Dr GS Chana's Practice Also known as The Yiewsley Family Practice

Updated 23 November 2016

Dr GS Chanas Practice (also known as The Yiewsley Family Practice) is a well-established GP practice situated within the London Borough Hillingdon and has a long history in the area dating back to 1921. The practice lies within the administrative boundaries of NHS Hillingdon Clinical Commissioning Group (CCG) and is one of eight member GP practices of the Wellcare Health Network in the Uxbridge and West Drayton locality.

The practice operates from Yiewsley Health Centre located at 20 to 22 High Street in West Drayton and the premises are owned and managed by NHS Property Services. The practice has occupied the premises for 43 years and shares the location with one other GP practice and a community health care organisation. It operates from the ground floor of the building renting four consultation rooms and a porta cabin which houses three consultation rooms. The reception and shared waiting area are on the ground floor with wheelchair access to the entrance of the building. There are disabled toilet facilities and two disabled car park spaces on site and restricted car parking off site.

The practice provides primary medical services to approximately 11,300 patients living in West Drayton, Yiewsley and parts of Cowley and holds a core General Medical Services Contract (GMS) and Directed Enhanced Services Contracts. The patient list size has grown by approximately 500 patients per year over the last 10 years due to new housing stock and is anticipated to continue to rise because of further housing development in the area. As a result the practice premises have become deficient in space. The practice is awaiting a decision on an application submitted by the landlord to NHS England, for extension of the current building/larger replacement of the portacabin, to address the shortage of space.

The practice population is ethnically diverse and has a higher than the national average number of patients between 0 and 14 years of age and a higher than the national average number of patients between 25 to 39 years of age. There is a lower than the national average number of patients 45 years plus. The practice area is rated in the fourth more deprived decile of the national Index of Multiple Deprivation (IMD). People living in more deprived areas tend to have greater need for health services. Data from Public Health England 2014/15 shows that the practice has a lower percentage of patients with a long-standing condition compared to CCG and England averages (53%, 50%, and 54% respectively).

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

The practice team comprises of two male and one female GP partner and a locum female GP who all collectively work a total of 36 clinical sessions per week. They are supported by a part time advanced nurse practitioner, three practice nurses covering two full time hours, a practice manager, assistant practice manager and nine administration staff.

The practice opening hours are from 8.00am to 12.00pm and 1.00pm to 6.30pm Monday to Friday with the exception of Thursday when closed at 5.30pm. Consultation times in the morning are from 8.00am to 11.30am Monday to Friday. Consultation times in the afternoon are from 1.00pm to 5.30pm Monday, Tuesday, Wednesday and from 1.00pm to 4.55pm Thursday and Friday. Extended hour appointments are offered from 7.30am to 7.50am Monday and Friday and from 7.15am to 7.45am Tuesday, Wednesday and Thursday. The out of hours services are provided by an alternative provider. The details of the out-of-hours service are communicated in a recorded message accessed by calling the practice when it is closed and on the practice website.

The practice provides a wide range of services including chronic disease management, minor surgery and health checks for patients 40 years plus. The practice also provides health promotion services including, cervical screening, childhood immunisations, weight loss advice, contraception and family planning.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr GS Chanas Practice (also known as The Yiewsley Family Practice) on 21 June 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, although documentation was not consistent.
• 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 felt the practice offered a good service and staff were friendly, helpful, polite and supportive and treated them with dignity and respect.
• 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 was equipped to treat patients and meet their needs, however space was restricted and the building in need of refurbishment.
• 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:

• Revise the incident reporting form so that it supports the recording of notifiable incidents under the duty of candour.

• Review the documentation and monitoring of all significant events to ensure a consistent approach.

• Implement a formal process for the recording of clinical meeting discussions.

• Revise the recording form used to monitor fridge temperatures to enable explanation/remedial action to be recorded in the event of temperatures falling outside of range.

• Regularly monitor practice compliance with I infection control protocols.

• Review the GP locum pack to ensure all relevant information is included.

