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Dr Manoj Prasad Good Also known as Apollo Surgery

Inspection Summary


Overall summary & rating

Good

Updated 3 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Manoj Prasad’s practice on 13 September 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Implement planned actions to ensure care plans are in place for patients with poor mental health.
  • Take action to improve the disabled facilities and premises access for patients with mobility difficulties.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 October 2016

  • There was an effective system in place for reporting and recording significant events.
  • Outcomes and learning to improve safety in the practice had been shared with staff and were discussed at both practice meetings and with the patient participation group. Information was disseminated to all staff.
  • When there were unintended or unexpected safety incidents, people received reasonable support, information, and a verbal or written apology where appropriate. They were also 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 people safe and safeguarded from abuse. There was a lead member of staff for safeguarding children and vulnerable adults.
  • Risks to patients were assessed, embedded and well managed.

Effective

Good

Updated 3 October 2016

  • Our findings at inspection showed that effective systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • Data showed patient outcomes were at or above average compared to local and national average with the exception of percentage of patients on the mental health register who had a comprehensive, agreed care plan. The practice planned to target this area to ensure these were completed for all patients on the mental health register. All clinical staff we spoke with were aware that this was an area that they would be focusing on and we saw minutes of meetings where areas of underperformance had been discussed.
  • The practice had carried out five clinical audits in the last 12 months. Two of these were completed audit cycles where the improvements made were implemented and monitored.
  • 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 multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 3 October 2016

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
  • Data from the national GP patient survey showed patients consistently rated the practice higher than others for most aspects of care.
  • Views of external stakeholders were positive and aligned with our findings.
  • We found that information for patients about the services available.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 3 October 2016

  • 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 engaged with the Clinical Commissioning Group (CCG) to provide relevant targeted in-house services for its patients.
  • Data from the national GP patient survey showed patients’ satisfaction with how they could access care and treatment was consistently above local and national averages.
  • Patients were able to access appointments and services in a way and at a time that suited them. Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
  • The practice was equipped to treat patients and meet their needs.
  • Information about how to complain was available and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 3 October 2016

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. The practice was aware of practice performance levels and changes had been made where required.
  • There was a documented leadership structure and all staff felt supported by management. The practice had policies and procedures to govern activity and held regular practice meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care.
  • There was a proactive engagement with staff and staff we spoke with were highly motivated. The patient participation group was very engaged and active.
  • There was a strong focus on continuous learning and development at all levels. Staff had received regular performance reviews and had clear objectives.
Checks on specific services

People with long term conditions

Good

Updated 3 October 2016

  • Performance for diabetes related indicators for the practice was 92% which was above both the CCG average of 83% and national average of 84%.The practice had set up a pre-diabetic register and identified patients at higher risk of developing diabetes in order to support and advise patients on changes to prevent diabetes developing.
  • All these patients had a named GP and 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.
  • Patients attending for annual reviews were allocated extended appointment times of 30 minutes to allow full discussion of their long term condition.

Families, children and young people

Good

Updated 3 October 2016

  • Same day appointments were available for all children under 16 years of age and those patients with medical problems that require same day consultation.
  • Immunisation rates for childhood vaccinations were above CCG averages.
  • A self-check appointment service screen was available for the convenience of patients and allowed reception staff more time to deal with other queries.
  • Fortnightly antenatal and postnatal clinics were held by a midwife at the practice.
  • The practice’s uptake for the cervical screening programme was 82%, which was slightly above the CCG average of 78% and the same as the national average.
  • Appointments were available outside of school hours.
  • The premises were suitable for children and babies and baby changing facilities were available.

Older people

Good

Updated 3 October 2016

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • A facility for online repeat prescriptions and appointments bookings was available.
  • Patients were able to book telephone consultations with the GP.
  • There were longer appointments available for older patients.
  • The practice had a level access and the consultation rooms were all located on the ground floor. A hearing loop was also available at the practice.
  • An equality assessment had been carried out by the practice which had identified that improvements were required with disabled access of toilets and as well as access to the premises.
  • There were marked parking bays for the disabled near the practice.

Working age people (including those recently retired and students)

Good

Updated 3 October 2016

  • 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.
  • The practice offered extended hours on Mondays and Tuesdays from 6pm to 7.30pm to accommodate working patients who could not attend during normal opening hours.
  • Patients could book appointments or order repeat prescriptions online. Patients were also able to book telephone consultations with the GP.
  • A text service to both mobiles and landlines had been implemented by the practice to communicate with patients unavailable to answer calls such as those at work.
  • Weekly phlebotomy clinics were held at the practice for the convenience of patients.
  • The practice offered a full range of health promotion and screening that reflected the needs for this age group. The practice nurse provided support to those identified as requiring advice on their diet, smoking cessation and alcohol awareness. Patients were also signposted to more specialist services where appropriate.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 October 2016

  • There were longer appointments available for patients with complex needs such as those with dementia, a learning disability and patients experiencing poor mental health.
  • The practice was an outlier for the percentage of patients on the mental health register who had a comprehensive, agreed care plan documented which was 63% for the practice compared to 89% CCG and 88% nationally. The practice told us that a plan was being developed to target this in order to ensure care plans was in place for all patients on the mental health register. All clinical staff we spoke with were aware that this was an area that they would be focusing on and we saw minutes of meetings where areas of underperformance had been discussed.
  • The practice had informed patients experiencing poor mental health about how to access various support groups.
  • Weekly sessions by the Healthy Minds Counselling service were offered at the practice.
  • The GP we spoke with had good knowledge of the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005. We saw evidence that the GP had completed mental capacity training.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 3 October 2016

  • The practice held a register of patients living in vulnerable circumstances and alerts were in place on the clinical patient record system.
  • Translation services were available.
  • There were longer appointments available for patients with complex needs such as those with dementia or a learning disability.
  • There was a lead staff member for safeguarding and we saw evidence to show that staff had received the relevant training.
  • The practice had policies that were accessible to all staff which outlined who to contact for further guidance if they had concerns about a patient’s welfare.
  • Staff members we spoke with were able to demonstrate that they understood their responsibilities with regards to safeguarding.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.