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Dr N A Nayyar & Partners - Riverside Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 1 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N A Nayyar and Partners at Riverside Medical Centre on 17 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 had a variety of appointment options which included sit and wait sessions, pre-bookable and urgent appointments and telephone consultation and advice.
  • The practice provided 30 minute appointments for new mums and babies for the six week post-natal check. This additional time allowed the practice to offer improved levels of support and better meet identified needs.

  • 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:

  • The practice had a dedicated learning disability nurse who worked closely with learning disability patients, carers and other health and social care professionals to provide effective and accessible services. The practice had been involved in the development of templates for health checks in association with the local learning disability team, and had provided training and awareness raising amongst other practices of learning disability health care. Of 88 patients on the practice register of patients with a learning disability 94% had a health action plan in place which is reviewed annually. In addition we were provided with examples of how staff had gone out of their way to help patients with a learning disability resolve personal and social problems.

An area where the provider should make improvement was:

  • The practice should review its records in relation to the immunity and vaccination status of its staff to ensure that these were up to date.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 August 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

  • There was a nominated lead for safeguarding children and adults. Systems were in place to keep patients and staff safeguarded from abuse.

  • There were processes in place for safe medicines management which included a programme of regular medication reviews.

  • There were systems in place for checking that equipment was tested, calibrated and fit for purpose.

  • Full immunity checks on staff had not been carried out or recorded in relation to conditions such as measles, mumps, rubella and chickenpox.

Effective

Good

Updated 1 August 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits were through and demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • The practice used a computer protocol for patients with autism to remind staff that they may need to adapt their communication methods to aid understanding. In addition they were in the process of identifying other patients with disabilities to ensure that their preferred communication requirements were met.

Caring

Good

Updated 1 August 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • The practice demonstrated a patient centred approach. For example, it used novel and innovative ways to communicate effectively with patients with a learning disability.

  • All patients assessed as being near the end of life were assigned a named GP to enable them to have improved continuity of care.

  • The practice had a hearing loop available for those with a hearing impairment, and the waiting room, transit corridors and consultation rooms were large enough to facilitate wheelchair access.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 1 August 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice had contributed to the development of and participated in a Wakefield Vanguard programme which sought to develop an approach to joined up health and social care services. The practice had 31 patients in homes covered by the programme and provided services which included advanced care planning and reviews, vaccinations and dementia screening. Data from the practice showed:

    • 67% of these patients had received a dementia review

    • 93% of these patients had an avoiding unplanned admissions care plan in place.

  • The practice had a dedicated learning disability nurse who worked closely with learning disability patients, carers and other health and social care professionals to provide effective and accessible services. The practice has 88 patients on their learning disabilities register of which 94% had an annual health action plan in place. In addition we were provided with examples of how staff had gone out of their way to help patients with a learning disability resolve personal and social problems.

  • Patients could access a specialist diabetic clinic held in the surgery which included insulin initiation services, and patients with more complex needs could access clinics delivered by the practice in conjunction with an external diabetes consultant and specialist diabetes nurse.

  • There are innovative approaches to providing integrated patient-centred care. For example, the practice offered an avoiding unplanned admissions service which provided proactive care management and support for those patients who were at high risk of an unplanned hospital admission, this included patients with specific long term conditions.

  • 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.

  • Patients can access appointments and services in a way and at a time that suits them. Patients had a range of appointment options which included sit and wait morning sessions, pre-bookable appointments, urgent appointments, telephone consultation and advice and home visits.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had appointed a GP with responsibility for complaint handling and investigation.
  • Information about how to complain was available in the waiting area and on the practice website and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 1 August 2016

The practice is rated as good for being well-led.

  • Staff had contributed to the development of the practice mission statement and overall vision, and consequently this was clearly understood and embraced by all staff within the practice.

  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured through effective communication methods that this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • A programme of continuous clinical and internal audit was used to monitor quality and to make improvements. Where deemed appropriate findings from audits were shared outside the practice with other health professionals.

  • There was a strong focus on continuous learning and improvement at all levels, and the practice used new and innovative approaches to improve outcomes for patients in the area, these included the development of specialist services for learning disability patients and supporting the secondment of an advanced care practitioner to gain experience in the practice.  
Checks on specific services

Older people

Good

Updated 1 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 care planning and reviews for older patients with chronic diseases, these reviews were usually annual but could be as frequent as every three months if deemed appropriate to the needs of the patient. If appropriate multi-condition reviews were also available.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visit requests were triaged to determine the necessity and urgency of visits.

  • All patients over 75 years old had a named GP and had been informed of this by letter.

  • The practice had contributed to a Wakefield Vanguard programme which sought to develop an approach to joined up health and social care services and to reduce emergency admissions.  The practice had 31 patients in homes covered by the programme and provided services which included advanced care planning and reviews, vaccinations and dementia screening.

