Archived: JR Nathan

Updated 19 November 2015

The practice is located in Riverview Health Centre, Sunderland and provides primary medical services to patients living in the Hendon area of the City of Sunderland. The practice provides services from one location: Riverview Surgery, Riverview Health Centre, West Lawrence Street, Sunderland, SR1 1XW. The practice shares premises with another GP practice and external services and is based on the ground floor of a purpose built building. The premises has on-site parking, disabled parking, a disabled WC and access is step-free.

The practice has one GP partner (male) and one practice manager partner. Additionally the practice employs a nurse practitioner, a practice nurse and two staff who carry out administrative and reception duties. The practice provides services for just over 2,400 patients based on a Personal Medical Services (PMS) contact.

The practice is open between 8:30am and 6pm Monday to Friday. Appointments are available from 8:30am to 11:30am every Monday, Wednesday and Friday morning and from 12:30pm to 5:30pm every afternoon. The practice has an open clinic from 8:30am to 10:30am on Tuesday and Thursday. Extended hours are available every Tuesday when the practice remains open until 7pm. Additionally the practice initiated and managed extended hours provision which is available to all patients in the locality. This allows patients to access a GP at the surgery between 6pm and 8pm Monday to Friday and 9am to 2pm on Saturday and Sunday.

Information from Public Health England placed the area in which the practice was located in the lowest decile. In general, people living in more deprived areas tend to have greater need for health services. The practice’s age population is weighted towards people of working age; the practice had a significantly lower percentage of patients aged over 60 than the CCG and England averages.

The service for patients requiring urgent medical care out of hours is provided by the 111 service and Primecare and Northern Doctors Urgent Care (NDUC). From 01 October 2015 out of hours will only be provided by the 111 services and NDUC

Updated 19 November 2015

Letter from the Chief Inspector of General Practice

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.
• Staff had generally received training appropriate to their roles, however, some gaps and further training needs had been identified and planned for completion. Staff felt supported and team working was demonstrated.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They also told us the practice was very clean.
• Information about services and how to complain was available and easy to understand, however, patients told us they were not aware of how to make a complaint.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice worked well with commissioners and other organisations to ensure relevant services were available to support patients to manage their own care; for example, the recent provision of a pulmonary rehabilitation service.

We saw one area of outstanding practice:

• The practice had initiated a comprehensive extended hours service as part of the project in the Clinical Commissioning Group (CCG) locality. The practice had led, and still managed the provision of this service for the locality which provides 7 day access to primary care and aims to reduce demand at Accident and Emergency. This was based in the practice building and ensured consistency of care and reflected the needs of the local population in a deprived area. The service uses locality clinicians to provide care for locality patients.

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

Importantly the provider should:

• Review its policies and procedures to ensure they reflect current guidance and best practice. For example, recruitment policies made reference to primary care trusts. The business continuity plan did not include contact details for key services. The safeguarding policy did not reflect current local organisational structures.
• Ensure evidence based care is planned and delivered by introducing care plans for suitable groups of patients and individuals.
• Ensure that the views of patients are represented at the practice by reviewing the patient participation group arrangement currently in place.
• Ensure staff are provided with appropriate training to specifically ensure that information governance training is provided for all staff and infection control training is provided for the Infection Control lead.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 November 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management with the support of the doctor when required and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. As the practice had only one GP all patients effectively had a named GP. The practice provided structured annual reviews to check that their health and medication needs were being met. For those people with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. The practice had procedures in place to monitor medication effectively and provided information for patients on managing their condition.

Updated 19 November 2015

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; for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses. The opening hours of the practice ensured this group were able to access services and the extended weekend opening times allowed clinicians to review care at weekends, reassure patients and reduce attendance at Accident & Emergency Departments. The practice ensured children were always offered an urgent appointment when requested. The practice had recently set up a register of young carers to support the needs of this hard to reach group.

Updated 19 November 2015

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. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. Patients told us they had enough time during appointments. The practice held a register of palliative care patients and we saw evidence that regular palliative care meetings were held. The practice had close working relationships with district nurses.

Updated 19 November 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group. The practice provided information and support for the students who registered at the practice and recognised the needs of this group, for example sexual and mental health services. The practice provided information and support to improve patient outcomes, for example in the lifestyle advice clinic. They also offered travel vaccinations and well-women and well-man clinics. Cervical screening rates were above the CCG and national averages.

Updated 19 November 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). People experiencing poor mental health were offered at least an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia. The practice worked with the local pharmacist to monitor medication use when patients were experiencing poor mental health.

Updated 19 November 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held a register of some patients living in vulnerable circumstances, for example people with a learning disability. It carried out annual health checks for people with a learning disability, 100% had been offered an annual health check that focused on their individual needs. If a patient had declined to complete the health check the practice continued to work to engage with the patient. It offered longer appointments for people with a learning disability. The practice worked with local leads to ensure that support for people with a learning disability ensured they could access secondary care appointments.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told 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 staff demonstrated this knowledge during the visit. Staff demonstrated excellent knowledge of the needs of vulnerable adults and children.

Staff at the practice demonstrated individual knowledge of the needs of vulnerable patients at the practice and could explain the processes used to support their needs, for example contact with local hostels, support services and social workers based in secondary care. Homeless people were able to register at the practice and links to drugs and alcohol services were well developed.