Background to this inspection
Updated
14 May 2018
Dr Prakashchandra Jain’s Practice provides services to 1,593 patients from one location at The Surgery, 2 Parklands Drive, Askam in Furness, Cumbria, LA16 7JP. This is the site we visited during the inspection.
The practice provides their services under a General Medical Services (GMS) contract to patients and is part of the NHS Morecambe Bay clinical commissioning group (CCG). The practice also dispenses medication to their patients.
The practice is located in a single storey building. There is a disabled WC, wheelchair and step-free access. There is a car par at the rear of the premises. This is a single-handed practice run by the GP. There is no practice manager. There is a practice nurse, three receptionists/dispensers and a medicines manager.
The opening hours for the practice are 9am to 6pm Monday, Tuesday, Thursday and Friday, and 9am to 11.30am on Wednesdays. For the periods between 8am to 9am and 6pm to 6.30pm (and 11.30am to 6.30pm on Wednesdays) calls are taken by the receptionist who then contacts the GP to respond. The surgery is closed at weekends. Outside of these times, a pre-recorded message directs patients to 999 emergency services, NHS 111 or out-of-hours providers, as appropriate.
Open access consultations with the GP are available between 10am to 11am Monday to Friday and 5pm to 6pm Mondays, Tuesdays, Thursdays and Fridays. Routine appointments with the nurse are available between 9am and 5pm Monday and Thursday and from 2pm to 5pm on Tuesdays.
Information taken from Public Health England places the area in which the practice is located in the sixth most deprived decile. In general, people living in more deprived areas tend to have greater need for health services.The service for patients requiring urgent medical attention out of hours is provided through the NHS 111 service and Cumbria Health on Call.
Updated
14 May 2018
This practice is rated as good overall. (Previous inspection May 2015 – Good) The practice was rated as requires improvement for safety at the previous comprehensive inspection in May 2015. The practice acted quickly to address concerns on that occasion and was re-rated as good for safe practice at a focussed inspection in May 2016.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Good
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) - Good
We carried out an announced comprehensive inspection at Dr Prakaschandra Jain on 23 March 2018 as part of our inspection programme.
At this inspection we found:
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The practice took steps to improve systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
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The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
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Staff involved and treated patients with compassion, kindness, dignity and respect.
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Patients found the appointment system extremely easy to use and reported that they were able to access care when they needed it. Patients had asked the GP to keep an open appointment system when he took over the practice 30 years ago. This remained in place, and feedback showed it was appreciated by patients.
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The practice leadership was knowledgeable about issues and priorities relating to the quality and future of services. They understood the challenges and were addressing them.
The areas where the provider should make improvements are:
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Put in place a formal system to be able to demonstrate when patient safety alerts have been read and actioned by staff.
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Look at ways of ensuring patients can access the practice premises easily and can call ofr assistance when required.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
17 September 2015
The practice is rated as good for the care of people with long-term conditions.
The practice had systems to ensure care was tailored to patients’ individual needs and circumstances. We spoke with the GP and nurse who told us regular patient care reviews, for example for patients with chronic obstructive pulmonary disease (COPD - severe shortness of breath caused by chronic bronchitis, emphysema, or both) or asthmatic conditions, took place. Nationally reported data showed the outcomes were good for patients with long-term conditions. For example, for patients with COPD who had been reviewed by a health care professional in the preceding 12 months the practice achieved 100% which was 8.8% above the local CCG average and 10.4% above the England average. For patients with asthma who had an asthma review in the preceding 12 months the practice achieved 78.7% which was 3.4% above the local CCG average and 3.2% above the England average.
The practice ensured timely follow-up of patients with long-term conditions by adding them to the practice registers. Patients were then recalled as appropriate, in line with agreed recall intervals.
Families, children and young people
Updated
17 September 2015
The practice is rated as good for the care of families, children and young people.
The practice provided antenatal clinics on Mondays by appointment. The practice operated an open access service and all patients who attended the practice were seen on the day. Appointments were available outside of school hours The premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Childhood immunisation rates were in line with or slightly above averages for the local Clinical Commissioning Group (CCG). For example, MMR vaccination rates for two year old children were 100% compared to 96.4% across the local CCG; and MMR dose 2 rates for five year old children were 78.9% compared to 70.1% across the local CCG.
Updated
17 September 2015
The practice is rated as good for the care of older people.
Nationally reported data showed outcomes for patients were good for conditions commonly found in older people. They offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission had care plans. The practice was responsive to the needs of older people, including offering home visits.
The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.
Working age people (including those recently retired and students)
Updated
17 September 2015
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. For example, they offered open access appointments. All patients who attended the practice were seen on the day.
Cervical screening rates for women aged 25-64 were 89.7%, which was above the local CCG average by 6.9% and above the England average by 7.8%.
For caring for patients with hypertension (high blood pressure) the practice achieved an overall score of 96% which was 7.9% higher than the local CCG average and 7.6% above the England average.
People experiencing poor mental health (including people with dementia)
Updated
17 September 2015
The practice is rated as good for the population group of people experiencing poor mental health (including people with dementia).
For patients experiencing poor mental health national reported data showed the practice achieved an overall score of 100% for providing care to these patients, which was 8.8% above the local CCG average and above the England average by 9.6%. For patients with dementia the practice achieved 100% for providing care to these patients, which was 4.4% above the local CCG average and above the England average by 6.6%.
The practice worked with patients experiencing poor mental health and provided personalised support.
People whose circumstances may make them vulnerable
Updated
17 September 2015
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
Systems were in place to identify patients, families and children who were at risk or vulnerable. The practice worked in collaboration with other agencies, for example, health visitors and district nurses, to ensure vulnerable families and children and other patients were safe.
The practice maintained a register of patients with learning difficulties.
The practice sign-posted vulnerable patients to various support groups and other relevant organisations. Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities to ensure they were safeguarded.