practice had carried out their plan to make improvements in the areas that we identified in our previous inspection on 5 December 2016. This report covers our findings in relation to those areas and also additional improvements made since our last inspection.

The effective domain is now rated as good and overall the practice remains rated as good.

Our key findings were as follows:

• The practice had purchased disposable curtains for consultation and treatment rooms in July 2017. The cleaning schedule indicated that the curtains were due to be replaced in January 2018.
• The practice had invested in an e-learning training programme, which allowed management to monitor staff training and identify when refresher training was required.
• The GPs had completed fire safety and infection control training.
• Non clinical staff had completed adult safeguarding training.
• The practice had reviewed the results from internal and external patient surveys and identified a number of areas for improvement. Action plans had been put in place to improve patient satisfaction.
• The practice had improved their overall QOF score to around 96% (up from 90%) of the total number of points available. The practice had also taken action to improve performance in specific areas such as diabetes and mental health.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 March 2017

• Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified.

• Performance for diabetes related indicators was below the national average. For example, 81% of patients with diabetes, on the register, with a diagnosis of kidney disease or abnormal urine reading were treated with appropriate medicine compared to the CCG average of 96% and national average of 93%. Staff were aware of the practice performance and explained that they were proactively contacting patients and booking them in with the diabetic nurse who attended the practice.

• Longer appointments and home visits were available when needed.

• 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 offered a range of services in-house to support the diagnosis and monitoring of patients with long term conditions including spirometry, phlebotomy and followed recognised asthma pathways.

• The percentage of patients with Chronic Obstructive Pulmonary Disease (COPD) who had a review undertaken including an assessment of breathlessness using recognised methods was 70%, compared to CCG average of 92% and national average of 90%.

• The practice actively referred patients to services such as pulmonary rehabilitation (a programme of exercise and education for people with long-term lung conditions), cardiac rehabilitation (a programme of exercise and information to help patients return to physical activities after a heart attack) and DESMOND (a diabetes education and self-management programme).

Updated 15 March 2017

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates were relatively high for most standard childhood immunisations. Any missed appointments for immunisations or eight week baby checks were followed up and referrals were made to the health visiting team if three appointments were missed.

• The practice was accessible for pushchairs, there were baby changing facilities and the practice was breast-feeding friendly.Appointments were available outside of school hours and the premises were suitable for children and babies. The practice held a weekly midwife clinic.

• Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals. The practice offered sexual health advice and emergency contraception.

• The practice’s uptake for the cervical screening programme was 78%, which was comparable to CCG average of 81% and the national average of 82%.

• Staff we spoke with demonstrated positive examples of joint working with midwives and health visitors. The percentage of patients aged eight or over where a diagnoses of asthma has been confirmed after initially presenting with symptoms (on or after 1 April 2006), was 95% compared to CCG average of 90% and national average of 89%.

Updated 15 March 2017

• The practice offered proactive, personalised care to meet the needs of the older people in its population. All patients had a named GP.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice proactively worked with the wider healthcare team such as district nurses and community matrons. The local fire service attend the practice during flu campaigns to discuss and arrange home safety checks for elderly patients.

• The practice provided a variety of health promotion advice and literature which signposted patients to local community groups and charities such as Age UK. Data provided by the practice showed that 89% of patients aged over 75 had received a health check in the last three years.

• The practice was accessible to those with mobility difficulties.

Updated 15 March 2017

• 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. For example, there were extended opening available early morning and late evenings. Blood specimen collection times from the pathology department were increased to provide flexibility with appointments for blood tests.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• For accessibility, telephone consultation appointments were available with the GPs.
• The practice offered travel vaccinations available on the NHS and staff sign posted patients to other services for travel vaccinations only available privately such as to a yellow fever centre.
• The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.
• Data from the national GP patient survey indicated that the practice was rated above local and national average regarding phone access and opening times.

Updated 15 March 2017

• The practice carried out advance care planning for patients with dementia. QOF data showed that 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 local and national average, with a 0% exception reporting rate.

• QOF data showed that 78% of patients with a mental health related illness had a comprehensive, agreed care plan documented in their record in the preceding 12 months, compared to the CCG average of 92% and national average of 88%. The exception reporting was 5% which was the same as the CCG (5%) and below the national exception reporting (13%).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. There was a designated lead for dementia who carried out nationally recognised memory tests, staff explained that where concerns were identified then patients were invited to attend further tests and referred to the memory clinic.

• The practice had told patients experiencing poor mental health about 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. The lead GP was part of Walsall CCG mental health steering group where an active role had been taken to develop mental health pathways.

Updated 15 March 2017

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability. There was a designated lead for learning disabilities. Data provided by the practice showed that 55% of patients had a care plan in place, 73% received a medicine review and 82% had a face-to-face review in the last 12 months.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example, they provided a shared care service in partnership with the local addiction service for patients affected by substance misuse allowing them to obtain their medicine at the surgery. The practice also operated a zero tolerance clinic for patients who had been excluded from their GP practice.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations such as citizen advice and the practice operated an in-house food bank.
• Staff we spoke with knew how to recognise signs of abuse in vulnerable adults and children. Staff was 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.
• Carers of patients registered with the practice had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Data provided by the practice showed that 1.4 % of the practice list were carers.