Archived: Dr S A Chacko & Dr R E Hubber --- Peel GPs

Updated 10 September 2015

Dr S A Chacko & Dr R E Hubber surgery is based in Bury, Greater Manchester. The practice treats patients of all ages and provides a range of medical services. The staff team includes two GP partners, two practice nurses and a healthcare assistant. The administration team consists of the practice manager and 12 administrative and reception staff.

The practice is open Monday to Friday from 08.30 to 18.00. Patients can book appointments in person, on-line or via the telephone. The practice provides telephone consultations, pre bookable consultations, same day (advanced access) appointments and home visits to patients who are housebound or too ill to attend the practice. The practice closes one afternoon per month for staff training. When the practice is closed patients access BARDOC the out of hours provider.

The practice is part of Bury Clinical Commissioning Group. It is responsible for providing primary care services to approximately 3,300 patients. The practice has a General Medical Services (GMS) contract.

Updated 10 September 2015

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dr Chacko and Dr Hubber on the 5 May 2015. We found that the practice was performing at a level which led to a rating judgement of good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed, and care was planned and delivered following the best practice guidance. Staff had received training appropriate to their roles, and any further training needs were identified and planned.
• Baby clinics were timed to run alongside health visitor clinics within the building. This provided maximum convenience for families and maximised on immunisation rates.
• Patients said they were treated with compassion, dignity and respect, and they were involved in their care and decisions about their treatment.
• Information about how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment, that there was continuity of care, with urgent appointments available the same day.
• The practice was part of the Easy GP Scheme run by Bury GP Federation. This gave patients access to routine pre bookable and same-day GP appointments at four sites across the Bury area from 8 am to 8 pm Monday to Friday and 8 am – 6 pm at the weekend.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Staff worked with local services Bury Drug and Alcohol Team to support patients with addiction. A drug counsellor attended the practice to see patients once a week, and a GP from a neighbouring practice provided specialist support for these patients.
• There was a clear leadership structure that focussed on the care and treatments provided to patients. The leadership was proactive in using methods to improve patient care and improve service provision. Staff felt supported by management. The practice proactively sought and acted on feedback from staff and patients.
• The practice works closely with and supports the provider of the “zero tolerance” scheme and would take registration from patients removed from previous practices for violent or aggressive behaviours. This supported these patients to access the service when in need of medical care.

However, there were also areas of practice where the provider needs to make improvements.

Also, the provider should:

• Provide information in the patient waiting area in different languages to support patients whose first language is not English
• Ensure medicines are stored securely.
• Ensure GPs receive training on the Mental Capacity Act and Deprivation of Liberty Safeguarding.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 September 2015

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

A robust recall system for annual reviews and other monitoring for patients with chronic diseases and long term conditions was in place. Clinical staff were up to date with management and monitoring of long term conditions. GPs ran regular chronic disease clinics in addition to the appointments offered by the practice nurses. The practice also used clinical software Vision Plus to opportunistically review chronic disease monitoring and management. Patients whose long term conditions left them at increased risk of hospital admission were covered by the Unplanned Admission Enhanced Service. They had care plans in place with quarterly reviews and post discharge reviews. The practice was proactive in offering flu vaccination to those eligible or in at risk groups.

Updated 10 September 2015

The practice is rated as outstanding for the care of families, children and young people. GPs had recently reviewed and improved the provision of child health surveillance. A newly designed welcome pack was available to families of new babies registered with the practice. The practice offered a ‘one stop’ clinic for the 6/8 week check. First immunisations and postnatal appointment for mothers and baby clinics were timed to run alongside health visitor clinics within the building to minimise the number of appointment attendances for the family. Baby changing facilities were available along with a room that could be used for breastfeeding. The practice promoted national and local immunisation campaigns. The telephone triage system ensured children were seen quickly, and for parents and carers to have access to medical advice in a timely fashion. The practice offered a full range of family planning services on site including implants and coils. Midwife appointments were available at the practice. Clinical staff engaged with other agencies for safeguarding purposes and all staff were up to date with safeguarding training and were aware of when and how to get further advice. Appointments for immunisations were available to fit around school times. Children’s attendance at A&E was monitored. Surveillance of A&E discharge summaries as they enter practice were acted upon where necessary. The A&E discharge summaries were always sent automatically to health visitors who were proactive in identifying such concerns.

Updated 10 September 2015

The practice is rated as good for the care of older people. The practice gave all patients over 75 years of age a named responsible GP. The building was fully accessible for patients who have mobility problems. Staff were alert to and made adjustments where possible for patients with sensory disabilities. For example, a hearing loop was available and assistance dogs were welcomed. Reception staff would escort patients who experience mobility problems to consultation rooms when needed. Staff were proactive in offering Influenza and shingles vaccinations to patients over 65 years. If patients became housebound timely home visits were offered. GPs and clinical staff worked at a local nursing home under the local enhanced services scheme. They completed a weekly visit to see all patients to address their care needs.

Updated 10 September 2015

The practice is rated as good for the care of working age people (including those recently retired and students). The practice nurse and health care assistant appointments were available from 8 am and routine GP appointments were available to pre-book in advance from 8.30am. Prescriptions and online appointments were bookable 24 hours a day. The telephone triage service ensured a flexible appointment system. The practice was part of the Easy GP Scheme run by Bury GP Federation. This gave all patients access to routine pre bookable and same-day GP appointments at four sites across the Bury area from 8 am to 8 pm Monday to Friday and from 8 am to 6 pm at the weekend. NHS health checks were actively promoted for newly registered patients and patients already registered at the practice.

Updated 10 September 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The telephone triage service allowed for a quick response for patients who felt their mental health was deteriorating, or they were at crisis point and longer appointments were available to these patients. Annual reviews were held for patients with complex mental health needs, with care plans being put in place as appropriate. GPs engaged with a local dementia diagnosis and management enhanced service which meant more patients could be diagnosed and managed at the practice by familiar GPs rather than going to secondary care. The practice offered and invited all patients with dementia for an annual review and physical health check. Through a local enhanced service, the practice cared for the majority of patients in a local nursing home. These were predominantly patients with a history of dementia. Weekly review visits were offered to any patient needing care. Patients’ care plans and planning for end of life care was reviewed annually or as necessary.

Updated 10 September 2015

The practice is rated as outstanding for the care of people whose circumstances may make them vulnerable. All staff kept up to date with current safeguarding guidelines (adult and child). A record was kept of patients who may be seen as being vulnerable. For example patients who may misuse substances, patients involved in domestic violence or patients with mental health problems. Patient confidentiality was maintained. GPs attended inter-agency meetings such as vulnerable adult meetings. Reception staff were alerted by red flags on the IT system about patients who had failed to collect prescriptions regularly with clinical staff being notified where appropriate. Patient information leaflets were readily available regarding child and adult safeguarding issues. Clinical staff worked with local Bury Drug and Alcohol services. Patients with a learning disability, together with their carers, were offered an annual review with a 30 minute appointment.