Archived: Dr Veerayya Yarra & Dr Anitha John Also known as Wilnecote Health Centre

Updated 28 September 2016

Dr Yarra and Dr John’s Practice is registered with the Care Quality commission (CQC) as a two GP partnership. The practice has good transport links for patients travelling by public transport and parking facilities are available for patients travelling by car. The practice has a Personal Medical Services contract with NHS England to provide medical services to approximately 2,400 patients. A PMS contract is a locally agreed alternative to the standard General Medical Services (GMS) contract used when services are agreed locally with a practice which may include additional services beyond the standard contract.

The practice is situated in Wilnecote Health Centre, a purpose built single storey building owned and managed by NHS Properties. There is level access to the building and all areas are easily accessible by patients with mobility difficulties, patients who use a wheelchair and families with pushchairs or prams. The practice is located in the town of Tamworth. There are pockets of deprivation but overall the area is less deprived when compared to national averages. There are a lower proportion of elderly patients when compared to local and national averages. For example, the percentage of patients aged 65 and over registered at the practice is 14% which is lower than the local Clinical Commissioning Group (CCG) average of 20% and the national average of 17%.

The practice team consists of two GP partners (one male, one female). The clinical practice team normally includes a nurse but at the time of the inspection the nurse had left and recruitment was underway to find a replacement. Clinical staff are supported by a practice manager and four administration / receptionist staff. In total there are seven staff employed either full or part time hours to meet the needs of patients.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 9.30am to 11.30pm each morning (9am to 11am on a Thursday), and from 4.30pm to 6pm each afternoon (1pm to 6.30pm on a Wednesday). Extended hours are offered from 6.30pm to 7.45pm one evening per week. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed. Patients are directed to the out of hours service, the NHS 111 service and the local Walk-in Centres.

Updated 28 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Yarra and Dr John’s Practice on 18 July 2016. Overall the practice is rated as requires improvement.

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

• There was a system in place for reporting and recording significant events, however it was not always used when events had been identified.
• Risks to patients were assessed but not always well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care was mixed, the practice generally scored lower than local and national averages in questions included in the GP National Patient Survey.
• Patients said they were treated with compassion, dignity and respect but the feedback on how they were involved in their care and decisions about their treatment was below local and national averages.
• Information about services and how to complain was available and easy to understand. Investigations were made as a result of complaints and concerns. Results including learning outcomes were documented and shared with all staff.
• Patient feedback complimented the practice on access via the telephone system.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas where the practice must make improvements:

• Ensure that all necessary pre-employment checks are carried out on staff.
• Implement systems and processes to assess, monitor and improve the quality and safety of the service.
• Ensure that all significant events identified are recorded and reviewed.

We saw areas where the practice should make improvements:

• Complete and assess fire evacuation drills at the practice.
• Implement a system to track blank prescriptions throughout the practice.
• Implement a system to record that medicines alerts have been acted on.
• Consider how the practice could proactively identify carers in order to provide further support and treatment.
• Ensure that a copy of the business continuity plan is accessible in such an event that restricted access into the building.
• Review the patient recall system to improve the number of regular reviews carried out on patients with long term conditions.
• Consider how to further promote the national screening programmes for detection of cancer.
• Carry out monitoring of clinical capacity to assess appointment availability against demand.
• Ensure that verbal complaints are recorded and reviewed in addition to written complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 September 2016

The practice is rated overall as requires improvement. The concerns which led to these ratings applies to everyone using the practice, including this population group.

However we did find some positive features for this group of patients:

• The practice used a risk stratification tool to identify 2% of patients most at risk of hospital admission. A care plan had been completed for each of these patients and was reviewed at least annually.
• Daily emergency appointments, longer appointments and home visits were available when needed for these patients.
• For patients with the most complex needs, the named GP and nursing staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice encouraged the use of home monitoring blood pressure machines to support in the management of hypertension.

Updated 28 September 2016

The practice is rated overall as requires improvement. The concerns which led to these ratings applies to everyone using the practice, including this population group.

However we did find some positive features for this group of patients:

• There were systems in place to identify and follow up children who were at risk, for example, children on the protection register were identifiable to all staff from their electronic notes.
• All staff had received training in child safeguarding.
• Same day appointments were provided for children and were available outside of school hours.
• Health visitor led baby clinics were held on the premises for child health surveillance which included postnatal checks for mother and six week baby checks. For convenience and whenever possible, the practice aimed to offer both mother and baby checks at convenient times on the same day.
• The practice supported mothers who wished to breastfeed their child and a room was available within the building which included a baby change table.

Updated 28 September 2016

The practice is rated overall as requires improvement. The concerns which led to these ratings applies to everyone using the practice, including this population group.

However we did find some positive features for this group of patients:

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• All patients aged 65 years and over had a named GP.
• The practice offered home visits at designated times and urgent appointments for those older patients who had difficulty attending the surgery.
• The Clinical Commissioning Group (CCG) pharmacist linked to the practice assisted in the completion of medication reviews for patients aged over 65 years.
• The practice worked regularly with the community healthcare team to coordinate the care of the elderly patients

Updated 28 September 2016

The practice is rated overall as requires improvement. The concerns which led to these ratings applies to everyone using the practice, including this population group.

However we did find some positive features for this group of patients:

• 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.
• Appointments could be booked up to two months in advance and a telephone consultation service was provided by the GPs.
• The practice offered online services which included repeat prescription ordering and access to patient records.
• A full range of health promotion and screening that reflected the needs for this age group was available.

Updated 28 September 2016

The practice is rated overall as requires improvement. The concerns which led to these ratings applies to everyone using the practice, including this population group.

However we did find some positive features for this group of patients:

• Patients diagnosed with dementia were invited for annual face to face reviews and care plans were completed.
• The practice worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia.
• The practice offered patients who experienced poor mental health continuity of care and appointments with the same GP. A higher than average number of patients had been exempted from having the annual check in 2015/16, however the practice planned to improve the performance for 2016/17 with an improved patient recall system.
• Staff had an understanding of how to support people with mental health needs and dementia. All staff had received training in how to deal with mental health.

Updated 28 September 2016

The practice is rated overall as requires improvement. The concerns which led to these ratings applies to everyone using the practice, including this population group.

However we did find some positive features for this group of patients:

• The practice held a register of patients identified as vulnerable and all reception staff had received training in adult safeguarding.
• A register of patients with a learning disability was held and there were ten patients on the register. Two of the ten patients had received an annual health check with the support of the local community learning disability team in the preceding 12 months.
• Longer appointments were offered to patients with a learning disability.
• Staff were aware of their responsibilities regarding confidentiality, information sharing, documentation of safeguarding concerns and how to contact relevant agencies.
• The practice worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.