Dr Y Thankey, Dr A Kachhia & Dr S Johnson Also known as Riversley Road Surgery

Updated 15 March 2017

Dr Y Thankey & Dr A Kachhia, also known locally as Riversley Road Surgery, is a practice in the town of Nuneaton. The practice operates under a General Medical Services (GMS) contract with NHS England. A GMS contract is one type of contract between general practices and NHS England for delivering primary care services to local communities. The practice was established in the 1950s and currently operates from premises purpose built in 1982 with accessible facilities for patients with additional needs such as step-free access.

Riversley Road Surgery has a patient list size of 4,586, with higher than average levels of social deprivation. The patient lists age distribution is broadly in line with the national average, with the exception of a slightly higher population of older people. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients. For example, the practice offers minor surgery, unplanned admissions, rotavirus and shingles immunisation and risk profiling and case management.

The clinical team includes two male and one female GP partners and one practice nurse. The team is supported by a practice manager and six administrative and reception staff. Riversley Road Surgery is a training practice which has qualified junior doctors working under the supervision of the GPs. At the time of the inspection there was one trainee GP in place. The practice also has a modern apprentice working in the reception team.

Riversley Road Surgery is open from 8am to 6.30pm from Monday to Friday. The practice is closed between 12.30pm and 2pm, during which the practice telephone lines divert to an answering machine which provides a mobile number to dial if the matter is urgent. Outside of opening hours there are arrangements in place to direct patients to out-of-hours services provided by NHS 111.

Updated 15 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Y Thankey & Dr A Kachhia (also known locally as Riversley Road Surgery) on 14 September 2016. Overall the practice is rated as good.

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

• The practice had a suitable system to report and record significant events. We saw that these were fully investigated and patients affected were notified and supported.

• Procedures were in place for monitoring and managing risks to patient and staff safety, and there were arrangements to deal with emergencies and major incidents. Although we were told that fire alarm tests and drills had been carried out the practice’s log book was not up to date to confirm this.

• The practice delivered care in line with relevant and current evidence based guidance and standards. Systems were in place to keep all clinical staff up to date with current guidelines.

• The practice held annual staff appraisals meetings to review professional development and identify learning needs. Staff we spoke with during the inspection told us they had access to appropriate training to cover the scope of their work.

• We spoke with eight patients who we met in the waiting area during the inspection. All were satisfied with the overall standard of care and felt their privacy and dignity was respected by staff at the practice. We also received a high comment card return rate with similarly high patient satisfaction.

• Information for patients about the services available was easy to understand and accessible.

• Improvements were made to the quality of care as a result of complaints and concerns.

• Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was higher than local and national averages.

• 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 practice had invited a local PPG which had won a PPG of the Year award to share learning with their members.

The area where the provider should make improvement is:

• Maintain an up to date fire safety log book to ensure that procedures are followed and equipment is safe to use.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 March 2017

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

• The practice maintained registers of patients with long-term conditions. These were used to monitor the patients’ health and ensure they were offered appropriate services.

• The nursing team had lead roles in chronic disease management.

• Performance for diabetes related indicators was similar to or higher than CCG and national averages. For example, 90% of the practice’s patients with diabetes had a blood pressure reading within the target range in the preceding 12 months compared with the CCG average of 78% and the national average of 78%. Exception reporting was 5% for this indicator, compared with the CCG average of 7% and the national average of 9%. 93% of patients with diabetes had a record of a foot examination in the preceding 12 months compared with the CCG average of 89% and national average of 88%. Exception reporting was 6%, in line with the CCG average of 7% and the national average of 8%.

• The practice ran specialist clinics and offered longer appointments for patients with long term conditions.

• Clinical staff engaged with healthcare professionals to provide a multidisciplinary package of care. Multidisciplinary team (MDT) meetings were held every three months.

Updated 15 March 2017

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

• Childhood immunisation rates for the vaccinations given were comparable to CCG averages. For example, childhood immunisation rates for the vaccinations given to under one year olds were all 100%, which was comparable to the CCG average of 97% to 99%. Rates for five year olds from 91% to 94%, which was lower than the CCG average of 94% to 99%.

