Dr AM Deshpande & Dr P Gurjar Practice Also known as Dr A Deshpande & Partners

Updated 20 April 2017

This practice is also known as ‘The Neera Medical Centre’. There is an agreement with a neighbouring church that patients can use their parking spaces. The practice is situated close to a train station.

The practice is based within a medical centre shared with another health care provider.

The current list size is just over 3000 patients and the practice is open to new patients. There are two male GP partners. The practice has a regular female locum GP (one day a week) and a regular male locum GP. There are two female locum practice nurses who both work part-time.

There is a practice manager, a senior receptionist and two receptionists. They all have shared roles including administrative functions.

The practice is open between 8am and 6.30pm Monday to Friday. Pre booked appointment times vary according to day and the GP. Every week day appointments are available from 9.30am. The morning session can last either to 11.30am or 12.30pm with minor variations. After this the GP will make telephone consultations and complete home visits. Afternoon session start times range from 3.30pm to 5.30pm depending on the day. The afternoon session usually finishes at 6pm, except on Mondays when the afternoon clinic is from 5.30pm to 7.30pm. There is no GP onsite on Thursday afternoons. Practice nurses are available Wednesdays and Thursdays. Patients from the practice can access evening and weekend appointments with a GP or nurse through a local arrangement that is shared between different practices covering a rota. These appointments are pre-bookable only.

The practice area demographic comprises of mainly white British, with other nationalities including Polish. There are fairly low levels of income deprivation affecting older people.

The practice is responsible for the evening and weekend service called ‘Thurrock Health Hubs’. Patients are able to book through the practice to see either a doctor or a nurse between 9.15am and 12.30pm at the weekend, at one of four ‘hubs’, or in the evening. We did not inspect the hubs’ premises as part of this inspection, although some of the systems and processes overlap.

When the practice is closed primary medical services can be obtained from the out of hour’s provider, Integrated Care 24 via the non-emergency 111 service.

Updated 20 April 2017

Letter from the Chief Inspector of General Practice

We previously carried out a comprehensive inspection at Dr AM Deshpande & Dr P Gurjar Practice on 4 May 2016. The practice was rated as inadequate overall. Specifically they were rated as requires improvement for effective, caring and responsive, and inadequate for safe and well-led. The practice was placed in special measures for a period of six months. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Dr AM Deshpande & Dr P Gurjar Practice on our website at www.cqc.org.uk.

This second inspection was undertaken following the period of special measures to review their progress and was an announced comprehensive inspection on 16 January 2017. Overall the practice is now rated as good.

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

• Staff were aware of their responsibilities regarding safety, and the reporting and recording of significant events. There were policies and procedures in place to support this. Any learning identified was shared with staff.
• The practice assessed risks to patients and staff and there were systems in place to manage them.
• Where patients were prescribed medicines requiring monitoring we found that the system in place was effective. There was a system in place for clinical staff to receive, action and disseminate patient and medicine safety alerts.
• The practice had a defibrillator and oxygen, as well as all the medicines expected to be onsite in case of medical emergencies. There was a system in place to check that equipment was in working order and medicines had not expired.
• There was a system in place to record and monitor the issue and use of prescription stationery.
• The practice business continuity plan had relevant contact details to enable staff to take action in the event of a loss of utilities or premises.
• Policies and procedures were up to date and had clear version control and a review date. These were easily accessible to staff.
• Staff had a clear awareness of consent issues including Gillick competencies and Fraser guidelines.
• Appraisal sessions had been booked for administrative staff however following the completion and manager review of preparation forms these were postponed in order for the partners and management team to address some of the issues raised. This included a review of all staff contracts, staff appraisals would be held once this work had been completed.
• There was a portable hearing loop for those with a hearing loss to use.
• There was a system in place to identify and support carers.
• We saw evidence of audits that demonstrated improvements in patient outcomes.
• Views of patients from comments cards and those we spoke with during the inspection were mostly positive. Patients said they were treated with dignity and respect, and they were involved in their care and decisions about their treatment.
• Complaints were investigated appropriately and in a timely manner and learning was shared with all staff.
• The practice had implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from CQC, the local Clinical Commissioning group (CCG) and its own staff.
• The management and staff team structure had had some changes since our previous inspection. There was still further progress to be made however we found that the two practice managers and two partners were working as a team to ensure that the potential risks to patients and staff were being identified and the structure of support and learning within the staffing team was being improved.
• Staff told us they felt supported and able to suggest improvements to the way that the service was run.
• The culture of the practice was friendly, open and honest. It was evident that the practice complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure that non-clinical staff have appraisals.
• Improve patient confidentiality when attending consultations with the practice nurse.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 April 2017

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

• Clinical staff had lead roles in chronic disease management.
• Nationally reported data showed that outcomes for patients for long-term conditions were in line with or lower than compared to other practices locally and nationally. For example, numbers of patients with diabetes receiving appropriate reviews were lower than the local and national average for some indicators and similar for others. The practice was aware of this data and had recruited nursing staff with backgrounds in long term conditions to improve the service provided to this group.
• Longer appointments and home visits were available when needed.
• For those patients with the most complex needs, clinical staff worked with relevant health and care professionals to deliver a multidisciplinary package of care. 

Updated 20 April 2017

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

• Children would always be offered appointments. If no appointment slots were left they would be seen by a GP on a ‘sit and wait’ basis.
• Immunisation rates were above the 90% standard for all childhood immunisations to the age of two. Immunisation rates for 5 year olds were in line with CCG and national averages.
• Appointments were available outside of school hours. The premises were suitable for families.
• Clinical staff had an understanding of Gillick competence and Fraser guidelines.

Updated 20 April 2017

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.
• Those patients unable to come to the practice, for example, due to being housebound, were able to access home visits from the GP.
• The facilities and consulting rooms were level access for those with reduced mobility.
• Policies and procedures were now in place to support the service provided to this population group.

Updated 20 April 2017

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

• The practice offered extended hours on a Monday evening at the practice.
• Extended hours were available via the local ‘hub’ service in the evenings and at weekends.
• The practice offered a full range of health promotion and screening that reflects the needs for this age group.
• The practice had a range on online services available.
• Nationally reported data showed that outcomes for patients for uptake of cervical smears were in line with other practices locally and nationally.

Updated 20 April 2017

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

• 96% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the national average.
• The practice performance for some mental health indicators was lower than the CCG or national average; however this was due to the very low numbers of patients affecting the data.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• There was information in the waiting area to sign post patients experiencing poor mental health to various support groups and voluntary organisations.

Updated 20 April 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice was aware of those patients on their register who lived in vulnerable circumstances.
• If patients required a longer appointment due to complex needs or multiple medical conditions this was available.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• There were established systems and processes in place to ensure patient safety and enable staff to identify and take appropriate action to safeguard patients from abuse. Staff knew how to recognise signs of abuse in vulnerable adults and children.
• The practice had identified 46 patients as carers (approximately 1.5% of the practice list).