Archived: Dr Linda Kandola Also known as The Gamston Medical Centre

Updated 13 May 2016

The Gamston Medical Centre is located in Gamston which is a suburb of West Bridgford in the Rushcliffe district of Nottinghamshire. It is approximately 3 miles from Nottingham. There is direct access to the practice by public transport and parking is also available on site.

The practice currently has a list size of approximately 5316 patients.

The practice holds a Personal Medical Services (PMS) contract which is a locally agreed contract between NHS England and a GP to deliver care to the public. The practice provides GP services commissioned by NHS Rushcliffe CCG.

The practice is situated in an area with very low levels of deprivation. It has a higher than national average adult population who are of working age as well as children up to the age of around 14. A higher number of those of working age registered at the practice are employed compared with the local CCG average.

The practice is managed by one GP (female) who works on a full time basis. The practice also has a salaried GP (female) who works part time. (0.68 Whole Time Equivalent, WTE) Three long term locum doctors work at the practice (one male, two female) on a part time basis. 0.23 WTE, 0.11 WTE, 0.45 WTE). They are supported by clinical staff; two female part time practice nurses, two female part time healthcare assistants. The practice also employs a practice manager, practice manager assistant, and a team of reception, clerical and administrative staff.

The practice is a training practice for trainee GPs and is involved in the teaching of medical students from a local medical school. Two of the trainee doctors work in the practice on an annual basis.

The practice is open on Mondays to Fridays from 8am to 6.30pm. Appointments are available Mondays 8.30am to 12pm and 3.30pm to 6pm, Tuesdays 9am to 12pm and 3.30pm to 6pm, Wednesdays 9am to 12pm and 4pm to 6pm, Thursdays 9am to 12pm and 4pm to 6pm and Fridays 9am to 12pm and 3.30pm to 6pm. The practice is closed during weekends.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are currently provided by Nottingham Emergency Medical Services. When the practice is closed, there is a recorded message giving out of hours details.

Updated 13 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Linda Kandola also known as The Gamston Medical Centre on 15 March 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. Learning outcomes were shared with staff.
• Risks to patients were assessed and well managed. Health and safety precautions had been taken which included checking that equipment was fully working and safe to use and infection prevention control measures were in place.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audit drove quality improvement. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patient feedback which included the National GP Patient Survey rated the care provided highly.
• Information about services and how to complain was available and easy to understand. All staff we spoke with knew the procedure in place for addressing patient complaints.
• Patients said they found it easy to make an appointment, although not always with a named GP. The practice was seeking to recruit an additional salaried GP to respond to patient demand. There was continuity of care, with urgent appointments available the same day.
• 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 areas where the provider should make improvement are:

• Ensure that evidence of staff identification is obtained and held on personnel files during recruitment.

• Review their process and recording procedure for exception reporting, in particular areas of QOF achievement, such as mental health and heart failure indicators.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 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 with support from practice GPs.

• Patients at risk of hospital admission were identified as a priority and appropriate action was taken to reduce the likelihood of attendance. The practice had identified 113 people on its register for people who were at risk of hospital admission and all of these patients had a care plan in place.

• National data showed the practice was performing broadly in line with the local CCG average for its achievement within eleven diabetes indicators.The practice achieved91% of the available QOF points compared with the CCG average of 95%. Achievement was however above the national average of 89%.

• 91% of patients diagnosed with asthma, on the register, had an asthma review in the last twelve months. This was above the CCG average of 79% and national average of 75%.

• The practice offered near-patient testing for anticoagulation. This meant that immediate test results were available for these patients who were subject to routine monitoring.

• The practice had 615 patients with chronic diseases registered. All these patients were offered a structured annual review to check their health and medicines needs were being met.

• Practice supplied data showed that 510 patients had received these checks although this data had not been verified and published. 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.

• Longer appointments and home visits were available when needed.

Updated 13 May 2016

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 for all standard childhood immunisations ranged from 91% to 99%. This was comparable to CCG averages which ranged from 94% to 99%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and our discussions with staff supported this.

• The practice promoted providing confidential teenage health advice and information was displayed in the practice and on their website for young people to see.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw that effective collaborative working took place between doctors in the practice, midwives and health visitors. This was evidenced through our discussions held with a health visitor during our inspection.

Updated 13 May 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. All older patients had a named GP. Frequent visits were made by the practice GPs to their care home patients in and outside of working hours. A care home manager we spoke with praised the practice for their responsiveness and hands on approach.

• Care plans had been implemented for those patients identified as close to the end of life. The practice held regular multidisciplinary meetings where all patients who were vulnerable and requiring intervention were discussed with input from other care teams into their holistic care.

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

• Data supplied by the practice showed that flu vaccination rates in 2015/16 for the over 65s were 82% (CCG average 78%) Saturday flu clinics were offered to patients to encourage uptake.

Updated 13 May 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered appointments on weekdays up until 6pm which enabled some flexibility for working age patients, students and those recently retired to attend. The practice told us they had also increased telephone consultations to accommodate these patients.

• The practice told us that staff contacted these patients after 6.30pm with test results.

• 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.

• 94% of women aged over 25 but under 65 had received a cervical screening test in the previous 5 years. The practice was performing above the CCG average of 88% and national average of 82%.

Updated 13 May 2016

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

• 100% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was above the CCG average of 93% and above the national average of 88%. Exception reporting was 10.3% above CCG average however and 11.6% above national average.

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG average of 88% and national average of 84%. Exception reporting was in line with the CCG average and national average.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. We saw a variety of information displayed in the practice, for example, Alzheimer’s Society literature.

• 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. Unplanned admissions were regularly reviewed by the practice and contact could be made with the local mental health team if required.

Updated 13 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 living in vulnerable circumstances including those with a learning disability. There were 12 patients on the learning disability register, and 9 of these had received an annual health check in the last twelve months. The practice told us they telephoned these patients to arrange their reviews.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Documentation supported that patients received ongoing care and support from the appropriate health care service(s).

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. A number of self help organisation contact details were made available for patients which included domestic violence, rape crisis and the Samaritans.

• 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.