Dr N Chandra and Partners Also known as North Road Suite

Updated 4 August 2016

Dr N Chandra and Partners provide primary care services to 8343 patients in the Ravensthorpe area of Dewsbury under a Personal Medical Services (PMS) contract. The practice is known locally as North Road Suite.

• The area is on the second decile on the scale of deprivation. Twenty eight per cent of patients are from Black Minority Ethnic populations, 5% of the patient population are from Eastern European populations and 6% of patients claim disability living allowance. Thirty two per cent of older people were affected by Income Deprivation (national average 16%). The area is affected by high levels of unemployment, 13% compared with the national average of 5%.

• The practice is located on the first floor of Ravensthorpe Health Centre which hosts another GP practice as well as health visitors, midwives and a dental surgery. The practice has car parking and is fully accessible to wheelchair users. A lift is installed to provide access to all floors.

• There are three GP partners, two male and one female, the practice also has a male GP who works on a sessional basis, a female advanced nurse practitioner, four female practice nurses, three healthcare assistants, a female phlebotomist and a team of administrative staff. The practice merged with a single handed GP in 2014 who retired.

• The practice is open between 8am and 6.30pm Monday to Friday. Appointments are from 8.05am to 11.40am every weekday morning and from 4pm to 6.20pm Mondays, Wednesdays, Thursdays and Fridays. Extended hours appointments are offered on Tuesdays and Wednesdays from 3.40pm to 7.20pm.

• When the practice is closed, out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

Updated 4 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N Chandra and Partners on 21 April 2016. Overall the practice is rated as outstanding.

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

• All staff were open, transparent and fully committed to reporting incidents and near misses. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning and personal reflection from internal and external incidents were maximised.
• The whole team was engaged in reviewing and improving safety and safeguarding systems. They used the Care Quality Commission fundamental standards to measure standards of care and signed up to the NHS England Sign up to Safety campaign.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, they developed practice specific protocols to safeguard patients, identify patients at risk of exploitation and assess patient need.
• Feedback from patients about their care was consistently and strongly positive.
• The practice carried out regular patient engagement and surveys, including surveys for children for whom they introduced specific survey forms.
• 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 and reduced inequalities. For example, they worked with the local community support workers to create new practice specific literature in Urdu and European languages.
• Comprehensive information about the practice and services was made available to patients including a patients’ charter and quarterly practice and patient group newsletter..
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from external stakeholders, patients and from the patient participation group. For example, the practice reserved child only appointments after school and increased the availability of urgent appointments as a result of PPG discussions.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was active review of complaints and how they were managed and responded to, and improvements are made as a result. People who use services were involved in the review. The practice had a mission statement and a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed. Staff, patients and external stakeholders were encouraged to contribute to the practice strategy to deliver this vision.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

• The practice was very responsive to the needs of minorities. They engaged with the local community to co-produce practice specific information in their own language, for example, Urdu, Hungarian and Polish and introduced specific survey forms for children. Hungarian patients had a 21% fail to attend (FTA) rate for new patient appointments. They worked with local community support workers to create new practice specific literature in these languages. After the introduction of these resources the FTA rate decreased significantly.
• The practice recognised problems locally with human trafficking. They consulted local authorities and national guidance. The information was discussed with staff to raise awareness and identify indicators of modern slavery. Bespoke protocols were developed to assess these patients upon registration and at subsequent appointments or if they failed to attend for appointments.
• Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, they invited dementia patients and family members to suggest how services could be improved, which they acted upon.
• The practice made significant efforts to identify and support carers. There was a named carers champion who worked with local organisations to support carers and attended local carers champion meetings and events. We saw a dedicated carers corner in the waiting area with up to date information and saw examples of the support offered to patients, carers and their families. Carers were given a direct practice telephone number to ring for support. A local carer support organisation had acknowledged the practice’s proactive approach to carers. The practice was featured in the Carers Count newsletter shortly after the inspection. The practice had significantly increased the proportion of carers on their register as a result of this activity.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Eighty eight per cent of patients with diabetes, on the register, had a record of a foot examination and risk classification (CCG average 89%, national average 88%).
• Longer appointments and home visits were available when needed.
• The practice identified a high prevelance of Chronic Obstructive Pulmonary Disease (COPD). Two nurses received additional training in spirometry to deliver local care to this group of patients which increased the number of patients who had their diagnosis confirmed.
• Patients at risk of hospital admission but not under the care of the community matron were referred to the CCG care co-ordinators. The practice worked with and referred patients to a care co-ordinator who liased with NHS and social care services to ensure patients were supported.
• 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.
• Many Eastern European patients presented with poorly managed long term conditions. The practice used interpreters and produced patient information in other languages to encourage patients to manage their condition and attend for screening and review appointments.

