Dr S Johal & Partner Also known as Oakland Medical Centre

Updated 5 May 2017

Dr S Johal & Partner (also known as The Oakland Medical Centre) is a well-established GP practice situated within the London Borough of Hillingdon. The practice lies within the administrative boundaries of NHS Hillingdon Clinical Commissioning Group (CCG) and is a member of the Wellcare Health Ltd locality.

The practice provides primary medical services to approximately 7,000 patients living in Hillingdon within the practice boundary. The practice holds a core General Medical Services Contract (GMS) and Directed Enhanced Services Contracts. The practice is located at 32 Parkway, Hillingdon, Uxbridge, UB10 9JX with good transport links by bus services.

The practice operates from a purpose built building owned and managed by the GP partners. The building is set over three floors with lift and stair access. There are four consultation rooms and two treatment rooms on the ground floor, four consultation rooms on the first floor and three consultation rooms on the third floor. The reception and waiting area are on the ground floor with wheelchair access to the entrance of the building. There are toilet facilities on each floor of the practice including those for people with disabilities. There are car parking facilities at the rear of the practice.

The practice population is ethnically diverse and has a similar to the national average number of patients between 0 and 19 years of age and higher than the national average number of patients 65 years plus. The practice area is rated in the third less 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 (59%, 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, surgical procedures and treatment of disease disorder & Injury.

The practice had within the last year experienced difficulties with the recruitment of a permanent practice manager following the resignation of the previous post holder. Three separate interim practice managers had been employed to cover the vacancy until the permanent position was filled in April 2016 by the current practice business manager. Additionally two of the GP partners had unexpected separate periods of absence due to illness, within the last twelve months.

The practice team comprises of two male GP partners, three female salaried GPs (one is currently on maternity leave and one on a year’s sabbatical), three female locum GPs and two male locum GPs who all collectively work a total of 26 clinical sessions per week. They are supported by a part time advanced nurse practitioner, two part time practice nurses, a health care assistant, a practice business manager and seven administration/reception staff.

The practice opening hours are from 8.50am to 6.30pm Monday to Friday. Consultation times in the morning are from 9am to 12.30pm and in the afternoon from 3pm to 6pm Monday to Friday. Extended hour appointments are offered from 6.30pm to 8pm Wednesday evening and from 7am to 08.50am on Thursday morning. Pre-bookable appointments can be booked four weeks in advance. 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, contraception and family planning.

Updated 5 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S Johal & Partner (also known as The Oakland Medical Centre) on 7 April 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the 7 April 2015 inspection can be found by selecting the ‘all reports’ link for Dr S Johal & Partner on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 8 December 2016 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 April 2015. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now 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.
• The practice had clearly defined and embedded systems to minimise risks to patient’s safety.
• 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.
• The practice had effective systems in place to minimise risks to patient safety.
• Staff were aware of current evidence based guidance.
• Patients said they felt the practice offered an excellent service and staff were helpful, friendly and professional and treated them with dignity and respect.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients found it easy make an appointment with a GP with urgent appointments available the same day.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice acted upon feedback from staff and patients.
• The provider was aware of and complied with the requirements of the duty of candour.

However, there were also areas of practice where the provider needs to make improvements.

The areas where the provider should make improvement are;

• Review the arrangements for the disposal of sharps used to administer cytostatic medicines.
• Review the security arrangements of the room where clinical waste and cryotherapy equipment is stored.
• Review the arrangements for the cleaning of clinical equipment including schedule and log.
• Consider the options for documenting when emergency medicines are taken from stock by clinical staff.
• Continue to make improvements in the performance for QOF, including patient outcomes in long-term conditions, childhood immunisations and to align with local and national averages.
• Ensure that recommendations from clinical audit are actioned.
• Continue to identify and support more patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 May 2017

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

• The practice had two dedicated diabetic nurses who had received enhanced training in management of diabetes including insulin initiation. They pro-actively re-called patients and conducted annual health checks in a dedicated weekly diabetic clinic.
• The practice kept a register of patients with long-term conditions and they were invited for structured annual health checks including medication review.
• Longer appointments and home visits were available when needed.
• The practice held monthly multi-disciplinary team meetings to discuss and manage cases of patients with complex medical needs. These meetings were attended by the primary care co-ordinator, members of the community nursing team, community matron and palliative care nurse.
• Patients with risk factors for developing long term conditions were identified through NHS health checks and routine screening. Patients were referred to appropriate services to help modify risk factors.
• Patients with long term conditions at risk of hospital admission were identified by the primary care co-ordinator and invited for review to create integrated care plans aimed at reducing this risk.
• The practice offered flu immunisation to patients with long term conditions in line with national guidance.

Updated 5 May 2017

The practice is rated as good for the care of families, children and young people.

• There was a named GP lead for safeguarding children, staff had received role appropriate training and were aware of their responsibilities to raise concerns.
• The practice provided shared antenatal care with the local midwife team and routine post-natal care including six week post-natal checks.
• Childhood immunisation rates for the vaccinations given to under two year olds for 2015/16 achieved the 90% national target rate in three out of four sub-indicators. The overall achievement score fell below the national average. Vaccination rates for five year olds were comparable to CCG and national averages. The practice had a recall system for babies and children who had not attended for their immunisation.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The uptake for the cervical screening programme 2015/16 was 77%, which was comparable to the CCG average of 73% and the national average of 81%.

Updated 5 May 2017

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

• Older patients at risk of hospital admission were identified by the primary care co-ordinator and invited for review to create integrated care plans aimed at reducing this risk.
• The practice held monthly multi-disciplinary team meetings to discuss and manage cases of older patients with complex medical needs. These meetings were attended by the primary care co-ordinator, members of the community nursing team, community matron and palliative care nurse.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• There was a wellbeing officer attached to the practice who could assist older patients with their social care needs and referred them to local community support groups as required.
• There was a named GP lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.
• The practice offered flu and shingles immunisation for older patients in line with national guidance.

Updated 5 May 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• Extended hour appointments were available twice a week for patients unable to attend the practice during normal working hours. Telephone consultations with a GP were also available daily.
• There was the facility to book appointments and request repeat prescriptions online.
• The practice offered health checks for new patients and NHS health checks for patients aged 40 to 74 years of age with appropriate follow-up of any risk factors identified.
• Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.

Updated 5 May 2017

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

• 76% of the 100 patients’ diagnosed with dementia on the practice list had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 87% and the national average of 84%.
• 56% of the 52 patients, on the register, with schizophrenia, bipolar affective disorder and other psychoses, had a comprehensive, agreed care plan documented in the last 12 months; compared to the CCG average of 92% and national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice advised patients experiencing poor mental health how to access various support groups and voluntary organisations.
• The practice had two counsellors from Improving Access to Psychological Therapies (IAPT) who provided general counselling services and cognitive behavioural therapy one and a half days a week.
• Patients on the mental health register were invited to annual health checks including medication review and blood tests if required.   

Updated 5 May 2017

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 in vulnerable adults and children 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 and those with a learning disability.
• The practice offered annual health checks for patients with a learning disability with longer appointments available if required.
• 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.