• Same day appointments and appointments outside of school hours were available for children.

• The premises were suitable for children and babies. For example a baby changing room and a breast feeding room were available.

• There was a lead GP for children’s safeguarding who liaised with health visitors to discuss any concerns. The practice used an alert system to ensure staff were aware of any safeguarding concerns regarding children.

Updated 15 March 2017

The practice is rated as good for the care of older people.

• Care was tailored to meet the needs of the older people in the practice population.

• GPs made home visits to older patients who had difficulty attending the practice.

• Same day appointments were available for older people who required an urgent consultation.

• The practice offered the flu vaccination to patients aged over 75, as well as pneumococcal and shingles vaccinations where appropriate. The practice had a high flu immunisation rate and had been approached by the CCG to share good practice.

• Male patients over the age of 65 were offered abdominal aortic aneurysm (AAA) screening which was carried out at the practice.

Updated 15 March 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered appointments at the end of the day after 5pm to accommodate working age people.
• The practice offered online access to appointment booking and repeat prescription ordering.

• Telephone consultations were available for patients who did not feel they required a physical consultation or who had difficulty in attending the practice during opening hours.

• Patients over the age of 45 were offered a cardiovascular disease check when they registered with the practice.

Updated 15 March 2017

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

• Quality Outcomes Framework (QOF) data showed that the practice was performing above local and national averages in its care of patients with dementia. For example, 95% of patients diagnosed with dementia had a face to face care review in the past 12 months, compared with an average 84% in the CCG area and nationally. Exception reporting for this indicator was also below average at 5%, compared with the CCG average of 6% and the national average of 8%.

• Performance for mental health related indicators was higher than the CCG and national averages. For instance, 97% of patients with a form of psychosis had a comprehensive, agreed care plan documented in the preceding 12 months, compared to the CCG average of 92% and the national average of 88%. Exception reporting was 0%, significantly lower than the CCG average of 9% and the national average of 13%. 100% of the same group had also had their alcohol consumption recorded in the previous 12 months, higher than the CCG average of 93% and the national average of 90%. The practice had not exception reported any patients for this indicator, whereas the CCG average was 6% and the national average 10%.

• The practice liaised with multidisciplinary teams in the management of patients experiencing poor mental health and care plans were in place for those with dementia.

Updated 15 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of vulnerable patients. There were 91 patients on the register at the time of the inspection. The practice used this information to monitor and improve care for these patients, and liaised with social services regarding their needs.

• The practice did not have any homeless patients registered when we carried out the inspection, but had provisions in place to treat homeless patients. The practice told us they would always try to obtain some form of contact for homeless patients so that they could to continue to monitor their health.

• Longer appointments were available for patients with a learning disability. The practice had also recruited a second practice nurse with a background in learning disabilities who would shortly take up the post. The practice hoped to be able to offer extended appointments with the GP lead for learning disabilities and the new nurse so that patients could attend with their carer for a full review, a flu vaccination, and any other needs.

• There was disabled access, a hearing loop and information about available translation services was displayed in the patient waiting area.

• Staff had received safeguarding training and knew how to recognise signs of abuse in children and adults.

  The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of vulnerable patients. There were 91 patients on the register at the time of the inspection. The practice used this information to monitor and improve care for these patients, and liaised with social services regarding their needs.
• The practice did not have any homeless patients registered when we carried out the inspection, but had provisions in place to treat homeless patients. The practice told us they would always try to obtain some form of contact for homeless patients so that they could to continue to monitor their health.
• Longer appointments were available for patients with a learning disability. The practice had also recruited a second practice nurse with a background in learning disabilities who would shortly take up the post. The practice hoped to be able to offer extended appointments with the GP lead for learning disabilities and the new nurse so that patients could attend with their carer for a full review, a flu vaccination, and any other needs.
• There was disabled access, a hearing loop and information about available translation services was displayed in the patient waiting area.
• Staff had received safeguarding training and knew how to recognise signs of abuse in children and adults.