Archived: Mahavir Medical Centre

Updated 4 August 2017

Mahavir Medical Centre is a GP practice providing primary medical services under a General Medical Services (GMS) contract to around 1400 patients within a residential area. The practice’s services are commissioned by West Leicestershire Clinical Commissioning Group (WLCCG).

Mahavir Medical Centre is located on Chestnut Way, East Goscote which is approximately eight miles from Leicester. It serves East Goscote and surrounding villages.

The practice is situated in a wheelchair accessible two storey building and has a parking area for cars which includes disabled parking. Street parking is also available nearby.

The service is provided by two part time male GP partners who between them provide ten sessions per week. There is also a part time nurse prescriber. They are supported by a part time practice manager and reception/administration staff. The practice had recently been approved to take medical students but had not yet had any placements.

The practice is open from 9.00am to 1.00pm and 3.30pm to 6.30pm Monday to Friday with the exception of Thursday when they are open from 9.00am to 1.00pm and closed for the remainder of the day. Appointments are available from 9.00am to 11.50am and from 3.30pm to 5.40pm on Mondays, Tuesday, Wednesday and Friday and from 09.00am to11.50am on Thursdays. Although the practice is closed on Thursday afternoons the GPs are still available for urgent appointments.

When the practice is closed during the day patients are able to contact a manned external answering who are able to put patients in contact with one of the GPs via mobile telephone if necessary. After 6.30pm patients are able to contact the Out of hours services which are provided by Derbyshire Health United (DHU) via the NHS 111 service. Patients are directed to the correct numbers if they phone the surgery when it is closed.

Updated 4 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mahavir Medical Centre on 25 July 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 systems to minimise risks to patient safety. Risks had been assessed but we found that the fire and legionella risk assessments were not comprehensive and may not have covered all associated risks. Following our inspection the practice arranged for external risk assessments to be undertaken.

• Prescription forms and pads were stored securely and there was a system to monitor the use of prescription forms but not prescription pads.

• 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. There was an evident focus on ongoing learning and development.
• The practice were committed to providing holistic, patient centred care suited to individual needs and circumstances.
• Results from the national GP patient survey were much higher than local and national averages and showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. They were rated particularly highly on the helpfulness of receptionists which was also reflected in patient comments on the day of our inspection.
• 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 who commented on their care described the service as excellent and personalised. They 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, and we saw that this feedback was acted on to improve the service.
• 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:

• Ensure the system for monitoring the movement of prescriptions includes both prescription forms and pads.

• To strengthen the system for clinical audits to include more structure and a fuller analysis to ensure quality improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2017

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

• Specialist nurses were used to manage long-term conditions such as asthma, chronic obstructive pulmonary disease, chronic kidney disease and heart failure.
• The practice offered flexible appointment times and same day appointments and patients at risk of hospital admission were identified as a priority.
• 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.
• 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 including care navigators and care co-ordinators to deliver a multidisciplinary package of care.
• Referrals to specialists were made in an appropriate and timely way with referrals done on the spot to avoid any delays in referral and patients given a choice of provider at the same time.
• Patients were able to attend health education events relating to long term conditions through the local federation.
• Accurate disease registers were maintained with proactive case management which had resulted in an increase in rates of prevalence.

Updated 4 August 2017

The practice is rated as good for the care of families, children and young people.

• There were systems to identify, prioritise and follow up children living in disadvantaged circumstances and who were at risk, for example, children of substance abusing parents and young carers, with more frequent reviews where necessary.
• Children and young people were treated in an age appropriate way and recognised as individuals, with their preferences considered.
• Immunisation rates were very high for all standard childhood immunisations and non-responders were followed up.
• Appointments were available on the day for children.
• 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. Midwives were able to send tasks via the practice computer system directly to clinicians.

• Clinicians kept their knowledge, skills and competences up to date in order to recognise and respond to an acutely ill child.

Updated 4 August 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. They offered a number of services which we were not commissioned but useful to older people such as ear syringing, simple dressings, spirometry and ECGs.
• 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.
• Over 75’s were offered health checks.
• There was a named accountable GP for all patients which maintained a high level of continuity of care.
• Consideration was given to carer’s needs, for example by securing a patient and their carer in the same care home.
• Staff were able to refer directly to ‘first contact’ scheme with patient’s consent which provided signposting to various avenues of support for older patients.

• There was a co-ordinated multi-disciplinary approach to care and feedback from care homes where some residents were patients of the practice was extremely positive.

• In order to save patients with hearing aids unnecessary travelling, the practice had arranged for hearing aid batteries to be available at the practice.

Updated 4 August 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; end of the day slots were held for working people to enable them to attend the practice, capacity had been increased on Friday mornings and telephone consultations were always available at a time to suit the patient.
• 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.
• Extended services were provided in house reducing the need to travel to hospital.
• SMS messaging and confirmation of appointments were used where possible.
• When the GPs felt it necessary patients were given their mobile numbers and were able to contact them out of hours. Support was provided and sign posting to avoid hospital admission.

Updated 4 August 2017

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

• The practice carried out advance care planning for patients living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Care was tailored to patient’s individual needs and circumstances, including their physical health needs. This included annual health checks for people with serious mental illnesses.
• Access to a variety of treatments was facilitated such as listening and advice, cognitive behavioural therapy and counselling.
• The practice utilised a mental health facilitator who was also invited to all multi-disciplinary team meetings
• When the practice did not feel appropriate secondary care had been given to patients they raised this with stakeholders and with the services concerned in order to avoid the same problem reoccurring and try and improve services for patients.
• Staff signposted patients to Dementia Action Alliance for further support and information.
• The data we held reflected that performance for mental health, depression and dementia related indicators were much lower than the CCG and national averages. However information we reviewed during the inspection did not correlate with this. We found that there appeared to be a system error which meant that despite the correct information having been recorded on the relevant template the information had not always pulled through to the QOF and therefore the data was incorrect. The practice had an action plan to address these issues.

Updated 4 August 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 and carried out health checks.
• The practice had a number of patients in a care home for people with a learning disability and we received positive feedback from them. The nurse prescriber attended the home to administer flu vaccines and provide blood tests. The home told us the needs of the residents were accommodated on these occasions by the nurse attending in non- uniform in order to reduce anxiety.
• End of life care was delivered in a coordinated way which took into account the individual needs of those whose circumstances made them vulnerable.
• The practice offered longer appointments for patients with a learning disability or any vulnerability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff 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.

• Information on how to access GP services and support groups was made available through a number of avenues including the practice leaflet, the patient participation group, practice website and going forward there were plans to use social media. The practice aimed for patients to feel able to access their services without fear of stigma and prejudice.
• Longer appointments were offered where required.
• All staff were aware of and used the first contact referral service for vulnerable patients which put them in touch with numerous avenues of support.
• If patients are vulnerable, this was identified in their patient record so all staff were aware.