Archived: Dr Pankaj Srivastava Also known as Holmlands Medical Centre - Dr P Srivastava

Updated 31 May 2016

Dr Pankaj Srivastava is registered with the CQC to provide primary care services, delivered under a PMS contract.

Dr Srivastava retains the services of three GPs, one female and two males. There were three practice nurses (all female) who provided disease management, health screening, immunisation and vaccine clinics and other health initiatives.

Practice opening hours were from 8.30am to 6.30pm. Extended hours appointments were available each Thursday, when the practice was open until 8pm in the evening.

The practice is located within an area rated as being at the mid-point of social deprivation. Life expectancy for males is 77.9 years of age and for females is 81.9 years of age. In terms of age, the population of males and females aged between 60 and 69 years was higher than the England average, making up almost 19% of the practice register.

Out of hours services were not provided by the practice, but by another, external provider.

Updated 31 May 2016

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr Pankaj Srivastava, also known as Holmlands Medical Centre. Our inspection was a planned comprehensive inspection which took place on 15 January 2015. Dr Pankaj Srivastava (“the practice”) delivers services under a Primary Medical Services (PMS) contract.

The service provided by Pankaj Srivastava is rated overall as good. We found care and treatment delivered to patients was safe, effective, caring and responsive to patients’ needs. Some improvements were required in the area of well-led.

Our key findings were as follows:

• Patient safety was at the heart of the practice’s delivery of services. Systems in place supported this and all staff were clear about their responsibilities.
• Care and treatment of patients was effective. We found the ‘sit and wait’ system of seeing patients had reduced the amount of time lost by GPs due to patients’ failure to attend appointments.
• All patients we spoke to on the day of our inspection, and in information from CQC comment cards, confirmed that the practice staff and clinicians were caring and compassionate.
• The practice was responsive to patients’ needs. Access to clinicians was very good and patient feedback had been considered by the practice in the development of its services.
• The practice was supportive of those patients who were also carers and had offered those carers training in emergency first aid.

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

Importantly, the provider must:

Comply with regulation 21(b) and (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Request and keep copies from locum supply agencies of all checks conducted on any locum supplied, confirmation of their entry on the NHS England Performers List and evidence of adequate indemnity insurance.

In addition the provider should:

Address the non-attendance of district nurses at practice multi-disciplinary team meetings for management of care of patients at end of life.

Make arrangements for the practice nurse to receive annual appraisal with input from a clinician and have systems in place to review the work of the practice nurse, for example by way of clinical audit.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 26 March 2015

The practice had processes in place for the referral of patients with long term conditions that had a sudden deterioration in health. The GP reviewed all unplanned admissions to hospital. Registers of patients with long term conditions were kept and annual reviews of patients were carried out, including a review of medications. If needed these patients were seen more regularly to monitor their conditions. All patients with an unplanned admission to hospital were reviewed by the GP on discharge. We saw health promotional advice, information and referral to support services for example smoking cessation.

Updated 26 March 2015

The practice nurse delivered immunisations and vaccines to children and adult patients. We saw that a system of follow up was in place to capture any patients, particularly child patients, who had failed to attend these appointments. There was a walk-in (sit & wait) system in place from 8.00am each morning between Monday and Friday. All patients arriving at the practice before 10.00am would be seen. Feedback from patients was that they valued this system and on the day of our inspection, we saw that it worked well, particularly in meeting the needs of families with children.

Updated 26 March 2015

All older patients were assigned a named GP and given access to a direct line for that GP. If older patients were admitted to hospital in an unplanned way this was reviewed by the GP and if required, changes would be made to their treatment plan for example a change in medicines. Health promotional advice and support was given to patients and their carers if appropriate and information leaflets were freely available at the practice. These included signposting older patients and their carers to support services across the local community. Older patients were offered vaccines such as the flu vaccine each year.

Updated 26 March 2015

The facility for patients to pre-book appointments between 4.00pm and 6.00pm helped to meet the needs of those patients who had work commitments. Extended hours were available on Thursday evenings to see a nurse or doctor from between 6.30pm and 8.00pm. Clinicians at the practice routinely took patients’ blood pressure readings and recorded these along with patients’ weights. GPs were encouraged to ask questions about patients’ family history to increase the consideration for referral of patients who may show early signs of particular cancers, for example, bowel or lung cancers.

Updated 26 March 2015

The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients an annual appointment for a health check and a

medication review. Clinicians routinely referred patients to counselling and talking therapy services, as well as psychiatric provision. One of the salaried GPs at the practice had acted as the lead for dementia screening of patients, and for timely referral for formal diagnosis of those patients.

Updated 26 March 2015

The deputy practice manager was responsible for maintaining a register of all those patients who were carers. They had arranged first aid and cardio-pulmonary resuscitation training for carers, to be delivered by St Johns Ambulance, free of charge. All carers were offered a longer consultation time with the GP to ensure their own health needs were not overlooked. Where any carer had not attended for a routine annual health check, the deputy practice manager could demonstrate an effective system of follow-up to ensure a further appointment was offered and attended by the carer. When we reviewed the care plans of people who were more vulnerable to unplanned hospital admission, we saw the practice had annotated care plans to show if a patient was living alone. This enabled other clinicians to assess the priority for a home visit, if required.