Archived: Drs A E Williams, D De Rosa & A N Koodaruth

Updated 30 August 2016

Drs A E Williams, D DeRosa & A N Koodaruth is registered with the Care Quality Commission (CQC) as a three GP partnership. The practice is located in Wolverhampton. The practice has good transport links for patients travelling by public transport and parking facilities are available for patients travelling by car. The practice is a located in a health centre owned by the Royal Wolverhampton Trust. The practice occupies rooms over two floors with patient access, services and facilities provided on the ground floor. There is access to the building via a ramp and all areas are accessible by patients with mobility difficulties, patients who use a wheelchair and families with pushchairs or prams.

The practice team consists of three GP partners, one female and two male. One of the GP partners had left the partnership and the practice had successfully recruited a new partner. The practice is in the process of registering the new partner with the CQC. The GP partners work a total of 21 sessions between them and are supported by a full time practice nurse and a part time healthcare assistant. Clinical staff are supported by a practice manager and eight administration / receptionist staff. In total there are 14 staff employed either full or part time hours to meet the needs of patients. The practice also use GP locums at times of absence to support the clinicians and meet the needs of patients at the practice.

The practice is open between 8am and 6.30pm Monday, Tuesday, Thursday, Friday and 8am to 1pm on Wednesday. Appointments are from 8.30am to 11.30pm every morning, 4pm to 6.30pm Monday and 3pm to 6.30pm, Tuesday, Thursday and Friday. Extended hours appointments are offered from 6.30pm to 7.30pm on Mondays. This practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service provided by Vocare via the NHS 111 service.

The practice has a General Medical Services contract with NHS England to provide medical services to approximately 4,300 patients. It provides Directed Enhanced Services, such as the childhood immunisations, minor surgery and asthma and diabetic clinics. The practice has a higher proportion of patients, mainly male patients aged 15 to 19 and a higher proportion of female patients between the ages of 45 and 85 plus when compared with the average across England. The income deprivation affecting children of 19% was similar to the national average of 20%. The level of income deprivation affecting older people was higher than the national average (21% compared to 16%).

Updated 30 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs A E Williams, D De Rosa & A N Koodaruth on 23 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.
• Risks to patients were assessed and well managed.
• 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.
• 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 and easy to understand. 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 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 management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

There were areas of practice where the provider must make improvements:

• Ensure that the practice protocols and procedures are reviewed so that all staff have mandatory training related to health and safety such as fire safety and infection control.

There were areas of practice where the provider should make improvements:

• Ensure national guidelines for children who do not attend for hospital events are followed.
• Review the current arrangements for checking the safety of the environment and receiving reports on the outcome of environmental risk assessments carried out at the practice to confirm that required actions are addressed.

• Review complaint handling procedures and establish a system for identifying, receiving, recording, handling and responding to verbal complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 August 2016

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

• The GPs and practice nurse had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The GP and practice nurses worked with relevant health care professionals to deliver a multidisciplinary package of care to patients with complex needs.
• The practice Quality and Outcomes Framework (QOF) for the care of patients with long-term conditions was higher overall compared to the local and national average. For example the practice performance for diabetes related clinical indicators overall was higher than the local Clinical Commissioning Group and England average (94% compared to the local average of 82% and England average of 89%).
• Longer appointments and home visits were available when needed.
• 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.

Updated 30 August 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. This included for example children who were identified as at risk of abuse and babies and children who did not attend for immunisation appointments. However the practice did not routinely follow up children who did not attend hospital appointments. Immunisation rates were relatively high 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.
• The practice offered patients the opportunity to register at the practice as a family.
• The records of new born babies were linked to their parents’ records.
• Babies were given their first immunisations on the same day as mothers were offered their six week postnatal check.
• The practice’s uptake for the cervical screening programme was 81% which was comparable to the local CCG average of 78% and England average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice held a weekly GP clinic at a local boarding school for boys and girls.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 30 August 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 offered home visits and urgent appointments for those older patients with enhanced needs.
• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.
• The practice maintained a register of housebound older patients, older patients who required a home visit and those who could attend the surgery but needed a specific appointment to suit them and their carers.
• Older patients were offered urgent appointments for those with enhanced needs plus longer appointments which gave them more time to discuss health issues with a clinician.

Updated 30 August 2016

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

• The practice had adjusted some of the services it offered to meet the needs of the working age population, those recently retired and students to provide improved accessibility and flexibility.
• The practice offered on the day pre-bookable appointments, the last pre-bookable appointment was offered at 6pm. Telephone consultations were available.
• Out of hours appointments were available from 6.30pm to 7.30pm. Three of these appointment slots were protected and allocated to patients who worked where possible.
• The practice was proactive in offering online services as well as signposted to a full range of health promotion and screening that reflects the needs for this age group.
• The practice offered returning students temporary registration with a GP.

Updated 30 August 2016

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

• 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 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.

The practice QOF data showed that:

• 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was the same as the national average.
• 97% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This was higher than the England average of 88%. The exception reporting rate for this indicator was 3.3% in comparison to the England average of 12.6%

Updated 30 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of vulnerable patients which included patients with a learning disability. The practice offered longer appointments for patients with a learning disability.
• An easy read (pictorial) letter was sent to patients with a learning disability inviting them to attend the practice for their annual health check.
• The practice was alerted to other patients whose circumstances may make them vulnerable to ensure that they were registered with the practice if appropriate.
• 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.
• 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.