Dr Goyal & Associates Also known as Church Elm Lane Medical Practice

Updated 26 April 2017

Dr Goyal and Associates, also known as Church Elm Lane Medical Practice, is a GP service based in The Health Centre in Dagenham. Dagenham is a town in the London Borough Barking and Dagenham, which is to the east of London. The Health Centre is situated in a residential area and is well served by public transport links. It is a modern, purpose built building which has a car park including allocated disabled parking spaces. The practice is part of NHS Barking and Dagenham Clinical Commissioning Group and provides GP services under a General Medical Services contract with NHS England to around 5800 patients.

The practice profile shows a higher than average number of patients aged 0 to 14 years and females aged 24 to 44 years. At 76 for males and 81 for females, life expectancy is in line with the CCG and national averages of 77 for males and 81 for females and 79 for males and 83 for females respectively. Results from the 2011 census show a majority white British population as (49%) followed by those of black African ethnicity in (15%). The practice locality is in the second most deprived decile on the deprivation scale. Level one represents the highest levels of deprivation and level ten the lowest.

The practice’s opening times are from 8am to 6pm Monday to Friday. Surgery times are from 8.30am to 1pm and then 2pm to 6.30 on Tuesday and Friday and 7.30pm on Monday and Wednesday. There is no afternoon surgery on Thursday when the practice is closed. Extended hours are from 6.30pm to 7.30pm on Monday and Wednesday and 9am to 12pm on alternate Saturdays. Outside of these hours GP services are available at the local GP hub and the NHS 111 service. Clinical services are provided by two partners (female nine sessions, male six sessions), two salaried GPs (both female, six sessions each), a trainee GP (female six sessions), a medical student (six sessions), a senior practice nurse (female, full time), a practice nurse (female, part time), a trainee pharmacist (female, eight sessions) and two part time healthcare assistants (HCA) (female). The practice is a teaching and training practice.

Dr Goyal & Associates is registered to provide the registered activities of Treatment of disease, disorder or injury; Family planning and Diagnostic and screening procedures from The Health Centre, Dagenham, Barking and Dagenham, RM10 9RR.

The practice was inspected under the Care Quality Commission’s current inspection regime.

Updated 26 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Goyal and Associates Practice on 5 September 2016 The overall rating for the practice was good. The full comprehensive report on 5 September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Goyal and Associates on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 5 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key findings were as follows:

• The practice had records in place to demonstrate that emergency drugs were being monitored regularly.

• Risks to patients were well assessed, for example, staff protected patient’s confidentiality by removing their smart cards when vacating computer terminals.

• The practice had a carer’s identification protocol and the practice’s computer system alerted GPs if a patient was a carer or had a carer. The practice had identified 75 patients as carers (more than 1% of the practice list). A generic letter which encouraged patients to identify themselves as carers was also introduced and was sent out to patients when sending other communication for example reminder letters.

• Following the comprehensive inspection, the practice implemented an uncollected prescription policy which was managed by the GP and maintained by reception staff. Uncollected prescriptions were audited by way of a register including patient ID, date on prescription, outcome and date prescriptions were destroyed.

• The practice could demonstrate that fire drills had been carried out, however improvements were needed to ensure patient safety.

At our previous inspection on 5 September 2016, we rated the practice as requires improvement for providing safe services based on our findings which included issues around emergency drugs and repeat prescription management. At this inspection we found that the issues found during the previous inspection had been addressed. Therefore, the practice is now rated as good for providing safe services.

The area where the provider should make improvement is:

• Ensure staff designated has fire wardens are adequately trained to understand their roles and responsibilities when undertaking fire drills.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 November 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.

• Quality and Outcomes Framework (QOF) performance in 2014/15 for diabetes related indicators was 83% which was in line with the CCG average of 86% and the national average of 90%.

• A diabetes clinic was run at the practice by the practice nurse. A diabetic nurse specialist also attended once a month to see patients.

• Patients who regularly attended A&E were identified and assigned to the unplanned admissions register. These patients were regularly reviewed.

• 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.

Updated 29 November 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 were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 84% which was comparable to the CCG average of 80% and the national average of 82%.

• Children under the age of two years were prioritised for appointments.

• The health visitor clinic took place once a week at the practice.

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

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

Updated 29 November 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.

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

• The practice had a dedicated GP who carried out annual reviews for elderly house bound patients to take care of their complex needs and provide holistic care.

• There was a Palliative Care lead and monthly meetings took place to review patients on the palliative care register as part of the Gold Standards Framework.

Updated 29 November 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.

• New patient checks were offered on Saturdays for patients who could not attend during the week due to work commitments.

• Out of area registrations were accepted for people who worked close to the practice.

Updated 29 November 2016

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

• 97% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national average of 84%.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (01/04/2014 to 31/03/2015), which is comparable to the CCG average of 93% and the CCG average of 90%.

• 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.

• The practice had told 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.

• IAPT (Talking Therapies) services were based in the same building and could easily be accessed in case of urgent referrals and advice.

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

Updated 29 November 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, travellers and those with a learning disability.

• 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.