Archived: Dr Paramundayil Joseph Also known as Dill Hall Surgery

Updated 7 July 2016

Dr Paramundayil Joseph, also known as Dill Hall Surgery is located in a residential area of Accrington and operates from a building originally built as public house with on street parking available to three sides of the property. The building has been sympathetically converted and modernised in accordance with a conservation order and a number of the original features of the building remain evident. Alterations have been made to the side entrance of the building to facilitate access for those experiencing difficulties with mobility.

Dr Paramundayil Joseph shares the building and the services of a practice manager with another independent GP practice and close links are maintained between the two practices that includes the maintenance of a shared website and patient participation group. The practice delivers services under a general medical services (GMC) contract with NHS England to 2592 patients, and is part of the NHS East Lancashire Clinical Commissioning Group (CCG). The average life expectancy of the practice population for males (75 years) and females (80 years) is slightly below both the CCG and national averages (males – CCG 77 years, national 79 years and females – CCG 81 years, national 83 years). Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

Age groups and population groups within the practice population are generally comparable with CCG and national averages. However, it is noted the percentage of patients aged over 65 years (14%) is lower than both the CCG and national averages of 18% and 17% respectively.

The practice is staffed by one male GP who collaborated with the other GP operating from the same building and another GP practice in the local area to ensure provision of care to patients during periods of absence. The GP is supported by a practice nurse, a phlebotomist and a community matron. Clinical staff are supported by a practice manager and four administration and support staff. We noted the practice had recognised a need for additional support staff and was in the process of recruitment at the time of the inspection.

The practice is open between 8am and 6.30pm Monday to Friday with the exception of Wednesday afternoon when the practice is closed and cover is provided by another GP practice in the local area. Extended hours for patients are offered until 8pm on Thursdays. In addition to pre-bookable appointments that can be booked up to twelve weeks in advance urgent appointments are also available for people that need them. The practice offered an open surgery each day from 8 – 10.30am and both staff and patients told us the open sessions had been very popular.

When the practice is closed, Out of Hours services are provided by East Lancashire Medical Services and can be contacted by telephoning NHS 111.

The practice provides online patient access that allows patients to book appointments and order prescriptions.

Updated 7 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Paramundayil Joseph on 26 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. However, we noted action was ongoing to embed a system for the retention of complaint records.
• 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.

We saw one area of outstanding practice:

• Action had been taken to centralise practice management activity between Dr Paramundayil Joseph and the other practice operating from the same building. As a result learning from incidents and complaints was now shared through joint practice meetings.

However there were areas of practice where the provider should make improvements:

• Ensure the practice recruitment policy includes a requirement to confirm professional indemnity arrangements for nursing staff are in place in accordance with professional registration and legislative requirements.

• Clearly define the infection, prevention and control (IPC) lead role and responsibilities to enable the effective oversight and completion of IPC activity.

• Ensure comprehensive records of complaints are maintained to support learning and improvement.

• Ensure that the system in place to monitor expiry dates of medicines and associated items is effective.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 July 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 and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was between 75% and 95%. This was comparable to the national average range of 78% to 94%.

• 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 GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 7 July 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, for example, children and young people who had a high number of A&E attendances. 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 percentage of patients diagnosed with asthma who had an asthma review in the last 12 months was 87% which was higher than the national average of 75%.

• Cervical screening uptake data from 2014/15 for women aged 25-64 years was 88%, which was higher than the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with health visitors.

Updated 7 July 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Regular formal multi-disciplinary meetings and practice meetings were used to inform admission avoidance planning.

• Hospital post-discharge reviews were routinely undertaken for all patients aged 75 or older.

Updated 7 July 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.

• 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 also available.

Updated 7 July 2016

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

• 94% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.

• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the preceding 12 months, which was higher than the national average of 88%.

• A record of alcohol consumption was recorded for 100% of patients with mental health related conditions compared to 90% nationally.

• 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 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.

Updated 7 July 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.

• The practice offered longer appointments for patients with a learning disability.

• 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.