Dr GC Chajed's Practice Also known as Kingswood Medical Centre

Updated 13 April 2017

Dr GC Chajed’s Practice is situated in Basildon, Essex. The practice provides services for approximately 8600 patients. It holds a general medical services contract with Basildon and Brentwood Clinical Commissioning Group.

We reviewed the most recent data available to us from Public Health England which showed that the practice population is similar to the national average. Income deprivation affecting children is 26%, which is higher than the local and national average of 20%. Income deprivation affecting older people is 21%, which is higher than the local average of 15% and the national average of 16%.

The practice clinical team consists of two male GP partners, two female salaried GPs, two practice nurses and a healthcare assistant. They are supported by a practice manager and teams of reception, administration and secretarial staff.

Dr GC Chajed’s Practice is open from Monday to Friday. It offers appointments from 8am to 6.30pm daily. The practice does not provide extended hours appointments, however patients registered at the surgery are able to access evening and weekend appointments at another local surgery as part of the Prime Minister’s Challenge Fund initiative. Out-of-hours care is provided by Care UK via the NHS 111 service.

Updated 13 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr GC Chajed’s Practice on 7 February 2017. This inspection was a follow up to our previous comprehensive inspection at the practice on 3 June 2015 where breaches of regulation had been identified. The overall rating of the practice following the 3 June 2015 inspection was requires improvement. It was rated as inadequate for providing safe services, and requires improvement for providing effective, caring, responsive and well led services.

At our inspection on 7 February 2017 we found that the practice had improved. The ratings for the practice have been updated to reflect our recent findings. The practice is rated as good for providing safe, effective, caring, responsive and well led services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• The practice had implemented new systems and processes to ensure that risks to patients were assessed and well managed. For example, health and safety and legionella risk assessments had been undertaken.

• On our previous inspection we found that there was scope to improve the monitoring of emergency equipment and medicines. During this inspection, we saw that emergency equipment had been replaced and that there was evidence of a comprehensive monitoring system of stock held in the emergency trolley.
• Extensive work had been undertaken to ensure that there was an effective system in place to support patients who were prescribed medicines that required monitoring. Furthermore, a protocol had been developed to ensure that reviews of safety updates from the Medicines and Healthcare Products Regulatory Agency (MHRA) were undertaken.
• The practice maintained an overview of staff training needs, and proactively supported staff with professional development.
• A GP at the practice had worked closely with the clinical oncology team at Basildon Hospital on an initiative to address the local and national issue of emergency admissions for patients with cancer. The published data relating to this work showed that the practice made a significant improvement in their prevention of emergency admissions for patients with cancer, alongside improvements to cancer screening, diagnosis and referrals.
• Formal governance arrangements had been instigated to monitor the quality of the service provision.
• Feedback from patients about their care was very positive. Patients said they were treated with compassion, dignity and respect, and that clinical staff took their concerns seriously.
• We received positive feedback about the availability of routine and urgent appointments, and many patients commented on the excellent continuity of care offered by the clinicians.
• 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.
• Policies and procedures had been reviewed and updated to reflect the requirements of the practice. For example, amendments had been made to the practice’s chaperoning and repeat prescribing policies.
• There was a clear leadership structure in place and staff felt well supported by the GP partners and manager.

The areas where the provider should make improvements are:

• Develop a system for tracking prescription stationery stored within the practice.
• Continue to monitor patient feedback.
• Continue to monitor diabetes data and respond to outlying figures to achieve improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 April 2017

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.
• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor outcomes for patients (QOF is a system intended to improve the quality of general practice and reward good practice). Data from 2015/2016 showed that performance for diabetes related indicators was 73%, which was below the local average of 83% and the national average of 90%. Exception reporting for diabetes related indicators was 3%, which was lower than the local average of 8% and the national average of 12% (exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). We reviewed contemporary QOF data and saw that improvements had been made in the recent months.
• A system had been developed to ensure that patients with complex needs had a structured annual review to check their health and medicines needs were being met.
• The practice held designated clinics for patients with more than one long term condition. This was to provide holistic care and reduce the need for multiple appointments.
• 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 13 April 2017

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 Accident & Emergency attendances.
• Immunisation rates were high for all standard childhood immunisations.
• There were procedures in place for obtaining consent. Clinical staff were aware of their need to check parental responsibilities when obtaining consent in relation to treating children.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 81%, which was in line with the local average of 82% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice offered a full range of contraception services and chlamydia screening.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 13 April 2017

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

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visits were triaged by a GP to prioritise need and ensure appropriate and timely intervention. Clinical staff provided regular visits to patients in living in local care homes.
• The practice contacted all patients after their discharge from hospital to address any concerns and assess if the patient needed GP involvement at that time.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people, including rheumatoid arthritis and heart failure, were above local and national averages.
• Influenza vaccinations were offered both in-house and on domicillary visits.
• Monthly multidisciplary team meetings for vulnerable adults were hosted at the practice and attended by other community professionals, such as specialist dementia community nurses and district nurses, to ensure safe and effective care for this population group. We spoke with the local multidisciplinary team care co-ordinator, who attended weekly practice meetings and they reported that they felt ‘very much part of the team’.

Updated 13 April 2017

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

• 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.
• Telephone consultations were offered to patients who were not able to access the practice due to work commitments.
• Although the practice did not offer extended hours appointments, there were appointments available from 8am to 6.30pm daily. In addition to this, patients registered at the surgery were able to access evening and weekend appointments at another local surgery as part of the Prime Minister’s Challenge Fund initiative.
• Practice staff carried out NHS health checks for patients between the ages of 40 and 74 years. The practice was able to refer patients to a health trainer to encourage lifestyle changes. 434 health checks had been undertaken in the previous 12 months.
• The practice offered many NHS services in house, reducing the need for outpatient referral and therefore improving patient convenience.

Updated 13 April 2017

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

• Published data showed that 91% of patients diagnosed with dementia had received a face to face care review in the last 12 months, which was above the local average of 86% and the national average of 84%.
• 92% of patients experiencing poor mental health had a comprehensive care plan, which was above the local and national average of 88%.
• 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 where they may have been experiencing poor mental health.
• The practice had provided training on dementia awareness and the Mental Capacity Act 2005 to all members of staff to ensure that mental health and psychological wellbeing was considered at every contact.

Updated 13 April 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 travellers and those with a learning disability.
• Longer appointments were available for patients with a learning disability. 26 out of 36 patients on the learning disability register had received an annual health check in the past ten months.
• Staff were aware of the arrangements in place to allow people with no fixed address to register or be seen at the practice.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients, and held monthly multidisciplinary team meetings.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• Written information was available to direct carers to the various avenues of support available to them.
• 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.