Updated 4 August 2016

The practice is rated as outstanding 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, children and young people who had a high number of A&E attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG and national average of 82%.
• Appointments were available outside of school hours and a number of child only appointments were reserved after school hours.
• The premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice introduced specific patient survey forms for children.
• There was a practice safeguarding team and the practice developed systems to proactively identify children at risk. The team attended safeguarding meetings and met regularly with local safeguarding leads.

Updated 4 August 2016

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

• 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.
• Flu vaccination rates for the over 65s were 79% compared to the national average of 73%.
• The percentage of older people attending for screening programmes was comparable to national averages. For example, 50% of patients aged 60-69, were screened for bowel cancer within 6 months of invitation compared to the national average of 52%.
• The practice reviewed patients aged over 75 with more than 10 medications on repeat prescriptions and reviews for patients over 75 without any long term conditions.
• Care home staff were issued with a dedicated telephone number for instant access when the surgery is open.
• The practice referred vulnerable older people to the Kirklees Carephone home safety service which provides assistive technology to help older people to live independently in their own home.
• Older people were signposted to use The Silver Line which is a free confidential helpline providing information, friendship and advice to older people, 24 hours a day.
• Data showed that 31% of older patients were affected by income deprivation. The carers champion helped them to identify sources of financial help and assisted them with completing application forms. Older people at risk of hospital admission but not under the care of the community matron were referred to the CCG care co-ordinators. The practice worked with and referred patients to a care co-ordinator who liased with NHS and social care services to ensure patients were supported.

Updated 4 August 2016

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

• 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 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.
• The practice offered late appointments on Tuesday and Wednesday evenings for working people.
• The practice had a dedicated 24 hour appointment cancellation line and used text messages to remind patients of appointments.
• Drop in phlebotomy and ECG services were provided five days a week.

Updated 4 August 2016

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

• 90% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.
• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months (CCG average 89%, national average 88%).
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• They invited dementia patients and family members to suggest improvements and improve services. As a result staff had received additional dementia friendly training and dementia friendly signage and information was introduced.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• There were clinical and non clinical leads identified for dementia and mental health. Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice encouraged carers and family members to the West Yorkshire Police Herbert Protocol scheme which encourages carers to compile useful information which could be used in the event of a vulnerable person going missing.

Updated 4 August 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 including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• Staff regularly worked with other health care professionals in the case management of vulnerable patients.
• There was a named carers champion who worked with local support organisations to support carers. There was a dedicated carers corner in the waiting area with up to date information and carers were given a direct telephone number to ring for support.
• The introduction of a carers champion and proactive efforts to identify carers lead to an increase of carers recorded by the practice. The practice had 91 patients recorded as carers up to May 2015. The number of carers recorded increased by 162 to a total of 253 by April 2016 (3% of the patient list).
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations. Staff liased with local support groups and ensured that information given to patients was up to date.
• The practice had a dedicated safeguarding team who met with the local safeguarding teams regularly. 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 in normal working hours and out of hours.
• The service hosted a shared care specialist drug and addiction service. The GPs and specialist nurse from the community service worked closely with other local support services and safeguarding teams to support patients’ recovery and help them to regain their independence.
• The practice was registered with the Kirklees Safe Places scheme. The scheme helps vulnerable people who become confused, frightened or need help when they left their homes.