Background to this inspection
Updated
28 April 2017
The Care Quality Commission registered Dr Sreeni Vis-Nathan/Dr Parvathy Bowes to provide primary care services.
The practice provides services to approximately just over 5,600 patients from two locations:
- Ravensworth Surgery, Horsley Hill Road, South Shields, Tyne And Wear, NE33 3ET.
-
The Medical Centre, Wear Street, Jarrow, Tyne and Wear. NE32 3JN.
We visited these as part of this inspection.
Ravensworth Surgery is a medium sized practice providing care and treatment to patients of all ages, based on a General Medical Services (GMS) contract agreement for general practice. The practice is part of the NHS South Tyneside clinical commissioning group (CCG).
We previously inspected this practice on 2 June 2015, when Dr Sreeni Vis-Nathan was the provider of this service and registered as an individual with CQC. A new registration was made in July 2015 when a new partner joined the practice. The full comprehensive report on the June 2015 inspection can be found by selecting the ‘all reports’ link for Dr Sreeni Vis-Nathan on our website at www.cqc.org.uk.
Information taken from Public Health England placed the area in which the practice was located in the third most deprived decile. In general, people living in more deprived areas tend to have greater need for health services. The average male life expectancy is 76 years, which is three years lower than the England average and the average female life expectancy is 81 years, which is two years lower than the England average.
The percentage of patients reporting a long-standing health condition is higher than the national average (practice population is 71.2% % compared to a national average of 53.2%).
The practice was located in a building that had been adapted to meet patients’ needs.
The practice had two GP partners (one male and one female), a salaried GP (female), two practice nurses (female), a practice manager, an assistant manager and a team of administrative and reception staff.
The Ravensworth Surgery is open on a Monday, Tuesday, Wednesday and Friday between 8:30am and 6pm, and on Thursday between 8:30am and 12noon. The practice is closed at weekends. The Medical Centre at Jarrow is open on a Monday, Wednesday, Thursday and Friday between 8:30am and 6pm, and on a Tuesday between 8:30am and 8pm. A local agreement is in place for the 111 and out of hours service to provide cover between 6pm and 6:30pm when the practice closes.
GP appointments are normally available across both locations Monday to Friday between 8:30am and 11:30am, and 2pm and 4:30pm. These are extended hours appointments available at the Medical centre at Jarrow on a Tuesday evening. Phones lines are open 8:30am to 6pm.
The NHS 111 service and Vocare, known locally as Northern Doctors Urgent Care Limited (NDUC), provide the service for patients requiring urgent medical attention out of hours.
Updated
28 April 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Location name on 29 March 2017. 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 a system in place for reporting and recording significant events.
- The practice had clearly defined and embedded systems to minimise risks to patient safety.
- Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
- Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
- Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
- Patients we spoke with 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
The areas where the provider should make improvement are:
- Reduce the risk of contamination of water systems by legionella bacterium by undertaking the regular monitoring actions recommended within the latest legionella risk assessment.
- Consider the development of a practice business plan to support them in delivering and improving the service offered.
- Increase the opportunities for patients to feedback about their experiences of the service by setting up and maintaining an effective patient participation group.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
28 April 2017
The practice is rated as good for the care of people with long-term conditions.
- Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. This included reviewing the needs of patients who are housebound and also have long-term conditions.
- Performance for diabetes related indicators was similar to the clinical commissioning group (CCG) and above the national average. The practice achieved 93.3% of the points available. This compared to an average performance of 93.4% across the CCG and 89.8% national average. The practice’s clinical exception rate for diabetes was 8.3%, which was below the CCG average of 11.8% and England average of 11.6%.
- The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
- There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
- All these patients had a named GP and there was a system to recall patients for 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.
Families, children and young people
Updated
28 April 2017
The practice is rated as good for the care of families, children and young people.
- We found there were systems 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 accident and emergency (A&E) attendances.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
- The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
- The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
Updated
28 April 2017
The practice is rated as good for the care of older people.
- Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
- The practice offered proactive, personalised care to meet the needs of the older patients in its population.
- The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
- The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
- The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
- Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
Working age people (including those recently retired and students)
Updated
28 April 2017
The practice is rated as good for the care of working age people (including those recently retired and students).
- The needs of these populations 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, there was extended opening hours on a Tuesday evening at Jarrow Medical Centre.
- The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
People experiencing poor mental health (including people with dementia)
Updated
28 April 2017
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- 80.9% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months. This was slightly lower than the national average 83.8%.
- The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, 95% of patients with schizophrenia, bipolar disorder and other psychosis had their alcohol consumption recorded within the preceding 12 months. This compared to 89.3% England average.
- The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
- The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
- Patients at risk of dementia were identified and offered an assessment.
- The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
- The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
- Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.
People whose circumstances may make them vulnerable
Updated
28 April 2017
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.
- End of life care was delivered in a coordinated way, which took into account the needs of those whose circumstances may make them vulnerable.
- 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
- Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.