Tulasi Medical Centre

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Patients’ needs were mostly assessed, and care and treatment was delivered in line with current legislation, standards and evidence-based guidance supported by clear pathways and tools. Patients with long-term conditions were offered an effective annual review to check their health and medicines needs were being met. For patients with the most complex needs, the GP worked with other health and care professionals to deliver a coordinated package of care. The practice had carried out some quality improvement, however, some of the audits submitted did not contain bench marking or outcomes. Staff worked together and with other organisations to deliver effective care and treatment. The practice obtained consent to care and treatment in line with legislation and guidance. The difficulties with access to appointments affected patients experience of help to live a healthier life.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice registered to provide regulated activities with CQC in July 2023, therefore at the time of the assessment the national GP survey data for the provider had not been published. The practice had undertaken its own patient survey in February 2024, although the questionnaire did not include any specific question about assessing needs, 53 out of 74 patients described themselves very satisfied or satisfied of the experience at the practice and 55 patients stated they would recommend the practice. In addition, 60 patients responded that their overall experience of their last appointment was either fairly or very good. CQC received patient feedback from 12 people from August 2023, there were no specific complaints regarding assessment of needs. The practice had received 27 concerns/complaints from 1 December to 29 February 2024, there were no specific complaints regarding assessment of patient’s needs. CQC did not speak to patients on the days of the assessment.

Leaders explained how patients’ immediate and ongoing needs were fully assessed and patients’ treatment was regularly reviewed and updated This included their clinical needs and their mental and physical wellbeing. In addition, how patients presenting with symptoms which could indicate serious illness were followed up in a timely and appropriate way. Staff explained they had a call and recall policy for patients who required chronic disease management, cervical screening tests, childhood immunisations, or those who took certain medicines requiring regular blood tests. The process would be for a text message to be sent out to patients on the recall list to book a review, or the practice would contact the patient and in cases where contact was unsuccessful, the provider told us patients medicines would be short scripted to encourage them to contact the practice. Leaders and staff explained that all abnormal blood tests were followed up and they had a protocol for workflow, emails, post and test results in place. Leaders explained patients were told when they needed to seek further help and what to do if their condition deteriorated.

As part of the assessment a number of set clinical record searches were undertaken by a CQC GP specialist adviser. A sample of the records of patients with long term health conditions were checked to ensure the required monitoring was taking place. We also reviewed a sample of patients records who may have an undiagnosed long-term condition. These searches were visible to the practice. The search for patients with the possible diagnosis of kidney disease following a blood test result, identified 52 where a diagnosis may have been missed. We sampled 5 patient records and found 2 where the diagnosis of chronic kidney disease stage 3 was missing. A search for patients diagnosed with kidney disease who had not had the required blood test in the last 9 months and identified 5 where a diagnosis may have been missed. We sampled 5 patient records and found the correct monitoring. A search for patients with hypothyroidism, identified 5 out of 525 who may not have had the correct monitoring, we reviewed them and found two patients had not had the correct monitoring. We sampled 5 patients who had retinopathy with a blood result which may indicate a risk and found no issues with monitoring.

The practice registered to provide regulated activities with CQC in July 2023, therefore at the time of the assessment the national GP survey data for the provider had not been published. The practice had undertaken its own patient survey in February 2024, although the questionnaire did not include any specific question about evidence-based care, it found 53 out of 74 patients described themselves very satisfied or satisfied of the experience at the practice and 55 patients stated they would recommend the practice. In addition, 60 patients responded that their overall experience of their last appointment was either fairly or very good. CQC received patient feedback from 12 people from August 2023, there were no specific complaints regarding evidence-based care and treatment. The practice had received 27 concerns/complaints from 1 December to 29 February 2024, there were no specific complaints regarding evidence-based care and treatment. CQC did not speak to patients on the days of the assessment.

The leaders and staff told us the practice had systems and processes to keep clinicians up to date with current evidence-based practice. Staff had access to the National Institute for Health and Care Excellence guidelines, monthly clinical meetings where new care pathways were discussed. In addition, staff had protected time to attend training. Clinicians also used a text messaging group to share any new clinical learning.

The staff discussed patient care at monthly clinical, safeguarding and integrated care team meetings. A review of a sample of patients’ clinical records demonstrated they had received evidence-based care. The staff had completed some clinical audits to ensure they were meeting clinical guidelines.