People with long term conditions

Good

Updated 1 August 2016

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

  • GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. For example, the practice offered an avoiding unplanned admissions service which provided proactive care management and support for those patients who were at high risk of an unplanned hospital admission, this included specific long term conditions. In addition the practice held clinics for a number of conditions which included:

    • Chronic Obstructive Pulmonary Disease (COPD)

    • Coronary Heart Disease

    • Prostate cancer

  • Patients with long term conditions received information on disease management and were signposted to support groups and services. Patients also received regular reviews via the practice “Call and Recall” system. Wherever possible multi condition reviews were held to avoid repeated visits to the practice by patients. For example, in 2015/2016 140 patients with both cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) had received a multi condition review.

  • The practice offered specialist diabetic clinics which included insulin initiation and complex needs care planning.

  • Longer appointments and home visits were available when needed.

  • Clinicians within the practice had experience to deliver a wide range of specialist services which included those in relation to dermatology and musculoskeletal problems.

Families, children and young people

Good

Updated 1 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 and the practice held regular monthly meetings with health visitors to discuss safeguarding issues.

  • Immunisation rates were relatively high for all standard childhood immunisations and were between 99% and 100%.

  • We were told 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’s uptake for the cervical screening programme was 87%, which was above the CCG average of 83% and the national average of 82%. In addition the practice had an effective “Call and Recall” system in place to invite women aged 24-65 years for their screening appointment.

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

  • The practice provided 30 minute appointments for new mums and babies for the six week post-natal check. This additional time allowed the practice to offer improved levels of support and better meet identified needs.

  • The practice had recently registered as a c-card distribution centre which gave improved access to contraceptives to young people.

Working age people (including those recently retired and students)

Good

Updated 1 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. For example, the practice offered a range of patient access options which included:

    • Walk in sessions

    • Pre-booked and on the day appointments

    • Telephone consultations

    • Online services (27% of patients had signed up for practice on-line services).

  • The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group such as NHS health checks.

People whose circumstances may make them vulnerable

Outstanding

Updated 1 August 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability and those with poor mental health.

  • 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.

  • The practice had a dedicated learning disability nurse who worked closely with learning disability patients, carers and other health and social care professionals to provide effective and accessible services. The practice had been involved in the development of templates for health checks in association with the local learning disability team, and had provided training and awareness raising amongst other practices of learning disability health care. The practice took a person centred approach in relation to consultations with the learning disability nurse using appropriate communication methods which included the use of pictures and easy access formats. Patients with a learning disability were given annual reviews; some of these were delivered in the patient’s own home if they were unable to attend the surgery. Of 88 patients on the practice learning disability register 94% had a health action plan in place. In addition we were provided with examples of how staff had gone out of their way to help patients with a learning disability resolve personal and social problems.

  • The practice worked closely with staff from learning disability residential settings and provided advice and guidance. They tailored appointments to meet the needs of the patient as some patients found it difficult to attend the surgery when there were large numbers of other patients around.

  • The practice used a computer protocol for patients with autism to remind staff that they may need to adapt their communication methods to aid understanding. In addition they were in the process of identifying other patients with disabilities to ensure that their preferred communication requirements were met.

  • The practice was registered under the Wakefield Safer Places Scheme. This voluntary scheme seeks to assist vulnerable people feel safer when travelling independently. Registered sites have agreed to offer support to the individual and would contact a named relative, carer or friend if the person was in distress. In addition we were told that the practice took into account the needs of patients with dementia and held ” Working Towards Dementia Friendly” status (this meant the practice had registered for the recognition process for dementia friendly accreditation and was working towards the named standards to become fully dementia friendly).

People experiencing poor mental health (including people with dementia)

Good

Updated 1 August 2016

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

  • All patients with mental health issues were offered annual reviews, and a number received monthly reviews to meet their specific needs. This allowed the practice to monitor their symptoms and avoid deterioration in their mental health and wellbeing.

  • The practice kept registers of those with poor mental health and dementia and used these to plan reviews. At the time of inspection the practice had 126 patients on its mental health register and 80 patients on its dementia register, these were slightly above the national prevalence figures.

  • 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 care planning for patients with dementia.

  • Practice staff had a high level of knowledge of how to support those with poor mental health, this included being able to tell them about how to access various support groups and voluntary organisations.

  • The lead GP had a special interest in mental health and was accredited to carry out Deprivation of Liberty Safeguards (DoLs) assessments.

  • The lead GP also ensured that all staff had a good understanding of the Mental Capacity Act 2005 and DoLs. The GP also shared this knowledge through training and awareness raising with staff from other practices.

  • The practice had worked closely with other network colleagues and the Clinical Commissioning Group (CCG) to establish a local “Talking Shop”. When operational this would allow patients to quickly access a local, low level mental health service.

  • 70% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months; this was below the CCG average of 89% and the national average of 88%.