The Saluja Clinic

Updated 22 February 2017

The Saluja Clinic provides NHS primary medical services to around 9500 patients in Southall in the Ealing borough of west London. The service is provided through a general medical services contract. The practice is located in modern purpose built premises.

The current practice clinical team comprises two GP partners, and two salaried GPs. The GPs typically provide around 28 sessions in total each week. The practice employs two part-time practice nurses (one whole time equivalent) and a health care assistant. The practice has a financial partner and also employs a practice manager and administrative and reception staff. Patients have the choice of seeing a male or female GP.

The practice is open from 8am-6.30pm Monday to Friday and from 9am-1pm every Saturday. The practice offers online appointment booking and an electronic prescription service. Same day and longer appointments are available for patients with complex or more urgent needs. The GPs make home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet, on its website and on a recorded telephone message.

The practice population age profile is younger than the English national average with a relatively high proportion of adults aged 20-39 years. The practice catchment area is characterised by higher than average unemployment rates and areas of poor housing stock with associated health problems. The practice population is ethnically and culturally diverse with a majority being of Indian, Pakistani or Bangladeshi heritage. The practice population includes patients who have recently come to the UK with complex health needs including mental health problems associated with trauma.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures and treatment of disease, disorder and injury. The practice has not previously been inspected by CQC.

Updated 22 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Saluja Clinic on 15 August 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.
• There were mixed findings from the national GP patient survey and the practice's own feedback exercises. Patients who participated in the inspection consistently said they were treated with compassion 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. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice received mixed patient feedback about the ease of making an appointment. Urgent appointments were available the same day and non urgent appointments were available in around a week. The practice had taken action to improve the patient experience of making an appointment and access to the service.
• The practice had good facilities and was well 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:

• The practice should review its exception reporting rates for cervical screening which are relatively high and investigate whether it could do more to reduce these.
• The practice should actively encourage eligible patients to attend for breast and bowel screening.
• The practice should improve the use of clinical audit to drive improvement and investigate topics of particular relevance to the practice.
• The practice should take steps to reduce the risk of the vaccines fridge being accidentally unplugged.
• The practice should continue to explore ways to improve patient satisfaction with the service and access to the service.
• The practice should review the sustainability of its current staffing structure and work patterns.
• The practice should actively seek to increase the number of identified carers to ensure they have access to appropriate support.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 22 February 2017

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

• The practice achieved a Quality and Outcomes Framework score of 100% in 2015/16. It kept registers of patients with long term conditions. These patients had a structured annual review to check their health and medicines needs were being met. 
• The practice operated call-recall systems to encourage patients with long-term conditions to attend for their review. Nursing staff had lead roles in chronic disease management.
• The practice was performing well for indicators of chronic disease management. For example, the percentage of diabetic patients whose blood sugar levels were adequately controlled was 83% compared to the clinical commissioning group and national average of 78%.
• Patients identified as at risk were reviewed had a personalised care plan. Cases were discussed at regular multidisciplinary meetings.
• Patients with complex conditions were identified as a priority on the electronic record system and were able to book same day appointments, longer appointments and home visits when required.

Updated 22 February 2017

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

• 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 example 90% of children had received the standard recommended vaccinations by the age of one in 2015/16.
• 82% of patients with asthma had a review of their condition within the last year compared to the national average of 76%.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies. The practice prioritised younger children for same day appointments and sought advice from the local rapid access paediatric on-call consultant when appropriate to assess concerns and reassure parents.
• We saw positive examples of joint working with health visitors.

Updated 22 February 2017

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 was responsive to the needs of older people, and regularly carried out home visits and had an 'open door' policy for older patients some of whom were unfamiliar with appointment systems. The practice facilitated urgent appointments for those with enhanced needs.
• The practice provided the seasonal flu vaccination for patients over 65 and the shingles and pneumococcal vaccinations for eligible older patients.
• We received feedback from patients commenting on how well the staff treated older patients, for example, building a relationship and taking time during consultations.  

Updated 22 February 2017

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.
• For example, the practice operated a telephone triage system and telephone consultations with a GP for patients who did not need a face to face consultation. The GPs were also able to send relevant information leaflets by text message to patients' mobile telephones. 
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice cervical screening coverage rate was 82% which was in line with the national average of 81%. However practice exception rate reporting was unusually high for this indicator at 25%.

Updated 22 February 2017

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

• 100% (16 of 16) patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.
• 97% (of 72) patients diagnosed with a psychosis had a comprehensive care plan recorded in their records compared to the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health.
• For example, the local mental health team outreach service attended the practice regularly to support existing patients, carry out case reviews and provide a rapid assessment for patients presenting with new symptoms.
• The practice provided information for 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 and manage risk, for example through 'safety netting'.

Updated 22 February 2017

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 homeless people, and patients with a learning disability or lacking mental capacity to make decisions about their care.
• The practice had a relatively high number of registered homeless patients who were signposted to the practice by local homeless organisations and workers.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care and social services professionals in the case management or referral of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and were able to give us examples of positive ongoing support provided to patients in this position.
• 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.