Archived: Dr Gokaraju Arunaprasad

Updated 31 May 2017

The practice is located at Patience Lane Surgery, Patience Lane, Altofts, Normanton, West Yorkshire WF6 2JZ. The practice population is around 2,300 people and is a member of NHS Wakefield Clinical Commissioning Group (CCG). The practice is part of a local GP federation.

The practice is located in premises which provide easy access for those patients with a disability, or those who use a wheelchair; for example there is a ramp leading to the entrance door. Some parking is available on site for patients, including reserved places for those patients with a disability. Other parking is available at adjacent on street locations.

The practice age profile shows that 18% of their patients are aged under 18 years ( The CCG average is 20% and national average is 21%). 20% of patients are aged 65 years or older, compared to the CCG average of 18% and national average of 21%.

Average life expectancy for patients at the practice is 78 years for men and 82 years for women (CCG average is 77 years and 81 years and national average 79 years and 83 years respectively).

Information published by Public Health England rates the level of deprivation within the practice population as seven on a scale of one to ten. Level one represents the highest level of deprivation and level ten the lowest. The practice population primarily comprises white British patients.

The practice provides services under the terms of a Personal Medical Services (PMS) contract. The practice offers a range of enhanced local services in relation to:

• Childhood vaccination and immunisation

• Influenza and pneumococcal immunisation

• Avoiding unplanned admissions scheme

• Alcohol intervention and support services

• Rotavirus and shingles immunisation

• Dementia support

• Minor surgery

• Learning disability support

• Improving online access for patients

• Patient participation by use of patient participation group

In addition to these enhanced services the practice also offers support to patients with long term conditions such as asthma, diabetes and coronary heart disease.

The practice has a range of professionals attached to, or working closely with them; including health visitors, district nurses and midwives.

The practice is operated by one principal GP who is male. The medical team is augmented by three regular locum GPs, one male and two female. The clinical team is completed by a female practice nurse, female health care assistant and a female phlebotomist. The clinical team is supported by a practice manager and a range of administrative and reception staff.

The practice offers book on the day appointments, pre-bookable appointments, telephone triage consultations or home visits. Appointments can be booked in person, by telephone, or online.

The practice is open between 8am and 6.30pm Monday to Friday with a GP or practice nurse. Appointments are available:

• 8.30am to 10.30am, and 4pm to 6pm Monday, Tuesday and Wednesday

• 8.30am to 11.30am, and 3.30pm and 6pm on Thursday

• 8.30am to 10.30am and 3.30pm to 6pm on Friday.

Out of hours care is provided by Local Care Direct and is accessed by calling the practice telephone number, or contacting NHS 111.

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Gokaraju Arunaprasad (Patience Lane Surgery) on 28 September 2016. The overall rating for the practice was Good. However we rated the practice as Requires Improvement for providing safe services. The full comprehensive inspection report can be found by selecting the ‘all reports’ link for Dr Gokaraju Arunaprasad on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 27 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 28 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as Good for providing safe services.

Our key findings were as follows:

• The practice had developed a policy for Patient Group Directions (PGDs) and Patient Specific Directions which had been circulated to all staff. All relevant PGDs were in date, signed and accessible to users.

• The practice had undertaken a full risk assessment of emergency drugs held in stock, and had purchased additional stock to supplement the medicines held.

• Fire alarm tests were held weekly. A fire evacuation test had been carried out. Further fire drills were scheduled to be carried out at six monthly intervals.

  In addition we found:

• The practice had developed clear systems and processes for the dissemination of MHRA bulletins, including identifying that any necessary actions or changes had been carried out.

• The incident reporting system had been improved to include regular reviews of changes made or actions taken as a result of significant incidents.

• The practice had evaluated the immunisations offered to staff, and all existing staff as well as new recruits were offered immunisation against Measles, Mumps and Rubella (MMR) and Varicella (chicken pox). Other vaccines were available for appropriate staff.

• The practice had reviewed the systems in place to monitor and improve outcomes for patients. At the time of our visit the practice showed us they were beginning to participate in a local Improvement in Prescribing Plan (ImPP) looking at medicines optimisation audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 16 November 2016

The practice is rated as good 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. The nursing team reviewed patients for conditions which included coronary heart disease, asthma and chronic obstructive pulmonary disease.

• The practice had a recall system in place for asthma, rheumatoid arthritis, depression and dementia and was in the process of expanding this to include chronic obstructive pulmonary disease (COPD).

• Longer appointments and home visits were available when needed.

• 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.

• There was a page on the website dedicated to patients with long term conditions which contained links to other organisations and other information relevant to these conditions.

• A joint diabetes clinic was held in the surgery with support from a specialist diabetic nurse from a local secondary care provider. These clinics were held every two months and dealt with more complex cases. Diabetic reviews were scheduled either three monthly, six monthly or yearly depending on need.

• The practice had set itself a target to have a care plan in place for all patients with a long term condition by the end of March 2017.

• The in-house patient survey with regard to long term conditions showed high satisfaction levels and 100% of respondents stated that they had received enough support from the practice to help them manage their condition.    

Updated 16 November 2016

The practice is rated as good 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.

• Antenatal clinics were held fortnightly with the midwife attached to the practice.

• Immunisation rates were relatively high for all standard childhood immunisations.

• The practice’s uptake for the cervical screening programme was 86%, which was above the CCG average of 83% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had received Young Persons accreditation in 2015 for delivering accessible services to younger service users. For, example, the practice had an area of the website dedicated to providing information to this group of people. In addition t he practice was a c-card distribution centre, which gave local, confidential access to condoms to young people.
• There was a young person’s confidentiality policy available to reassure young patients with regard to the privacy and security of their own personal information and in their dealings with the practice.

Updated 16 November 2016

The practice is rated as good 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. For example, the practice carried out routine home visits to all housebound patients. These patients were also able to receive flu vaccinations from the GP during these visits. In 2015/2016 the practice achieved an uptake rate of 83% for those aged 65 years and over.

• There was a dedicated page for “Seniors” on the practice website which provided health information and guidance specifically for older people.

• The practice hosted Abdominal Aortic Aneurysm (AAA) screening each year for patients aged 65 years and over.

• The practice delivered an avoiding unplanned admissions service which provided proactive care management for patients who had complex needs and were at risk of an unplanned hospital admission.

Updated 16 November 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 had recently extended appointment times so that pre-bookable appointments were available before 9am and after 5.30pm on most days for GP consultations.

• The practice was proactive in offering online services such as repeat prescription requests and appointment booking and cancellation as well as a full range of health promotion and screening that reflects the needs for this age group.

• The practice hosted a weekly physiotherapy clinic which was delivered in conjunction with community services. Some of these appointments were available to patients after 5pm.

Updated 16 November 2016

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

• 85% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the local and national averages of 84%.

• Performance in relation for patients with mental health issues was generally comparable to local and national averages.

• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out 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.

• Staff had an understanding of how to support patients with mental health needs and dementia.

Updated 16 November 2016

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, carers and patients who received palliative care.

• The practice offered longer appointments for patients with a learning disability and those with more complex needs such as the frail elderly.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• 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 circumstances of vulnerable patients were recognised and the practice sought to flexibly meet these needs whenever possible. As an example they told us of a time when they had arranged to deliver a service to a patient who was unable to come to the surgery (this was a service which was usually only delivered in the environment of a surgery).