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Inspection Summary


Overall summary & rating

Good

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Anita Malkhandi on 2 December 2015. The practice has a branch surgery at the address: 4 Lexden Street, Warrington, WA5 1PT which was also inspected. Overall the practice is rated as good.

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

  • 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.

  • Patients said they were treated with compassion, dignity and respect and that they were involved in decisions about their care and treatment.

  • Patients felt the GP knew their needs well and that they received a personalised service as a result. Patients felt the practice had a strong personal element whereby they were listened to, seen and treated as individuals.

  • Patients felt well informed about their health needs and the treatment options available to them.

  • The practice was proactive in supporting patients with their health needs.

  • There were systems in place to reduce risks to patient safety for example, infection control procedures.

  • Patients found it easy to make an appointment and there was good continuity of care.

  • The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.

  • There was clear leadership and structure and staff understood their roles and responsibilities.

  • The practice proactively sought feedback from patients and acted upon it.

  • Complaints were investigated and responded to appropriately.

  • The practice learned from events and complaints and used this learning to improve the service.

  • The practice made good use of audits, the results of which were used to improve outcomes for patients.

We saw one area of outstanding practice:

  • The practice had a long standing arrangement for contacting vulnerable patients on a regular basis by telephone to ask after their welfare and check if they required any additional support from the practice.

The areas where the provider should make improvement are:

  • Review the system for following patients up for immunisations and health screening to ensure it is fully implemented and more effective in reaching patients who do not attend.

  • Complete the refurbishment of the branch surgery.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 February 2016

The practice is rated as good for providing safe services. The practice had systems, processes and practices in place to protect people’s safety and safeguard them from abuse. Infection control practices were carried out appropriately. The premises were well maintained and health and safety checks were in place. Staff were aware of their responsibilities to report safeguarding and information to support them to do this was widely available throughout the practice. There was a system in place for recording, reporting and investigating significant events. Systems for managing medicines were effective and the practice was equipped with a supply of medicines to support people in a medical emergency.

Effective

Good

Updated 4 February 2016

The practice is rated as good for providing effective services. Data showed that outcomes for patients were average overall for the locality. Where this was not the case the practice had acted upon this. Clinical staff assessed patient’s needs and delivered care in line with current evidence based guidance. Staff felt well supported and they had the skills, knowledge and experience to deliver effective care and treatment. Clinical audits were carried out which resulted in improved outcomes for patients. Staff worked on a multidisciplinary basis to support patients who had more complex needs if this was required. The practice worked in conjunction with other practices in the area to improve outcomes for patients.

Caring

Outstanding

Updated 4 February 2016

The practice is rated as outstanding for providing caring services. Data showed that patients rated the practice higher than others for several aspects of care from the GP. For example, for listening to them and treating them with care and concern. The practice contacted patients who were vulnerable on a regular basis by telephone to ask how they were and to check if they needed any support from the practice. This included; all patients who were over 90 years of age, patients experiencing an exacerbation of their physical or mental health condition, patients living in residential care/respite care and supported tenancies. Staff referred to this as the ‘ring round’. The list of patients contacted changed frequently in line with changes in patient's needs and the frequency of calls to a patient was dependent upon their individual circumstances. Contact could range from two calls per week to one call every two to four weeks. Staff were very proud of this service and it showed us that they knew the needs of the patient population well. The outcome for patients was that they felt cared about. Patients gave us very positive feedback about the practice. They provided examples to support their view that staff at the practice were interested in their well-being and cared about their health and welfare. We heard an example of how staff had gone above and beyond their duties to support a vulnerable patient to attend an appointment at the practice. Patients told us they could speak directly to their GP if they had any concerns about their health, they told us they felt listened to and they had trust and confidence in their GPs response to them because they felt their GP knew their needs well. Information for patients about support services was made available to them in the reception area. A register of carers was maintained and carers were offered regular health checks and immunisations.

Responsive

Good

Updated 4 February 2016

The practice is rated as good for providing responsive services. The practice reviewed the needs of the local population and worked in collaboration with partner agencies to improve outcomes for patients. Staff attended regular locality meetings to review the needs of patients and plan for meeting patient’s needs. Patients said they found it easy to make an appointment with their GP and that there was good continuity of care. The appointments system was well managed. The GP spoke to patients by telephone to triage patients and urgent appointments were available the same day. The practice had good facilities and was well equipped to treat patients and meet their needs. Complaints had been investigated and responded to appropriately.

