Archived: Dr Mangarai Kishan Rao Also known as Speke Neighbourhood Health centre (Dr.K.R.Mangarai)

Updated 20 October 2016

Dr Mangarai Kishan Rao is responsible for providing primary care services to approximately 2504 patients. The practice has a General Medical Services (GMS) contract and offers a range of enhanced services such as flu and shingles vaccinations, unplanned admissions and timely diagnosis of dementia. The number of patients with a long standing health condition is about average when compared to other practices nationally. The practice has two GP partners (one which was applying for CQC registration at the time of inspection) one practice nurse, administration and reception staff and a practice manager.

The practice is open from 8am to 6.30pm Monday to Friday with extended hours to 7pm on three evenings per week. Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits. The practice treats patients of all ages and provides a range of primary medical services. Home visits and telephone consultations are available for patients who required them, including housebound patients and older patients. There are also arrangements to ensure patients receive urgent medical assistance out of hours when the practice is closed.

The practice is part of the Liverpool Clinical Commissioning group. The area is the third most deprived in the city. In addition it is estimated that the average household income is significantly lower than both the Liverpool and national averages. Unemployment is significantly higher than the city rate and 6.7% of the population are long term sick or disabled. People living in more deprived areas tend to have greater need for health services. The population is slightly younger than the city average with a greater percentage of children aged 0-4 years.

Updated 20 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mangarai Kishan Rao on 14 September 2016. Overall the practice is rated as good.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.We saw good evidence of improving the service by learning from adverse events and errors.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff told us they felt supported.

• Feedback from patients about their care was consistently positive.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

• The National GP Patient Survey results showed that patient’s satisfaction with access to care and treatment was in line with local and national averages.

• Information about how to complain was available. There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

There were also areas of practice where the provider should make improvements. The provider should:

• Develop a system for the receipt of NICE guidelines and the cascading of these to relevant staff.

• Review the systems in place for responding to patient safety alerts. A lead person should be identified for this role to ensure that changes are made to patient care when alert information is received at the practice.

• Follow up children who do not attend their practice appointments. Regular safeguarding meetings and formal discussion should be set up with the community health visiting services.

• Review the arrangements for following up patients who have been discharged from hospital including reviewing all patient discharge letters

• Improve the care plans in place for patients with complex health needs, who are at high risk of avoidable unplanned hospital admissions.

• Update thepractice recruitment policy to ensure it reflects the recruitment of all staff groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 October 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs.

Updated 20 October 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. The practice had a reminder system for parents who did not bring children and babies for immunisation, sending these letters out in their native language whenever possible. Appointments for young children were prioritised. We found the practice did not have designated face to face meetings with the Health Visitor to review children under 5, which included vulnerable children and those newly registered at the practice. Instead these communications were undertaken via telephone or information was left for the Health Visitor to review on a weekly basis. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. The practice provided a comprehensive and confidential sexual health and contraceptive service delivering the full range of contraceptive services.

Updated 20 October 2016

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. The practice had named GPs for all patients and also specifically for those over the age of 75 years. The practice offered a variety of health checks for older people specifically memory screening and osteoporosis risk assessments.

Updated 20 October 2016

The practice is rated as good 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 had an active website as well as noticeboards in reception advertising services to patients.

Updated 20 October 2016

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. These patients were mostly known by reception staff and we saw they would call patients to remind them an appointment had been booked for them. Patients experiencing poor mental health were offered an annual review. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression.

Updated 20 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability to enable appropriate support to be provided. The staff we spoke with had appropriate knowledge about adult safeguarding and how to report any concerns. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. The practice referred patients to local health and social care services for support, such as drug and alcohol services.