Dr Parvinder Garcha Also known as Hounslow Family Practice

Updated 2 October 2017

Dr Parvinder Garcha, also known as Hounslow Family Practice, provides NHS primary medical services to approximately 3,800 patients living in the surrounding area of Hounslow. The practice has a General Medical Services (GMS) contract (GMS is one of the three contracting routes that have been available to enable commissioning of primary medical services). The practice is part of NHS Hounslow Clinical Commissioning Group (CCG) and the Great West Road locality (comprised of ten practices).

The practice team consists of a GP principal (male) and three sessional GPs (two male and one female) providing 14 clinical sessions collectively. The GPs are supported by a practice nurse (21 hours); a health care assistant (16 hours); a practice manager (37.5 hours); and eight receptionists / administrators. The practice employs a consultant business manager on a temporary basis.

The practice is located in a converted residential property with two consulting rooms on the ground floor and two consulting rooms on the first floor. A third consulting room on the first floor is not currently being used for clinical purposes. There are administrative areas on the ground and second floors. The ground floor of the premises is accessible by wheelchair.

The practice is open from 8am to 6.30pm every weekday, with the exception of Wednesday when it closes at 2pm (From October 2017 the practice will be open on Wednesday till 6.30pm). Pre-booked appointments are available during these times. Extended hours appointments are available from 6.30pm to 7pm on Monday and Thursday, 6.30pm to 7.30pm on Tuesday and Friday, and 7am to 8am on Wednesday. Same day appointments are available for patients with complex or more urgent needs. The practice offers an ad hoc emergency clinic on a Saturday. When the practice is closed, patients are advised to use the local out-of-hours provider or are booked an appointment at the local primary care service ‘hub’.

The practice population is characterised by average levels of income deprivation, employment rates and life expectancy. The practice has a higher percentage of patients aged 25 to 44 compared to the English average. The population is ethnically diverse.

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

Updated 2 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Parvinder Garcha, also known as Hounslow Family Practice, on 22 June 2016. The practice was rated as requires improvement for providing safe, effective, and well-led services, and good for providing caring and responsive services. Overall the practice was rated as requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Parvinder Garcha on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 11 September to check for improvements since our previous inspection. The practice is now rated as good for providing safe, effective, caring, responsive and well-led services. 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 a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• There was evidence of kind and compassionate care, with the GP principal providing his direct contact number to palliative care patients and their families. The GP also visited these patients in hospital and liaised with hospital staff to ensure continuity of care was maintained.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• There was a clear leadership structure and staff felt supported by the GPs and management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Implement safety signage to indicate oxygen is stored on the premises.
• Review the system to monitor and assess performance for the childhood immunisation programme.
• Advertise that a translation service is available to patients on request.
• Raise staff awareness of the practice’s updated complaints procedure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 October 2017

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

• GPs and nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice had performed well on the Quality and Outcomes Framework (QOF) for managing long-term conditions. Unpublished and unverified data indicated that overall performance for diabetes related indicators had improved from 83% in 2015/16 to 96% in 2016/17.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• All these patients had a named GP and there was a system to recall patients for 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 2 October 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 and emergency (A&E) attendances.
• Immunisation rates were comparable to CCG averages and below national averages. The practice told us about administrative errors which may have contributed to the low figures.
• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people.

Updated 2 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
• The practice worked collaboratively with other healthcare professionals in providing care and services to older people with complex needs. For example, utilising primary care coordinators to increase the quality in care planning and referring patients to community services.

Updated 2 October 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours from 6.30pm to 7pm on Monday and Thursday, 6.30pm to 7.30pm on Tuesday and Friday, and 7am to 8am on Wednesday. The GP principal also offered ad-hoc Saturday appointments at the practice, and pre-booked appointments in the evening and at weekends at the local primary care ‘hub’.
• The practice was proactive in offering online services to book appointments and order repeat prescriptions, as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice planned to introduce virtual consultations.

Updated 2 October 2017

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 patients living in vulnerable circumstances including those with a mental health illness.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice had signed up to the ‘common complex and serious mental health’ out of hospital service for monitoring and caring for patients with long-term depression and serious mental illness.
• In 2015/16, 88% of patients with a diagnosed psychosis had a comprehensive care plan in their records, which was comparable to the CCG and national averages of 89%.
• The practice carried out advance care planning for patients living with dementia. However, in 2015/16, 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months, which was below the CCG average of 86% and national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 2 October 2017

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, and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable. The GP principal gave his direct contact number to palliative care patients and visited them when they were admitted to hospital.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 had signed up to the ‘caring for homeless patients’ out of hospital service, aimed at people who were homeless and had difficulty accessing general practice care. There were currently 20 patients on the practice’s homeless register. Staff were able to recognise the challenges faced by these patients in terms of access and communication with the practice, and offered a supportive and flexible approach when booking appointments and reviews. The GP principal was the locality lead for homelessness and worked closely with other health providers to offer care to homeless patients. The practice address could also be used by homeless patients for correspondence with the hospital or other care services.