Archived: Dr Ranjit Ray Also known as County Road Surgery

Updated 28 May 2015

Dr Ranjit Ray County Road Surgery is in Ormskirk and is part of the NHS West Lancashire Clinical Commissioning Group (CCG.) Services are provided under a general medical service (GMS) contract with NHS England. There are 2080 registered patients. The practice population includes a higher number (32.5%) of young people under the age of 18, and people over the age of 65 make up 27.6% of the remaining population of the surgery. These values are all slightly lower than the CCG averages.

The practice sits at point seven on the scale of deprivation. Information published by Public Health England, rates the level of deprivation within the practice population group as seven on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice opens from 08.00 - 18.30 with consultations from 0830 to1740 Monday to Friday, and holds a yoga breathing clinic on Wednesday from 1-2pm which is open to patients and the local community not registered with the GP surgery. Patients requiring a GP outside of normal working hours are advised to contact an external out of hour’s service provider OWLS. (Out of Hours West Lancashire GP Service)

The practice is a single handed GP surgery, with one female practice nurses, one health care assistant, a practice manager, and administration staff. All staff except the GP work part time hours. The practice is not a GP training practice but does facilitate third year medical students for their two week primary care experience. The students are at the practice in an observational capacity only and verbal consent is gathered from all patients before the medical student joins their consultation with the GP.

The practice uses a GP telephone triage service each day to assess the health care needs of patients who request telephone appointments. These are available for call back by the GP at two points during the day. Both urgent and routine appointments are available each day.

On line services include appointment booking and ordering repeat prescriptions. The practice has recently moved to an Electronic Prescription Service for their patients and 70% of patients have taken advantage of this service since March 2015.

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ranjit Ray surgery on 05 May 2015

Overall the practice is rated as good. We found the practice to be good for providing safe, well-led, effective, caring and responsive services.

Our key findings were as follows:

• 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.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered after considering best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients
• The practice had a clear vision that had improvement of service quality and safety as its top priority. High standards were promoted and there was good evidence of team working.

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

The provider should:

• Ensure all policies are updated as required.
• Ensure an accurate record is available of all staff training.
• Ensure the GP sees all incoming clinical mail in a timely manner and responds appropriately.
• Ensure the offer of chaperone to patients is always recorded in the electronic notes even when the offer is declined.
• Work towards the implementation of a Patient Participation Group within the surgery.
• Improve communication within the team to ensure, as all staff work part time hours, they are aware of any changes in a timely manner.
• Ensure that if during consultation consent is given for student doctors to observe, this is accurately recorded in the patient’s electronic records and not just given verbally.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 May 2015

The practice is rated as good for the care of people with long-term conditions. Patients with long term conditions were supported by a healthcare team that cared for them using good practice guidelines and were attentive to their changing needs. Patients had health reviews at regular intervals depending on their health needs and condition. The practice maintained and monitored registers of patients with long term conditions for example diabetes, chronic obstructive pulmonary disease and heart failure. These registers enabled the practice to monitor and review patient conditions effectively and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. The practice offered weekly appointments with dietician’s within the practice at two separate clinics for both diabetic and routine support with their dietary needs.

Updated 28 May 2015

The practice is rated as good for the care of families, children and young people. Systems were in place for identifying and following up children who were at risk. For example, children and young people who had a high number of A&E attendances. Immunisation clinics for babies and young children were available on a weekly basis. Appointments both routine and urgent were available outside school hours and the premises were suitable for children and babies. Children needing urgent appointments were seen as soon as possible at the surgery. Children and young people were treated in an age appropriate way and recognised as individuals. Weekly midwife clinics were held  at the surgery and the midwife attended the monthly Multi-disciplinary team meetings to discuss any concerns or safeguarding issues. The population group of under 18 year olds accounted for 32.5% of the practice patient population which is lower than both the Clinical Commissioning Group (CCG) for this age group.

Updated 28 May 2015

The practice is rated as good for the care of older people. Nationally reported data showed that 27% of the patient population were aged 65 or over which was below the national average. The practice had good outcomes for conditions commonly found amongst older people. The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example, avoidance of unplanned admissions to hospital, timely diagnosis and support for people with dementia, and a shingles vaccination programme for those aged 70 and above. The practice was responsive to the needs of older people including offering home visits. The practice had started longer appointments at an afternoon surgery to assist elderly patients to attend for their health checks at a time that was more suitable for them and their families. All patients living in care homes had been reviewed and had care plans in place. The GP and practice nurse followed up any hospital admissions to ensure that patients’ needs were met to reduce the risks of patients being re-admitted to hospital. The practice safeguarded older vulnerable patients from the risk of harm or abuse. The practice offered a personal wellbeing clinic on yoga breathing techniques to support patients to manage their conditions by holistic means rather than medication.

Updated 28 May 2015

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 offered later health check appointments for working patients and telephone consultations were available at two sessions during the day. 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.

Updated 28 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients within this group received a timely recall for their annual physical health check. The practice took all reasonable measures to ensure high quality of mental health care was available to patients within the limitations of the local service available.

The practice provided an enhanced service with a view to facilitating timely diagnosis and support for people with dementia which they were actively working to improve upon. The health care assistant had recently visited a new local facility for dementia care and instigated some changes within the practice to support the care of this group of patients.

Staff told us the practice had sign-posted patients experiencing poor mental health to various support groups, and they were proactive in helping patients address issues to improve all aspects of their health.

Updated 28 May 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They had carried out annual health checks for people with a learning disability and offered longer appointments to support their individual needs.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. 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.