• Display notices in the reception areas informing patients that translation services are available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 November 2016

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

• There was GP and nurse led management of chronic conditions with annual health checks including medication reviews. Alerts were placed on patient’s electronic records to highlight when they were due for review and patients were sent reminder letters.

• The practice ran nurse led clinics for specific long term conditions, such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).

• 2014/2015 QOF data showed the practice was performing at or above national averages for performance indicators relating to long term conditions, for example diabetes and high blood pressure.

• The practice actively reviewed patient’s electronic notes to identify cases of undiagnosed long term conditions.

• The practice participated in local integrated care planning and admission avoidance schemes. Patients with long term conditions at high risk of hospital admission were identified and invited for review to create integrated care plans aimed at reducing this risk. Care plans could be completed at home visits for patients unable to attend the practice.

• The practice held monthly multi-disciplinary team meetings attended by members of the district nursing team, community matron and palliative care team to discuss patients with complex medical needs.

• Home visits, including flu immunisations, and longer appointments were available if required.

• The practice had access to a community COPD nurse who attended the surgery and reviewed patients with COPD, including those that utilised acute unscheduled services frequently.

Updated 23 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. There was a named lead for safeguarding children and staff had received role appropriate training. The GP safeguarding lead was a specialist in Female Genital Mutilation (FGM) with expertise in the identification and support of young women affected by FGM and those who may be at risk.

• Immunisation rates were similar to CCG averages for all standard childhood immunisations. Missed appointments for immunisations and families who repeatedly missed immunisations were referred to the health visitor team for review.

• 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. Same day appointments were also available for unwell children.

• Community paediatric nurse led clinics were held twice weekly.

• Routine ante-natal and post-natal care, including eight weeks mother and baby checks were provided by the practice.

• Nurse and GP-led family planning advice was offered as required.

Updated 23 November 2016

The practice is rated as good for the care of older people.

• There was a named GP lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.
• All patients over the age of 75 years had a named GP.
• The practice participated in local integrated care planning and admission avoidance schemes. Older patients at high risk of hospital admission were identified and invited for review to create integrated care plans aimed at reducing this risk. Care plans could be completed at home visits for patients unable to attend the practice.
• The practice had access to an Integrated Care Plan (ICP) Navigator who attended the surgery and supported the practice with complex patients at risk of admission.
• The practice held monthly multi-disciplinary team meetings attended by members of the district nursing team, community matron and palliative care team to discuss older patients with complex medical needs.
• Home visits, including flu immunisations, were available for patients unable to attend the practice due to illness or immobility.

Updated 23 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.

• Extended hour appointments were available in the morning for patients unable to attend the practice during normal working hours. Telephone consultations were also available on request.

• There was the facility to book appointments and request repeat prescriptions online. The practice used a text message appointment reminding service. Patients were encouraged to communicate with the practice via the practice website and through email.

• Patients had access to health checks for new patients and NHS health checks for patients aged 40–74. Appropriate follow-ups for the outcomes of health assessments and checks were made, where abnormalities or risk factors were identified.

• Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.

Updated 23 November 2016

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

• Dementia screening was offered opportunistically during routine appointments and home visits and as well as part of care plan assessments. Active case dementia case finding was also performed, for example older patients who had stopped attending the surgery were identified and received annual visits when screening for dementia could be completed.

• The practice maintained a register of patients diagnosed with dementia and these patients were invited for review to create integrated care plans.

• 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 how to access various support groups and voluntary organisations.

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

• Members of the community mental health team held clinics for patients at the practice and clinical staff had access to support and were aware of how to make urgent referrals to the specialist mental health services as required.

Updated 23 November 2016

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

• There was a named GP lead for safeguarding vulnerable adults. Staff knew how to recognise signs of abuse and 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.

• 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. These patients were invited for annual health checks including medication review.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• There was a named lead for safeguarding vulnerable adults and staff had received role appropriate training. The GP safeguarding lead was a specialist in Female Genital Mutilation (FGM) and held a weekly FGM clinic at the practice which could also be accessed by non-registered patients from the wider community. This had resulted in the diagnosis of 76 patients from the practice population who had been affected by FGM and other related difficulties, who were offered support and onward referral as appropriate.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.