Archived: Dr Surendra Baliga Also known as Shildon Health Clinic

Updated 6 August 2015

Dr Surendra Baliga is a sole GP, providing primary medical services (PMS) to approximately 1,400 patients in the catchment area of Shildon, which is the Durham Dales, Easington and Sedgefield Clinical Commissioning Group (CCG) area.

There is one GP, who is male, although it is possible for patients to request a female GP, who would attend from another practice under a sharing agreement. There is one nurse practitioner and one practice nurse, both of whom are female. These are supported by a practice manager, two reception and administrative staff, and a trainee.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; family planning; surgical procedure, maternity and midwifery services; and treatment of disease, disorder and injury. The practice has higher levels of deprivation compared to the England average. There are higher levels of people with a long term health condition, or with caring responsibilities, and lower levels of employment.

The practice has opted out of providing Out of Hours services, which patients access through the 111 service. The practice is a member of the South Durham Health CIC Federation.

Updated 6 August 2015

Letter from the Chief Inspector of General Practice

We carried out this comprehensive inspection on 19 May 2015.

Overall, we rated this practice as good. Specifically, we found the practice to be good for providing well-led, effective, caring, safe and responsive services.

Our key findings were as follows:

• The practice provided a good standard of care, led by current best practice guidelines.
• Patients told us they were treated with dignity and respect, and patient satisfaction levels were high.
• The practice performed well in the management of long term conditions, and was proactive in offering review and screening services.
• Patients could access appointments without difficulty, and were happy with the telephone and repeat prescribing systems.
• The building was safe for patients to access, with sufficient facilities and equipment to provide safe effective services.
• The practice had a caring, patient centred ethos and values, which staff were engaged with.

We saw several areas of outstanding practice including:

• The practice had gained an ‘Investing in Children Award '. Membership is awarded to show that the practice where engaged in dialogue with children and young people, and this had resulted in change to help ensure that children and young people were treated with respect and dignity.
• The Nurse Practitioner had attended local schools along with the school nurse to promote services available for young people at the practice.
• The practice was proactive in identifying carers, including young carers. The practice had close links with a local carer charity, who had information displayed in reception. The charity also attended at flu clinics, to meet patients and identify carers.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Improve on structured minute taking for clinical and staff meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 August 2015

The practice is rated as good for the care of people with long term conditions. People with long term conditions were monitored and discussed at multi-disciplinary clinical meetings so the practice was able to respond to their changing needs. Information was made available to out of hours providers for those on end of life care to ensure appropriate care and support was offered. People with conditions such as diabetes and asthma attended regular nurse clinics to ensure their conditions were monitored, and were involved in making decisions about their care. Nurses communicated with the GP for each condition, although much of this was not recorded. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. Attempts were made to contact non-attenders to ensure they had required routine health checks.

Updated 6 August 2015

The practice is rated as outstanding for the care of families, children and young people. The practice had a dedicated teenage health area on the website, covering subjects such as puberty, drugs and alcohol, and healthy eating. The practice had worked with a group of young patients to improve services and gained the ‘Investing in Children’ award. The practice consulted with young people on health matters and how to improve existing services to make them more accessible. The nurse practitioner had carried out joint visits with the school nurse to schools in the area to make young people aware of the services available at the practice and to help make them more confident in attending.

Systems were in place to identify children who may be at risk. The practice monitored levels of children’s vaccinations and attendances at A&E. Immunisation rates were high for all standard childhood immunisations, and parents could attend at convenient times for these if they were unable to attend an immunisation clinic. Full post natal and 6 week baby checks were carried out by the GP. Patients could access community midwife clinics and drop in child health clinics run by the health visitor from the practice building.

Updated 6 August 2015

The practice is rated as good for the care of older people. The practice held palliative care and multi-disciplinary meetings as required to discuss those with chronic conditions or approaching end of life care. Care plans had been produced for those patients deemed at most risk of an unplanned admission to hospital. Information was shared with other services, such as out of hours services and district nurses. Nationally returned data from the Quality and Outcomes Framework (QOF) showed the practice had good outcomes for conditions commonly found in older people. The over 75’s had a named GP and opportunistic screening for the early signs of dementia was offered, for which there had been a high uptake rate.

The practice worked with Advanced Nurse Practitioners employed by the local Federation, who visited those in Nursing Homes and those who were recently discharged from hospital, to try to decrease hospital admissions.

Updated 6 August 2015

The practice is rated as good for the care of working age people (including those recently retired and students). The needs of the working population had been identified, and services adjusted and reviewed accordingly. Routine appointments could be booked in advance, or made online. Repeat prescriptions could be ordered online. Evening appointments were available one day a fortnight, and appointments were booked flexibly to enable workers to attend. Telephone appointments were available, and patients received a text reminder of the appointment.

Updated 6 August 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). National data showed the practice performed well in carrying out additional health checks and monitoring for those experiencing a mental health problem. For instance, 100% of patients with dementia had been given a care review within the last 12 months. 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had an agreed care plan documented.

The practice made referrals to other local mental health services as required, and some counselling services could be accessed from the same site, providing easy access for patients.

Updated 6 August 2015

The practice is rated as good for the care of people living in vulnerable circumstances. The practice had a register of those who may be vulnerable, including those with learning disabilities, who were offered annual health checks. Patients or their carers were able to request longer appointments if needed. The practice had a register for looked after or otherwise vulnerable children and also discussed any cases where there was potential risk or where people may become vulnerable. The computerised patient plans were used to flag up issues where a patient may be vulnerable or require extra support, for instance if they were a carer. Staff were aware of their responsibilities in reporting and documenting safeguarding concerns.