We carried out an announced comprehensive inspection at the Nayar Practice on 5 March 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.

• Patients received effective care and treatment that met their needs.

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw several areas of outstanding practice including:

• Staff, teams and services were committed to working collaboratively and have found innovative and efficient ways to deliver more joined-up care to patients. In March 2017 the practice and six neighbouring practices developed the proactive primary coordinated care pathway. The practices hosted the pro-active care team, which included three pro-active care nurses, who visited frail, vulnerable or older patients in their own homes and implemented an advanced care plan with the patient/family/carers. The service involved working with other agencies such as social prescribing, admiral nurses, occupational therapists and community geriatrician to enable the patient to remain in either the home/community setting to reduce hospital admissions. Initially, patients were assessed using a risk stratification tool which included a review of patients living with dementia, learning difficulties, frailty, at risk of hospital admission, housebound, residing in care home or those with multiple long term conditions. The pro-active care nurse had identified 109 patients at risk and 102 of these have care plans in place. Of that 65 patients had consented to an enriched summary care record. Each patient with a care plan in place was asked to rate their confidence in their health needs and repeated when the care plan is reviewed. 80% of patients' are in the range of fairly confident/very confident in terms of managing their own health.

Whilst we found no breaches of regulations, the provider should:

• Consider completing a risk assessment in the absence of keeping some  emergency drugs.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection visit on 21 January2015 and the overall rating for the practice was good. The inspection team found after analysing all of the evidence that the practice was safe, effective, caring, responsive and well led.

Our key findings were as follows:

• The practice provided good, safe, responsive and effective care for all population groups in the area it serves.

• All areas of the practice were visibly clean.

• Where incidents had been identified relating to safety, staff had been made aware of the outcome and action taken where appropriate, to keep patients and staff safe.

• Patients received care according to professional best practice clinical guidelines. The practice had regular information updates, which informed staff about new guidance to ensure they were up to date with best practice.

• The service was responsive and ensured patients received accessible, individual care, whilst respecting their needs and wishes.

• The service was well led and there were positive working relationships between staff and other healthcare professionals involved in the delivery of service.

We saw several areas of outstanding practice including:

• The practice participated in the pilot use of ‘Cantab Mobile’. The computer technology uses a mobile screening tool, simple to use, and allows GPs to make informed decisions about their patients, and more efficient referrals into hospital, community or social care.
• Patients who required an annual or more frequent health review were contacted personally via the telephone. An appointment time convenient to the patient was then agreed. This had helped mitigate against non-attenders.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice