Dr Reynolds, Dr Waters, Dr Arfeen & Dr Varma Also known as Elthorne Park Surgery

Updated 21 September 2016

Dr R Shah & Dr P Reynolds & Dr M Waters & Dr A Arfeen's Practice is located in Hanwell in the London Borough of Ealing. The practice provides care to around 8586 patients.

The practice is registered as a partnership with the Care Quality Commission (CQC) to provide the regulated activities of: treatment of disease, disorder or injury; diagnostic and screening procedures; family planning services; surgical procedures and maternity and midwifery services.

The practice has a General Medical Services (GMS) contract and provides a full range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning, sexual health services and surgical procedures.

The practice has four GP partners and one long term locum GPs working a total of 31 sessions amongst them. However at the time of our inspection one of the partners was on long term sick leave. There is a good mix of female and male staff. The practice has a full time practice manager and an assistant practice manager. The rest of the practice team consists of one full time practice nurse, one health care assistant and seven administrative staff consisting of five receptionists, one medical secretary and one administrator.

The practice is currently open five days a week from 08:00- 18:15hrs on Mondays- Fridays. On Saturdays for pre-booked appointments between 08:00-12:00hrs. Consultation times are 08:15 until 12:50hrs and 15:00 until 18:00hrs.

When the practices are closed, the telephone answering service directs patients to contact the out of hours provider.

There were no previous performance issues or concerns about this practice prior to our inspec tion.

Updated 21 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr R Shah & Dr P Reynolds & Dr M Waters & Dr A Arfeen's Practice on 19 July 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.
• 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.
• However most patients said they found it difficult to make an appointment with a named GP, though they could request urgent telephone consultation if needed.

The areas where the provider should make improvement are:

• Review the below average QOF scores for patients with diabetes so as to improve.

• Actively seek to involve patients in developing and improving the service.

• Consider ways to improve the availability of patient appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 September 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 lower than the national average (practice 69%; national 78%).The practice were aware of this and were working to improve patients diseases management.

• 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 21 September 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 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.

• The practice’s uptake for the cervical screening programme was 77%, which was comparable to the CCG average of 78% and the national average of 81%.

• 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, health visitors and school nurses.

Updated 21 September 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.

• Systems were in place to identify and assess patients who were at high risk of admission to hospital and the practice would call them after discharge to ensure they were receiving appropriate follow up care .

Updated 21 September 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.

Updated 21 September 2016

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

• The dementia diagnosis rate was comparable to the national average (practice 76%; national 84%).The practice had sixty one patients who were eligible for the screening and had recorded an exception rate of three patients.

• 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 21 September 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.