We could not collect the evidence to score this evidence category.

The leaders explained that when people received care from a range of different staff, teams or services, it was coordinated, and staff worked collaboratively to understand and meet the range and complexity of people's needs. Shared care agreements were made with secondary care providers regarding the prescribing and monitoring of patient medication. The leaders explained that they provided the care and treatment for 180 people at two older peoples residential homes, a GP would visit the homes weekly to review peoples care and treatment.

The leaders submitted copies of Integrated care meetings for March 2024, these demonstrated working within a multidisciplinary team to discuss and improve outcomes for people with complex needs. The practice supported two nursing homes for older people, the managers at both the homes confirmed that staff attended the homes weekly, staff responded promptly to their requests, and they had good lines of communication with the practice. The local integrated Care Board told us the staff were working with them to make improvements.

Staff at GP extended hours service had access to the patients’ full medical records. Information was shared regarding safeguarding with urgent and emergency services The practice was informed about patients who had attended any emergency services promptly and any follow up was reviewed by the GP. The GP partners were responsible for the overview of specific clinical areas. The administration team were responsible for specific tasks, such as patient referrals, repeat medicines, and test results. The leaders explained that they were working with Barking, Havering, and Redbridge safeguarding team to develop a procedure regarding the transition of children on the safeguarding registers when they reached 18 years.

The practice registered to provide regulated activities with CQC in July 2023, therefore at the time of the assessment the national GP survey data for the provider had not been published. The practice registered in July 2023, therefore at the time of the assessment the national GP survey data for the provider had not been published. The practice had undertaken its own patient survey in February 2024, this did not include questions about patient medicines. CQC has received patient feedback from 12 people from August 2023, all the comments were negative and 7 were regarding access to appointments. The practice had received 27 concerns/complaints from 1 December to 29 February 2024, and 19 were regarding access to appointments.

The staff told us that patients had access to wellbeing coach’s and social prescribers provide signposting to financial advice, housing, and local groups such as walking. In addition, all staff were trained to provide information about self-referral to Improving Access to Psychological Therapies, (IAPT) services for patients with mental health concerns. The leaders told us they had carried out open days, alongside the primary care network, in the local community to provide information about services.

Posters and leaflets were available to direct patient where to seek further advice. The practice had a full-time care coordinator who provided advice about local support groups and activities. The practice had a list of patients who acted as carers for relatives and were planning to review the list and contact carers to review their support needs.

We could not collect the evidence to score this evidence category.

The leaders explained they monitored patient’s long-term condition needs on a weekly basis to decide which patients they would prioritise for follow up appointments. However, they did not formally record this or discuss their findings with at the governance or clinical meetings. The leaders and staff told us that audits were discussed at clinical meetings; this was confirmed in the minutes of the meetings we reviewed.

The provider registered with CQC on the 7 July 2023, therefore we have only reviewed completed audits from the date of registration, which meant some audits had not had a follow up audit. The provider submitted two completed audits a review of palliative care and a review of cancer diagnosis to ascertain any gaps in the services, both audits included a narrative about the audit, analysis of the data, a conclusion and learning. In addition, the provider submitted ongoing long-term health condition and medicine monitoring to demonstrate ongoing quality improvement. As this was ongoing some of the work was prior to the registration date and did not contain any benchmarking against good practice or outcomes. The practice had carried out a workflow and a review of urgent referrals audits, we observed the workflow audit did not contain any narrative, summary, or learning.

The provider submitted unverified data that demonstrated, from 1 April 2023 to 31 March 2024, the practice had carried out patient annual health reviews. For example, 785 out of 1,048 asthma reviews, 358 out of 414 chronic obstructive airways reviews, 1640 out of 1933-foot examinations for diabetes, 101 out of 142 learning disability reviews, and 50% of the severe mental health reviews.

We could not collect the evidence to score this evidence category.

Clinicians understood the requirements of legislation and guidance when considering consent and decision making. We saw that consent was documented. Clinicians supported patients to make decisions. Where appropriate, they assessed and recorded a patient’s mental capacity to make a decision.

The leaders submitted a copy of the consent policy and consent withdrawal of consent forms policy last reviewed in October 2023. However, this did not contain information about assessing capacity for consent to treatment. We reviewed five patients Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and found they were made in line with relevant legislation and were appropriate.