Archived: Dr Anil Joshi Also known as Chelsea Medical Services

Updated 1 October 2015

Dr Anil Joshi (also known as Chelsea Medical Services) is located at 45 Rosary Gardens, London, SW7 4NQ. The practice provides primary medical services through a personal medical services (PMS) contract to approximately 3300 patients in the London borough of Kensington and Chelsea. (PMS is one of the three contracting routes that have been made available to enable commissioning of primary medical services). The practice is part of the NHS West London Clinical Commissioning Group (CCG) which comprises 51 GP practices. The practice has a higher than national average number of patients between 25 and 44 years of age and a much lower than national average number of patients under 19 years of age. Patients over 70 years are also below national average. Life expectancy is 81 years for males and 85 years for females which is above the national average. The local area is the forth less deprived in the West London CCG.

The practice team consists of a male GP who is the provider (six sessions a week), a female salaried GP (eight sessions a week), practice administrator (23 hours a week), a locum nurse (four sessions a week) and a full time receptionist who is also trained to carry out health care assistant duties.

The practice provides a range of services / clinics including family planning, cervical screening, chronic disease management, child and travel vaccinations.

The service is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, treatment of disease, disorder and injury and maternity and midwifery services.

The practice opening hours are 08:00 to 18:30 Monday to Friday with extended hours on Wednesday to 20:00.

Updated 1 October 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 18 August 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 sought feedback from staff and patients, which it acted on.
• Some outcomes including child immunisations, cervical screening rates and some Quality and Outcomes Framework (QOF) clinical indicators were below the national and local average.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should;

• Formalise staff meetings.

• Update the patient leaflet.

• Continue to monitor and improve those areas where clinical outcomes are lower than the national and local average.

• Establish an active Patient Participation Group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 October 2015

The practice is rated as good for the care of people with long-term conditions. The GPs led in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Although latest QOF performance in the management of long-term conditions was below previous years, the practice was proactively targeting patients to facilitate improvement.

Updated 1 October 2015

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 low for all standard childhood immunisations, however the practice had a much lower than national average population of children. Appointments were available outside of school hours. The premises were not ideally suited for mothers with babies as the practice was at basement level with no access for prams. However, the practice had arrangements with another local practice to register mothers with babies if they preferred. We saw good examples of joint working with midwives and health visitors.

Updated 1 October 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people such as cancer and end of life care. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, the unplanned hospital admission avoidance Enhanced Service (ES) and a local Enhanced Service for older vulnerable patients over 85 years of age. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. The practice had an attached primary care navigator who helped with non-medical needs of older patients. Palliative care patients were entered onto Coordinate My Care and special patient notes sent to the local out-of-hours service informing them of the situation.

Updated 1 October 2015

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 such as appointments, repeat prescriptions and test results as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 1 October 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients with poor mental health had annual medical checks as recommended in the mental health enhanced service undertaken by the surgery. The practice undertook mental health checks as recommended in QOF and the majority of patients with poor mental health had a care plan. The practice had access to a crisis intervention service locally and had an attached community psychiatric nurse who provided support for patients. The practice signposted patients to local voluntary services where appropriate. The practice undertook the dementia screening enhanced service.

Updated 1 October 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice looked after a homeless hostel as part of a Local Enhanced Service (LES). On registration these patients received an extended new patient check which included mental health and drug and/or alcohol problems. The practice held a register of patients living in vulnerable circumstances including those with a learning disability and these were offered longer appointments. The practice had two patients with learning difficulties and had signed up to the learning disabilities enhanced service. A staff member had undertaken training to perform learning disability medical checks.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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.