Dr Kothari, Dr Nanda,Dr Brezina,Dr Hart and Dr Metcalfe Also known as The Puzey Family Practice

Updated 25 May 2016

Dr Kothari, Dr Nanda, Dr Brezina, Dr Hart and Dr Metcalfe is also known as The Puzey Family Practice. The practice is located centrally in the town of Rochford in Essex. There are good commuter links with a nearby train station; there is also ample pay and display car parking immediately outside the practice.

The practice is located in a building which is shared with a second practice.

At the time of our inspection the practice had a patient list size of 12,600.

There are four partner GPs; one female and three male as well as three salaried GPs; two female and one male. The nursing team are made of up an advanced nurse practitioner, four nurses, a healthcare assistant and two phlebotomists. The non-clinical team includes a practice manager, a team of receptionists, administrative staff and medical secretaries.

The practice has been a training practice since 2010, one GP is qualified as a trainer, there is also an associate trainer and two GPs enrolled on an associate trainer course. The practice provides training for medical students, GP trainees, F2 doctors and nurses.

The practice is open from 7am to 7pm Monday to Friday and from 8.30am to 11am on Saturdays. Appointments are available throughout these opening hours. In addition, the practice is a member of the local GP Alliance which offers appointments on Saturdays and Sundays at an alternative location.

When the practice are closed, patients are directed to 111 for out of hours services provided by IC24.

The patient demographics are very similar to national averages, the practice has a higher than average deprivation score than the CCG average but lower than average when compared nationally.

Updated 25 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kothari, Dr Nanda, Dr Brezina, Dr Hart and Dr Metcalfe, also known as The Puzey Family Practice on 5 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. All staff understood this system and significant events were routinely discussed with all staff to ensure improvements were made.
• Risks to patients were continually assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. There was a robust system in place to ensure new guidance was received and implemented by all staff.
• The practice worked with external organisations to provide a multidisciplinary approach to patient care. We received positive feedback from these organisations.
• 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 in several formats and was easy to understand. The practice proactively reviewed complaints at staff meetings and 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 and walk in appointments available the same day.

• Extended hours provided a range of appointments times for all patients. Home visits were routinely provided to ensure care for more vulnerable patients.

• Health checks, vaccinations and joint injections were all offered as home visits when patients were unable to attend the practice.

• A free acupuncture service was offered to patients when suitable in an attempt to reduce the use of analgesics.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was a training practice for medical students, doctors and nurses and staff were passionate about continuous professional development.
• The practice had strong, visible clinical and managerial leadership and governance arrangements. There was a clear leadership structure and staff felt supported.
• The practice proactively sought feedback from staff, the patient participation group and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

An area where the provider should make improvement is:

Continue to identify carers and offer these patients additional support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 May 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 such as diabetes and COPD. COPD reviews were offered at home for patients unable to attend the practice.
• Patients at risk of hospital admission were identified as a priority and monitored to reduce this risk.
• Data from 2014/2015 showed the practice performance for diabetes indicators was generally in line with local and national averages. For example, 80% of patients with diabetes, on the register, whose last measured total cholesterol (measured in the preceding 12 months) was five mmol/l or less, this was comparable to the CCG average of 77% and the national average of 81%.
• Longer appointments and home visits were proactively offered when needed and staff felt supported in offering these services.
• 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, a lead GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. This information was routinely shared with all clinical staff to ensure records were up to date. We also received positive feedback from external organisations with regards to palliative and multidisciplinary care.

Updated 25 May 2016

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

• There were systems to ensure GPs identified and followed 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 lead GP for safeguarding had a good awareness of vulnerable patients and shared this information with clinical staff.
• Immunisation rates were in line with or above local 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. Staff had a good understanding of Gillick competency.
• The practice performance for cervical screening was comparable to local and national averages; 82% of women aged 25-64 had a record of a cervical screening test performed in the preceding five years (01/04/2014 to 31/03/2015), compared to a CCG average of 87% and a national average of 82%.
• Appointments were available outside of school hours, early in the morning, after school and at weekends. The premises were suitable for children and babies.

Updated 25 May 2016

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

• The practice had a growing population of older people and adapted their services to provide proactive, personalised care to meet their needs.
• New guidance was routinely implemented to ensure the appropriate care and treatment of older people.
• The practice took pride in never declining a request for a home visit.
• In addition to routine home visits, patients who were unable to visit the practice were offered vaccinations, health checks and joint injections at home.
• Additional services such as Doppler vascular assessments were available to promote the diagnosis of vascular disease.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable to local and national averages.

Updated 25 May 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.
• Extended hours offered appointments at times convenient to patients who worked full time. Walk-in appointments were also available and a flexible flu vaccination programme allowed working aged people to attend when convenient.
• The practice was proactive in offering online services such as appointment booking and prescriptions. There was a range of health promotion and screening that reflected the needs for this age group.
• A free acupuncture service was provided when suitable to reduce the need for analgesia. which may have interfered with patient’s ability to work or drive.

Updated 25 May 2016

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

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (01/04/2014 to 31/03/2015); this was above the CCG average of 77% and the national average of 88%.
• There was a lead GP who regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and ensured advanced care planning for patients with dementia.
• A CCG counselling service was offered at the practice for patients experiencing poor mental health.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and information was available in the waiting area.
• 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 25 May 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 was an open door policy for registering patients with no fixed address and the practice prioritised these vulnerable patients.
• There was a lead GP for patients with learning disabilities who ensured health checks were carried out.
• The practice offered longer appointments for patients with a learning disability and provided 30 minute appointments for health checks. When these patients were unable to attend the practice, health checks were carried out as a home visit.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and ensured this information was shared with relevant staff or organisations when required.
• 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 all trained to a suitable level in safeguarding 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 had identified patients who were carers but acknowledged they could offer these patients additional support.