Archived: Dr Biju Kuriakose Also known as Greensward Surgery

Updated 22 March 2016

Dr Biju Kuriakose, also known as Greensward Surgery, is located in Hockley, Essex. At the time of our inspection, the practice had a list size of approximately 5800 patients and their list was open. The practice had a larger than average population group aged 40 years and over and a smaller than average population group aged below 40 years old.

• The practice had a lead GP and two salaried GPs supported by three trainee GPs.

• The nursing team comprised of two practice nurses and a healthcare assistant.

• The practice team comprised of a practice manager, three administrators and a team of six reception staff.

• The practice is a training practice for GPs.

The practice is located in a purpose built building in a residential area with on-site parking available, including dedicated parking bays for the disabled and access to the premises for wheelchair users.

The practice is open on Mondays to Fridays from 8am to 6.30pm, with extended hours on Fridays to 7.30pm.

Appointments are available from 9am to 12pm daily, from 3pm to 6pm Monday to Thursday and from 3pm to 7.30pm on Fridays.

Weekend and evening appointments are also available through the local GP Alliance at an alternative location.

When the practice is closed patients are signposted to out of hours services by calling 111. Out of hours care is provided by IC24.

Updated 22 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Biju Kuriakose on 18 February 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised and discussed on a weekly basis.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the GPs provided joint visits with the palliative care team to patient’s homes to improve patient care.

• Feedback from patients, staff and external organisations about the care provided was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. The practice regularly engaged with NHS England Area Team and Clinical Commissioning Group (CCG).

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, following patient feedback the extended hours were altered to suit patient demand.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment. There were weekly tutorials and clinical meetings to discuss guidelines, the impact on patients and actions to be taken.
• Information about services and how to complain was widely available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the Duty of Candour. Openness and transparency was promoted within the practice.
• The practice had a vision which had patient care as its top priority.

We saw several areas of outstanding practice including:

• A project to educate patients on A&E attendance which resulted in a 74% decrease in visits.

• An early detection test for deep vein thrombosis to reduce unnecessary referrals.

• The practice had won several awards including Primary Educator of the Year 2015 for the East of England.

However there were areas where the provider should make improvements:

• Conduct fire drills at the required intervals.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 22 March 2016

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

• Staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority using a risk stratification tool.

• The practice performed better than national averages for all the diabetes indicators within the Quality and Outcomes Framework.

• Longer appointments and home visits were available when needed.

• The practice provided joint visits with the palliative care team, we received very positive feedback from the palliative care nurse who told us the joint visits improved patient care and communication between care providers.

• 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.

• 73% of patients diagnosed with asthma, on the register, who had an asthma review in the preceding12 months that includes an assessment of asthma control using the 3 RCP questions (01/04/2014 to 31/03/2015) which was comparable to the national average of 75%.

Updated 22 March 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. A project had been undertaken to educate patients and this had reduced A&E attendances.

• 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.

• Most child immunisation rates were high achieving 100% in most areas.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 22 March 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.

• Flu vaccinations were offered at home for patients who were unable to get to the surgery. The practice had been recognised by the CCG for their flu vaccination program.

• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were good, for example 93% of patients with COPD had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (01/04/2014 to 31/03/2015) which was higher than the national average of 90%

Updated 22 March 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 very proactive in offering online services; we received very positive feedback regarding the practice website. The practice used an online service to enable patients to contact the GP with their medical concerns, the patients would get a response within 24 hours. The practice also utilised social media as a form of communication.

• The practice was part of the local GP alliance which offered patients weekend and evening appointments at an alternative location.

• The practice offered a full range of health promotion and screening that reflects the needs for this age group.

• 95% of women aged 25 to 64 years old had notes recording a cervical screening test performed in the preceding five years (01/04/2014 to 31/03/2015) which was higher than the national average of 82%.

Updated 22 March 2016

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

• The practice scored higher than the national average for all the mental health indicators within the Quality and Outcomes Framework. For example, 92

• The practice regularly worked with multi-disciplinary teams in the case management of people 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 including the Dementia Intensive Support Team.

• The practice enabled an external counselling service to use the practice premises to operate at no cost, this service was open to all patients at the practice

• 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 22 March 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 travellers and those with a learning disability.

• The practice offered longer appointments for patients with a learning disability, including 30 minutes for health checks.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• 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.

• The practice provided facilities for a counselling service which was available to its patients.