Dr Atul Arora

Updated 9 November 2017

The practice operates from a single location in Bromley, London. It is one of 45 GP practices in the Bromley Clinical Commissioning Group area. Dr Atul Arora is also known as Sundridge Medical Practice. There are approximately 5,200 patients registered at the practice. The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice has a personal medical services contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include childhood vaccination and immunisation, extended hours access, influenza and pneumococcal immunisations, minor surgery and remote care monitoring.

The practice has a higher than national average patient population of females and males aged zero to nine years and 25 to 49 years. Income deprivation levels affecting children and adults are below the national average.

The clinical team includes a male lead GP and two female salaried GPs. The GPs work a combined total of 15 sessions. There is a female salaried nurse, a female health care assistant and a male pharmacist practitioner. The clinical team is supported by a practice manager and seven reception/administration staff.

The practice is open between 8am and 6.30pm Monday to Friday and is closed on bank holidays and weekends. It offers extended hours with the GPs on Monday from 6.30pm to 8pm and with the nurse from 6.30pm to 7pm on Thursdays. Appointments are available from 9am to 1pm and from 4pm to 6.30pm Monday to Friday. There are three consulting/ treatment rooms, all of which are on the ground floor. There is wheelchair access throughout, and baby changing facilities. The practice directs patients requiring care outside of their normal opening hours to a contracted out of hours service.

Updated 9 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Atul Arora on 22 March 2016. As a result of our findings during that visit the provider was rated as requires improvement for providing safe and well-led care, and it was rated as requires improvement overall. The full comprehensive inspection report from that visit was published on 30 June 2016 and can be read by selecting the ‘all reports’ link for Dr Atul Arora on our website at www.cqc.org.uk.

The provider submitted an action plan to tell us what they would do to make improvements and meet the legal requirements. We undertook an announced focused follow-up inspection on 20 December 2016 to check that the provider had followed their plan, and to confirm that they had met the legal requirements. As a result of our findings during that visit the provider was rated as inadequate for safe and well-led and rated inadequate overall and placed into special measures. The full follow up report was published on 27 April 2017 and can be found by selecting the ‘all reports’ link for Dr Atul Arora on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 27 September 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• Risks to patients and other service users were assessed and well managed, specifically in relation in relation to fire safety, Legionella infection, and health

  and safety.

• The practice was suitably equipped to manage medical emergencies.

• There were systems and processes in place to monitor medicines; all emergency medicines were in date.

• All staff members were up to date with role specific training.

• All practice policies had been reviewed and updated.
• Nursing staff had been given legal authority to administer medicines.
• The practice was able to demonstrate that they had obtained evidence of immunisation for several key staff.
• Governance arrangements operated effectively.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and 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.

However, there were areas where provider should make improvements.

The provider should:

• Deliver training to staff so they are aware of which children are considered vulnerable.

• Review how all complaints are recorded.

• Deliver training to non-clinical staff so they are aware of the requirements of the Mental Capacity Act.

• Continue to review and improve how patients with caring responsibilities are identified and recorded on the clinical system to ensure that information, advice and support is made available to them.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 9 November 2017

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

• The lead GP had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable to the local and national average:
• 61% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 77%, national average of 78%). The exception reporting rate for the service was 7%, local 8% and national 13%.
• 74% of patients with diabetes on the register had their cholesterol measured as well controlled (local 77%, national average 80%). The exception reporting rate for the service was 7%, local 10% and national 13%.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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.

Updated 9 November 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 Accident and Emergency (A&E) attendances. All children were coded on the system; however, there was inconsistency with alerts on patients records.
• Immunisation rates were relatively high for most standard childhood immunisations.
• Patients told us, on the day of inspection, 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 worked with midwives, health visitors, district nurse and matrons to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 9 November 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care. The practice had 21 patients on its palliative register.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.(The practice used a process called co-ordinate my care, which is an NHS clinical service sharing information between healthcare providers, coordinating care, and recording wishes of how patients would like to be cared for)
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice provided care at five care homes.

Updated 9 November 2017

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

• The needs of this population 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, extended opening hours on a Monday and giving patients access to the three GP alliance hubs in the area.
• 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.

Updated 9 November 2017

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

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

• 97% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, (local average 82%, national average 84%).

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 83%, national average 89%). The exception reporting rate for the practice was 2%, local 7% and national 10%.

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months local average 83%, national average 89%. (The exception reporting rate for the practice was 5%, local 8% and national 13%).

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 9 November 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, travellers and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice had 12 patients on the learning disability register, 83% (10) had received a health check in the last year.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.