Archived: Westdale Lane Surgery Also known as Drs Khaliq, Malik, & Baynham

Updated 2 August 2016

Westdale Lane Surgery is located in the village of Gedling which is in Nottinghamshire. It is approximately four miles northeast of Nottingham city centre. There is direct access to the practice by public transport and parking is also available on site.

The practice currently has a list size of approximately 7638 patients.

The practice holds a General Medical Services (GMS) contract which is a locally agreed contract between NHS England and a GP to deliver care to the public. The practice provides GP services commissioned by NHS Nottingham North and East CCG.

The practice is situated in an area with lower levels of deprivation. It has a higher than national average older age population and a higher than local average number of patients with long standing conditions.

The practice is managed by three GP partners (2 male,1 female). Two GP partners work full time and one works on a part time basis. They are supported by one part time salaried GP (female). Other clinical staff include two full time advanced nurse practitioners, one part time practice nurse and one full time healthcare assistant. The practice also employs a practice manager and a team of reception, clerical and administrative staff. Three cleaners are also employed by the practice.

The practice is a training practice since 2013 and supports trainee GP placements. A GP trainee is a qualified doctor who is training to become a GP through a period of working and training in a practice.

The practice is open on Mondays to Fridays from 8am to 6.30pm. Appointments are available Mondays to Fridays, 8.30am to 11am and 2pm to 6pm. A walk in clinic is open Mondays to Fridays from 8am to 10.30am for those patients requiring to be seen urgently.

The practice is closed during weekends except for one Saturday morning per month where a nurse led clinic is open for patients who cannot attend for appointments at other times. Any minor surgical operations are also undertaken during this time.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are currently provided by Nottingham Emergency Medical Services. (NEMS) When the practice is closed, calls are automatically redirected.

The provider’s Certicate of Registration issued by the Care Quality Commission does not include maternity and midwifery services as a regulated activity provided. We have advised the provider to apply for this regulated activity as this service is currently being provided.

Updated 2 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Westdale Lane Surgery on 12 May 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. Learning outcomes were shared with staff.
• Risks to patients were assessed and well managed. This included effective health and safety management such as regular checks that equipment was safe to use. Appropriate arrangements were in place to ensure the practice could respond to emergencies and processes were in place to ensure good infection prevention control standards.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audit drove quality improvement. Staff had been trained and had the skills, knowledge and experience to deliver effective care and treatment to patients.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Patient feedback which included the National GP Patient survey generally rated the care provided higher than local and national averages.
• Information about services and how to complain was available and easy to understand. Staff we spoke with knew the procedure in place for addressing patient complaints. 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 had been recently renovated. It 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.

The areas where the provider should make improvement are:

• To continue to identify more carers and offer support to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 August 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.

• Longer appointments and home visits were available when needed and the practice had a low threshold approach when making decisions to visit these patients. The practice nurse was assigned to visiting housebound patients routinely every week.

• National data showed that 94% of patients with chronic obstructive pulmonary disease (COPD) had received a review in the previous 12 months. This was above the CCG average of 90% and national average of 90%. However, exception rate reporting was 11.9% above CCG average and 13% above national average. The practice had identified historically high exception reporting and had committed to reducing this. Evidence provided showed a proactive approach had been adopted and more recent data showed a decrease in this.

• The practice had 1663 patients registered with long term conditions on its register. All of these patients had been offered a structured annual review to check their health and medicine needs were being met.

• Practice supplied data showed that 1394 had received an annual review. 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 2 August 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 generally in line with local CCG averages 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.

• Appointments were available outside of school hours and the practice prioritised unwell children and babies.

• Information was displayed in the practice reception area which included teenage health clinics and clinics to assist new parents.

• We saw positive examples of joint working with midwives, health visitors and school nurses and documentation of meetings held supported a coordinated approach in place.

• The practice staff had recived training in domestic violence and female genital mutilation (FGM).

Updated 2 August 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. All older patients had a named GP. Frequent visits were made by the practice clinicians to their patients in care homes in and outside of usual working hours. Feedback we received from care homes praised the practice for their responsiveness, the caring approach towards residents and proactive approach.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. The practice GPs told us they applied a low threshold when making decisions to undertake home visits to see older patients.

• The practice had established systems to enable the recording and sharing of patients’ care preferences and key details about their care at the end of life. The practice had 38 patients on these care plans at the time of our inspection.

• National data showed the practice was performing above the local and national averages for its achievement within some areas of QOF such as osteoporosis indicators, taking exception rate reporting into account. 100% of patients aged 50 or over who had not attained the age of 75 had a diagnosis of osteoporosis confirmed and were being treated. This was the same as the CCG average and above national average of 92%. Exception rate reporting was however, 21.4% below CCG average and 10% below national average.

Updated 2 August 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. Same day appointments were available for those patients who could not attend the walk in clinic as well as pre-bookable appointments. The practice also offered telephone consultations to those who required them.

• 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 had opened a monthly Saturday morning nurse led clinic to those patients who wished to attend on weekend days.

• Data showed that 81% of women aged over 25 but under 65 had received a cervical screening test in the previous five years. The practice was performing below the CCG average of 86% and national average of 82%. Recent data supplied by the practice showed that the uptake of cervical screening had substantially increased since the monthly Saturday clinic was opened.

Updated 2 August 2016

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

• The practice held a register of 45 patients who had poor mental health. All of these patients had been offered an annual health check. Data provided by the practice showed that 42 of these checks had been undertaken.

• Data showed that 79% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was below the CCG average of 86% and below the national average of 88%. Exception reporting was however, 16.3% below the CCG average however, and 10.3% below the national average.

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was the same as the CCG average and higher than the national average of 84%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. We saw that a co-ordinated and effective approach was in place.

• Staff had a good understanding of how to support patients with mental health needs and dementia. One GP told us they ensured that patients with dementia were visited in residential homes by the same GP. They told us they recognised that these patients responded more effectively with this continuity of care provided.

• Carers of patients with dementia were also supported by the same GP.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. We saw information displayed within the practice which signposted patients, for example, Lets Talk Wellbeing service.

Updated 2 August 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. There were 24 patients on the learning disability register, and 23 of these had received an annual health check in the last twelve months. As a result of these reviews, at least 14 of these patients were identified as requiring further intervention because of serious physical, mental and social health care needs.

• We reviewed evidence that demonstrated the practice had adopted a proactive and passionate approach to engaging with patients with learning disabilities. Reviews and appointments took place at a flexible time and location to suit patients’ needs.

• The practice offered longer appointments for patients with a learning disability and reception staff were aware of these patients when booking appointments.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. We spoke to attached community based staff who told us the practice provided an exceptional service and nothing was too much trouble.

• 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. We were informed about two patients who were identified as requiring safeguarding and appropriate measures had been put into place within the last twelve months.