Archived: Dr Surinder Kumar Arora Also known as Herne Hill Road Medical Practice

Updated 31 May 2016

Dr Surinder Kumar Arora (also known as Herne Hill Road Medical Practice) is part of Lambeth CCG and serves approximately 6,000 patients. The practice is registered with the CQC for the following regulated activities Diagnostic and Screening Procedures, Family Planning, Maternity and Midwifery Services, Surgical Procedures and Treatment of Disease, Disorder or Injury.

The majority of the practice population is white but non British. The practice also has a significant number of Black and Afro Caribbean patients. The practice is situated in an area ranked within the second most deprived decile on the IMD deprivation index. The practice has a significantly higher proportion of working age people and lower proportion of older people comparative to the national average. The proportion of patients under 20 were in line with national averages.

The practice is run by two male partners and three female salaried GPs. There is a practice nurse, a nurse practitioner and another nurse who is also a midwife providing midwifery services. The practice is a teaching practice and hosts first, second and fourth year students from the local hospital. The practice offers 26 sessions per week.

The Practice is registered with CQC as a single handed practice however the practice has been operating as a partnership since 2015. The practice operates from purpose built premises which are owned by the partnership. The provider has submitted an application to cancel their existing CQC registration and has applied to register a new partnership.

The practice is open between 8.00 am and 6.30 pm Monday to Friday. Appointments are from 8.30 am to 11.20 Monday to Friday and resume 3.30pm to 18.00 in the evening except on Thursday when surgery resumes at 4pm. Extended surgery hours are offered between 7.30 and 8.30 am and 6.30pm to 7.30pm on Wednesdays. In addition to pre-bookable appointments that can be booked up to one month in advance, urgent appointments are also available for people who need them which can be booked the same day. Patients could also book appointments 24 hours or 48 hours in advance. If patients require treatment at the weekend the practice can refer them to the local GP access hub which provides care from 8am – 8pm seven days a week through the local Federation.

Practice patients are directed to contact the local out of hours provider when the surgery is closed.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These are:

Childhood Vaccination and Immunisation Scheme, Extended Hours Access, Facilitating Timely Diagnosis and Support for People with Dementia, Influenza and Pneumococcal Immunisation, Learning Disabilities, Minor Surgery, Patient Participation, Remote Care Monitoring and Rotavirus and Shingles Immunisation.

The practice had recently joined a Federation with other GP surgeries in the locality.

Updated 31 May 2016

We carried out an announced comprehensive inspection at Dr Surinder Kumar Arora (Herne Hill Medical Practice) on 9 February 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. However it was not always clear what action had been taken in response to significant events or the dates when these events had occurred.
• Risks to patients were not always well managed. We found that some staff had not completed certain mandatory training and that the practice did not always perform checks for new staff as outlined in their recruitment policy.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

• The practice ran educational sessions at the local library with input from the Patient Participation Group (PPG); including sessions for carers, cancer and dementia awareness and a well in winter evening. Though the PPG was already representative of the diversity of the patient population, the practice had run a further awareness session to promote patient inclusion.The practice manager and one of the receptionists had won a kindness award after being nominated by the PPG. The practice was subsequently approached by their Clinical Commissioning Group (CCG) to participate in a film about PPG’s.The PPG had raised money to purchase a specialised chair for the practice waiting area to accommodate elderly patients. One member of the PPG was actively involved in a community farming project. The practice referred patients to the farm whom they felt would benefit from participating in the project.

The areas where the provider must make improvement are:

• Improve its significant events procedures to ensure that action is taken to address all concerns identified.

• Ensure that mandatory training is completed in accordance with current guidelines.

• Ensure that pre-employment checks are completed for all staff and that systems are in place to monitor their professional registrations.

The areas where the provider should make improvements are:

• Consider reviewing its mechanisms for recording meetings.

• Consider documenting a strategic business plan.

• The practice should take further proactive steps to identify patients with caring responsibilities.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 31 May 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 the national average.

• The performance for asthma indicators was in line with the national average.

• Longer appointments and home visits were available when needed.

• All patients with long term conditions 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 through the use of virtual clinics which were jointly run with consultants from a local hospital.

• Clinics were held for patients with asthma, hypertension, diabetes and atrial fibrillation and are used to ensure medicines for these patients are optimised in accordance with current best practice.

Updated 31 May 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. The practice also held regular meetings with the community health visitor. Immunisation rates were relatively high for all standard childhood immunisations.
• The practice employed a health visitor and a midwife which improved continuity of care and enabled the practice to better meet the needs of children, pregnant women and young mothers.
• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had produced a leaflet to promote services in the local area for young people. The leaflet also made reference to the practice’s policy to see patients without an adult present if they were under 16 years of age.
• The practice was participating in a study which provided support in the use and choice of antidepressants in pregnancy.

Updated 31 May 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 told us that they would discuss patients at the end of their lives with the palliative care team when required.

• The practice conducted Holistic Health Assessments (HHA) for patients over 80 or those who were housebound.

Updated 31 May 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.

• The practice employed a nurse who undertook breast examinations and screening.

• The practice ran an out of hours cervical screening service and the practice performance for cervical screening was in line with national averages.

Updated 31 May 2016

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

• 82% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average
• Performance for other mental health related indicators was similar to the national average.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
• The practice had an in house counsellor and received support from the local mental health initiative.
• The practice accessed a local mental health hub which enabled holistic management of patients with mental health conditions in conjunction with primary care. The practice told us that this allowed patients to be escalated quickly when they required additional support from other agencies and also made it easier to transfer patients into the remit of primary care providers.
• The practice carried out advance care planning for patients with dementia.
• The practice told patients experiencing poor mental health how to access various support groups and voluntary organisations; including a community farming project which was supported by one of the practice’s PPG members.
• 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 31 May 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 those with a learning disability.

• The practice advised that they would register patients who had no fixed address at the practice.

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

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people; including those on the child protection register and those with a mental health condition.

• 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.

• Practice staff had under taken a Female Genital Mutilation (FGM) awareness training session in house.

• The practice had links with a local domestic violence organisation which had provided training to staff. The practice allowed the organisation to work from their premises when requested.

• The practice had signed up to a study which aimed to screen for hepatitis B and C in all groups deemed at risk.