Dr Sanjay Das Also known as Parkview Surgery

Updated 28 October 2016

Dr Sanjay Das’ practice provided services to approximately 4600 patients in the Lewisham area of south east London under a General Medical Services contract (an agreement between general practices and NHS England for delivering primary care services to local communities.). It sits within the Lewisham clinical commissioning group (CCG) which has 44 member practices serving a registered patient population of more than 284,000. Dr Das’ practice provides a number of enhanced services including Childhood Vaccination and Immunisation Scheme; Extended Hours Access; Influenza and Pneumococcal Immunisations; Facilitating Timely Diagnosis and Support for People with Dementia; Improving patient’s online access; Minor surgery; Remote care monitoring; Risk Profiling and Case Management; Unplanned admissions and rotavirus & shingles immunisation.

The staff team at the practice consists of one full time male GP, a self-employed female GP, a female practice manager, a part time female practice nurse and five administrators/receptionists. The practice provides 16 GP sessions per week.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments start from between 9am and 9.30am to 12.30pm every morning and 2.30pm to 6pm daily. Extended hours appointments are offered on Mondays and Wednesdays up to 7.30pm. Outside of these hours, patients are advised to contact the practices out of hour’s provider, whose number is displayed on the practice noticeboard. The practice provides an online appointment booking system and an electronic repeat prescription service. The premises are not purpose built but a ramp has been fitted to enable ease of access for patients with mobility difficulties and a hearing loop is installed.

The practice is registered with the Care Quality Commission to carry on the regulated activities of maternity and midwifery services, treatment of disease, disorder or injury, family planning, surgical procedures, and diagnostic and screening procedures.

The practice has fewer patients with a long standing health condition than both the CCG and England average (47% compared to 49% and 54% respectively). The average life expectancy for males is 79 years (CCG average 78; England average 79) and females is 84 years (CCG average 82, England average 83).

The population in this CCG area is predominantly white British. The second highest ethnic group is black or black British. The practice sits in an area which rates within the third most deprived decile in the country, with a value of 30.2 compared to the CCG average of 28.6 and England average of 21.8 (the lower the number the less deprived the area).

The patient population is characterised by an above England average for patients, male and female, between the ages of 25 and 39. Other ages groups are similar to the England average.

Updated 28 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sanjay Das on 13 September 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.
• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to the national average.
• Patients said they were treated with compassion, dignity 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.
• Two patients indicated on the Care Quality Commission comment cards that getting an appointment was difficult. Several of the patients we spoke to on the day made similar comments. The 2016 national patient survey results showed the practice fell below the national average for the ease of getting an appointment.
• We saw that where issues had been identified, for example following a health and safety audit, action had been taken and this had been recorded.
• 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.
• With the exception of the GP, staff had no knowledge of the Duty of Candour.
• Recruitment processes needed updating.

The areas where the provider should make improvement are:

• Review the policy of accepting Disclosure and Barring Service checks from previous employers.
• Keep recruitment files up to date and ensure they contain the information required in the regulations.
• Ensure staff have and maintain an understanding of the Duty of Candour appropriate to their roles.
• Keep under review how best to address patients’ concerns regarding the ease of getting an appointment.
• Take appropriate steps to identify patients who are also carers to allow the practice to provide support and suitable signposting.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 28 October 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 and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to or above the national average. For example the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c was 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was 76% compared to the Clinical Commissioning Group (CCG) average of 70% and England average of 78%. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 97% compared to the CCG average of 83% and England average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and 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. For example, quarterly multi-disciplinary meetings were held with the district nurse, social services and the palliative care and mental health teams.

• Patients with long term conditions were asked to see the practice nurse every six months and attend regular medicine reviews. Patients who did not attend were only given short supply repeat prescriptions until they attended.

Updated 28 October 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.

• Most childhood immunisation rates for the vaccinations given were comparable to Clinical Commissioning Group (CCG) averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 64% to 97% (CCG 71% - 92.5%) and five year olds from 68% to 98% (CCG 71% - 94%).

• Appointments were available outside of school hours. Emergency slots for children under 5 were available at the end of clinics. The premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• Weekly baby clinics were held and post-natal check-ups were available.

• The practice’s uptake for the cervical screening programme was 86%, which was comparable to the CCG average of 81% and the national average of 82%. Breast and bowel cancer screening was comparable to CCG and England averages except for the uptake of bowel cancer screening within 6 months of invitation (persons aged 60-69) where the practice average was 32.5% compared to the CCG average 43% and England average 55%.

• The practice nurse was a sexual health specialist and the practice offered smear tests, Human Papilloma Virus immunisations and free contraception.

Updated 28 October 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 patients over 75 had a named GP and had been informed of who that was.

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

• Patients most at risk were given an emergency mobile number.

• Flu jabs were offered to patients at home if they were unable to attend the surgery.

Updated 28 October 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.

• 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.

• Extended hours appointments were available for people who were working.

• The practice provided telephone consultations, online booking, electronic prescription requests and text message alerts and results.

Updated 28 October 2016

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

• < >

  Performance for mental health related indicators was similar to or above the national average. For example the percentage of patients with schizophrenia, bipolar affective

• disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 93% compared to the CCG average of 84% and England average of 88%.

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

  The practice carried out advance care planning for patients with dementia.

• Patients with long term conditions were screened for depression.

• 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 28 October 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 homeless people and those with a learning disability. There were 21 patients on the learning disability register. At the time of the inspection none had had an annual review; however, the GP told us that they set aside specific days in December to carry out all reviews. Staff told us all learning disability patients had had a review the previous year.

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

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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.

• The practice held six weekly child protection meetings with the health visitors.