Well-led

Good

Updated 4 February 2016

The practice is rated as good for being well-led. There was a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about their roles and responsibilities and lines of accountability. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures in place to govern activity and regular meetings were held to discuss the operation of the service. The GP and practice manager encouraged a culture of openness. The practice sought feedback from patients and acted upon it. The patient participation group was developing and they gave very positive feedback about the practice. There was a good focus on continuous learning, development and improvement linked to outcomes for patients.

Checks on specific services

People with long term conditions

Good

Updated 4 February 2016

The practice is rated as good for the care of people with long-term conditions. The practice nurse supported people with a chronic disease to have regular checks on their health. Data showed that people with diabetes were overall in line with the national average for having appropriate health checks. One area where the practice was below average had been identified and steps had been taken to address this. Longer appointments and home visits were available when needed. Patients with a long term condition had periodic reviews of their medication with a pharmacist employed by the practice. Patient feedback indicated that patients felt well informed and supported to manage their health conditions and the practice was proactive in recalling them for reviews and follow ups. The practice had a system for following up patients who did not take up health screening opportunities or did not attend health prevention appointments. However, this should be reviewed to ensure it is effective and fully implemented.

Families, children and young people

Good

Updated 4 February 2016

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, alerts on medical records identified children at risk.

Staff

shared information or concerns about patient's welfare with health visitors or other relevant professionals when required. Appointments were available outside of school hours and children were given appointments at short notice. The premises were suitable for children and babies and baby changing facilities were provided. Child immunisation rates were slightly below national average rates and the practice had made attempts to improve this. On the spot immunisation appointments were available to encourage uptake.

Older people

Good

Updated 4 February 2016

The practice is rated as good for the care of older people. The practice offered proactive and personalised care and treatment to meet the needs of the older people in its population. Home visits and urgent appointments were provided for those with enhanced needs. The appointments system was responsive to ensure frail patients who were at risk of an unplanned admission to hospital were spoken with and seen quickly. The practice maintained a record of people who were elderly and vulnerable and they contacted people who they had concerns about on a regular basis to check how they were and if they needed any support from the practice. For some people this contact was every Friday followed by another call every Monday. Patients who lived in residential care or were having a respite break were contacted twice weekly by the practice.

Working age people (including those recently retired and students)

Good

Updated 4 February 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered appointments that were  accessible, flexible and offered continuity of care for people in this group. The practice was part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre up until 8.00pm in the evenings Monday to Friday and 8.00am to 8.00pm at weekends through a pre-booked appointment system. Telephone consultations were also available every day. The practice offered online services, enabling people to book appointments on line, view their records and order repeat prescriptions. A range of health promotion information and screening that reflected the needs for this age group was available to patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 February 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Data showed that patients with mental health needs had been well supported with health promotion and health prevention advice. For example data showed that patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. The practice was aware of people who were subject to restrictions under the Mental Health Act. Patients experiencing poor mental health were provided with information about how to access support groups and voluntary organisations. Patients experiencing poor mental health who were at risk were contacted as part of a ‘ring around’ service provided by the practice.  

People whose circumstances may make them vulnerable

Outstanding

Updated 4 February 2016

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances. Annual health checks and longer appointments were available for people with a learning disability. An example was provided of how staff had supported a vulnerable adult to attend the practice by going to their home and supporting them to walk to the medical centre for a health check. Some information had been provided in pictorial form to support people during their consultations with the practice nurse. Vulnerable patients were provided with advice and support about how to access a range of support groups and voluntary organisations. The practice maintained a list of patients who were vulnerable as a result of their circumstances. For example, people who lived in residential care or supported housing, people who were experiencing an exacerbation of a health condition, people over 90 years of age. The list was fluid and it changed as people’s circumstances changed. Patients on the list were contacted on a regular basis by the health care assistant. This was referred to by staff as the ‘ring round’. The frequency of contact was determined by the patient’s individual needs. For example patients who had moved into residential care were contacted every Friday to check if they needed anything from the practice. They were also contacted on a Monday to check how they had been over the weekend. Patients experiencing an exacerbation of their condition were contacted until their symptoms had subsided. Patients with mental health needs were contacted to check on their welfare if they were deemed at risk. The GP was trained in supporting patients with substance misuse and they worked closely with the Community Drug and Alcohol Service in providing shared care for people with drug dependence. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies. Staff  shared examples with us of how they had responded to concerns about patients’ welfare.