Dr V G Tailor and Dr A Chesterman

Updated 25 November 2016

Dr Dhatt and Tailor, also known as the Hillcrest Surgery, provides primary medical services in the London Borough of Ealing to approximately 7,620 patients. The practice operates under a General Medical Services (GMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract).

The practice operates from one site. The surgery is a converted residential property over three floors. There is stepped and ramp access to the ground floor waiting area and reception desk. The practice has nine consulting rooms. The second floor comprises practice management facilities including a staff room, meeting room and offices.

Patients with mobility issues are offered appointments on the ground floor.

The practice clinical team is made up of two GP partners (male and female), four salaried GPs (two female and two male), two practice nurses, two healthcare assistants (HCAs) and other non-clinical staff.

The practice offers 40 GP sessions per week.

The practice opens between 8.30am and 6.00pm Monday to Friday.

Appointments are available between 8:30am to 12:45pm and 13:45am to 6:00pm Monday to Friday.

Extended hours are available on from 7:30am to 8:00am Monday to Friday.

When the practice is closed patients can call NHS 111 in an emergency or a local out of hour’s service.

The practice is registered with the Care Quality Commission to provide the regulated activities of; maternity and midwifery service, treatment of disease, disorder or injury, family planning, diagnostic and screening procedures and surgical procedures.

Updated 25 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Dhatt & Tailor also known as Hillcrest Surgery on 16 August 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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, except that the adult and child oxygen masks were not in sealed packaging.
• 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.

The areas where the provider should make improvement are:

• Review the system in place to make sure the practice has good facilities and is well equipped to treat patients and meet their needs, including ensuring adult and child oxygen masks are in sealed packaging.

Review arrangements in place to ensure that patients with caring responsibilities are identified, so their needs are identified and can be met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 25 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.

• 74% of patients diagnosed with asthma had an asthma review in the last 12 months; this was comparable to the local average of 76% and national average of 75%.The exception reporting rate was 4%

• Performance for diabetes related indicators was comparable to the local and national average, for instance:

• 85% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 72%, national average 77%). The exception reporting rate was 14%.
• 86% of patients with diabetes on the register had their cholesterol measured as well controlled (local average 75%, national average 81%). The exception reporting rate was 14%.
• 97% of patients with diabetes on the register had a recorded foot examination and risk classification (local average 88%, national average 88%). The exception reporting rate was 3%.

The practice confirmed that the reason for the high level of exception reporting for diabetes is due to the fact that they have a large moving population, therefore many patients who commence treatment at the practice do not continue with their care as they may have moved out of the area.

• 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 25 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 Accident & Emergency 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.

• 76% of women aged 25-64 had it recorded on their notes that a cervical screening test had been performed in the preceding five years; this was comparable to the local average of 78% and national average of 82%. The exception reporting rate was 4%.
• 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 and health visitors.

Updated 25 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.

• 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 25 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.

• The practice offered extended opening hours Monday to Friday from 7:30am to 8:00am.

Updated 25 November 2016

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

• Performance for mental health related indicators was comparable to the local and national average:

• 93% of patients diagnosed with dementia had a recorded review in a face to face meeting in the last 12 months (local average 88%, national average 84%).The exception reporting rate was 4%.

• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 92%, national average 90%).The exception reporting rate was 19%.

• 89% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months (local average 91%, national average 88%).The exception reporting rate was 24%.

  The practice confirmed that the reason for the high level of exception reporting for mental health is that approximately 20% of patients on the mental health register at the practice are admitted into hospital for long-term care and therefore are unable to attend for routine appointments scheduled by the practice.

• 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.

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

Updated 25 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.