Dr Mahendra Patel

Updated 16 August 2016

Dr Mahendra Patel is the lead GP and sole principal of Drs Patel, Taylor-Bernard, Taylor and Moghal, Shay Lane Medical Centre, Shay Lane, Altrincham. The practice is situated in a purpose built medical centre which also hosts another GP practice and an on-site pharmacy. There is adequate car parking available for both abled and disabled patients. It complies with the Disability Discrimination Act 1995 providing disability access, adequately alarmed disabled toilets, a hearing loop and sign language posters for the deaf and hard of hearing. They have also recently commissioned practice leaflets in braille for the blind and partially sighted.

The practice offers services to approximately 6,000 patients in the least deprived group under a personal medical services contract and provide a number of directed enhanced services. They have a higher than average patients group between the ages of 50 and 55 and over 65 years and much fewer than average patients between the ages of 20 and 40 years.

There are three male and one female GPs. Dr Patel is the lead and managing GP and works full time covering nine sessions. The other GPs cover a total of 18 sessions throughout the week. In addition there are two practice nurses who offer immunisations, cervical smears, family planning, screening and management of long term conditions and travel advice. They are not a training or teaching practice. The clinical staff are supported by a practice manager and reception/administration staff.

The practice is open from 8.30am until 6pm Monday to Friday and patients are directed to Mastercall when the surgery is closed. They do not offer any formal extended hours but are flexible in their approach and do not turn patients away if they require attention.

Updated 16 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mahendra Patel, Shay Lane Medical Centre, on 7th June 2016. Overall the practice is rated as outstanding.

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

• People were protected by a strong, comprehensive safety system and a focus on openness, transparency and learning when things went wrong. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

• Outcomes for patients were consistently better than expected when compared with other similar services. The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. They had a responsive and flexible appointment system adapted on a daily basis to meet patient demand.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. They had created a carer’s champion role and identified and made contact with all carers. The number of carers identified and supported since March 2016 had more than doubled to 76 which was 1.32% of the practice population...

• Services were tailored to meet the needs of individual people and ensured flexibility, choice and continuity of care. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. They had targeted “did not attend” (DNA) rates (failed appointments) and created leaflets to educate patients on the impact.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, including verbal complaints, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• We received 82 comments cards and all were positive
• The practice scored consistently high and achieved 100% for all Quality Outcome Framework (QoF) over the past three years with very low (always under 2% overall) exception reporting rates.

We saw areas of outstanding practice including:

• There were consistently high levels of staff and patient satisfaction and patient satisfaction results were consistently higher than national and local averages.

• There was a strong collaboration and support across all staff and a common focus on improving quality and people’s experiences.For example, the practice contacted the Action for Hearing Loss Charity and a member of clinical and administration staff attended training in basic sign language. The training enabled them to promote good practice and excellent communication for patients who were hard of hearing.The training was communicated throughout the practice and raised staff awareness of their duties under the Equality Act 2010 and Disability Equality Duty and provided positive interventions for patients with disabilities.

• The practice had recently commissioned practice leaflets in braille for the blind and partially sighted because they had some partially sighted patients and knew this would create a positive impact on their experiences at the practice.

• The lead GP of the practice conducted negotiations to secure and enable the relocation of pharmacy services into an on-site facility. This was done as a direct result of feedback from patients. The lead GP also undertook the discussion, co-ordination and planning of the alterations of the premises to facilitate the relocation which also resulted in additional car parking. Patients reported that the pharmacy had been very positive for both practices at the Medical Centre, reducing the amount of time spent from consultation to receipt of medicines and also giving patients the opportunity to pick up other essentials they might need without having to travel to another location when they were feeling unwell.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 16 August 2016

The practice is rated as outstanding 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. We saw that nursing staff utilised, reviewed and kept up to date care plans for patients with long term conditions.

• Performance for diabetes related indicators was better than the local and national average. Maximum quality outcomes framework (QoF) points and lowest Trafford exception reporting had been achieved in each of the past three years.

• Patients were empowered to become experts in their care and 100% of newly diagnosed diabetic patients had been referred to the Xpert Diabetes Programme giving them knowledge, skill and confidence to deal with the condition effectively.

• 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.

• Patients with chronic pulmonary obstructive disease (COPD) were provided with guidance instructions and “rescue” medicines for self-administration during exacerbations thus avoiding unnecessary hospital admission.

• Longer appointments and home visits were available when needed.

Updated 16 August 2016

The practice is rated as outstanding 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.

• An audit of safeguarding procedures resulted in the inclusion of a procedure for the registration and safe keeping of asylum seekers. (Five child asylum seekers had been placed with local foster carers over a six month period).

• All staff were up to date with child protection training and we saw evidence that concerns were raised by all staff with the safeguarding lead when identified.

• Staff evidenced that children and young people were treated in an age-appropriate way and were recognised as individuals. Sexual health, contraception advice and chlamydia screening was available to young people.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Child flu clinics were held after school to maximise attendance and there was a weekly antenatal clinic on-site with the community midwife.

• The percentage of female patients whose notes recorded that a cervical screening test was performed in the preceding five years was 86%.

Updated 16 August 2016

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

• The majority of the practice patients were over the age of 65. The practice offered proactive, personalised care to meet the needs of the older people in its population. Patients at risk of unplanned hospital admissions had care plans and were contacted following an admission to review any changes. We saw care plans which were utilised and kept up to date by all clinical staff when a patient was reviewed.

• They had a patients’ champion who was the nominated liaison with Healthwatch and who, as a longstanding user of their service, was able to assess practice performance.

• The practice was responsive to the needs of older people. Requests for appointments and home visits were fulfilled with same day availability for routine and urgent appointments resulting in the lowest accident and emergency attendance rate in Trafford.

• 74.5% of eligible patients were vaccinated against shingles.The national average was 38%.

Updated 16 August 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 appointment system was not fixed, it was continually reviewed and changes were made accordingly to meet patient demand.
• The practice offered on line services for prescriptions, appointments and access to records. There was an increasing contact from patients by email. They had identified a lead role within the practice to encourage and enable patients to use on-line services.
• Phone consultations were offered in the morning and afternoons which did not have to be pre-booked.
• Meningitis enhanced services were offered to students and a comprehensive travel service including yellow fever was available.
• Flu clinics were offered on Saturdays to allow flexible access for patients and maximise attendance.

Updated 16 August 2016

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

• 91% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was better than the local and national average of 84%.

• All the quality indicators relating to mental health were higher than the local and national averages with very low exception rates.

• 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.

• A carers register was maintained and services for carers were publicised in the waiting areas. A carers’ champion lead role had been assigned to a member of staff and specific training had been provided in order to develop this area and identify and encourage support for carers.

Updated 16 August 2016

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

• The practice held a register of patients living in vulnerable circumstances and offered services such as extended appointments, personal mobile contact, and information about how to access various support groups and voluntary organisations. The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had a learning disabilities lead and offered longer appointments for patients with a learning disability.

• 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.

• The practice supported the local Trussell Trust (a charitable organisation aimed at reducing hunger in the UK) and donated food supplies together with any food items received from patients such as gifts at Christmas time.