Archived: Dr Manoharan Dakshinamurthi

Updated 27 October 2016

Dr Manoharan Dakshinamurthi provides primary medical services in Bolton near Manchester from Monday to Friday. The practice is open between 8am and 8pm every Monday and 8am to 6.30pm every Tuesday to Friday. The first appointment of the day with a GP is 8.15am and the last appointment with a GP is 5.30pm. Same day urgent appointments and home visits are available each day.

The practice of Dr Dakshinamurthi is situated within the geographical area of Bolton Clinical Commissioning Group (CCG).

The practice has a Personal Medical Services (PMS) contract. The PMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Dr Dakshinamurthi is responsible for providing care to 2092 patients.

The practice consists of a single handed male GP, one long term locum GP, one part time practice nurse and is supported by a practice manager and a support team. Patients have access to a female GP as part of the local group of practices covering for each other during sickness and holidays. They are in the process of adding another GP partner to the practice.

When the practice is closed patients are directed to the out of hour’s service.

The practice is part of a group of practices who offer appointments to a GP and PN seven days a week and part of a group of small practices who provide cover during holidays and sickness.

Updated 27 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the practice of Dr Manoharan Dakshinamurthi on 12 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Feedback from patients about their care was consistently and strongly positive.
• Information about services and how to complain was available and easy to understand. The practice had not received any complaints within the last 12 months.
• Patients said they found it easy to make an appointment with a named GP and 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 provider was aware of and complied with the requirements of the duty of candour.
• The practice was part of a group of small local practices who provided cover for each other during holidays and sickness.

We saw one area of outstanding practice:

The practice made contact with vulnerable patients each month to check on their wellbeing, where the patient had not contacted the surgery for medication or an appointment

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 27 October 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 percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015) was 89% which was comparable to the CCG average of 88% and the same as the national average of 88%.
• 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.

Updated 27 October 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, for example, children and young people who had a high number of A&E attendances. Immunisation rates were 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.
• The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years (01/04/2014 to 31/03/2015) was 83% which was comparable to the CCG and national averages of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• All children under the age of 12 were offered a same day appointment if required.

Updated 27 October 2016

The practice is rated as good for the care of older people.

• Patients aged over 75 had a named GP and a structured annual review to check their health and medicine needs were being met. For those patients with the most complex needs, the named GP worked with the relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice offered proactive, personalised care to meet the needs of the older patients 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.
• The practice embraced the Gold Standards Framework for end of life care. This included supporting patients’ choice to receive end of life care at home.
• The practice offered carers support, knowledge and were able to signpost them to other support services.
• All carers were offered an annual health review.

Updated 27 October 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 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.
• Late appointments were offered every Monday evening for patients unable to attend the surgery during normal working hours.

Updated 27 October 2016

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

• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%.
• 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months which is higher than the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance 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 such as Think Positive.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 October 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 homeless people, asylum seekers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• 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.
• The practice made contact with vulnerable patients each month to check on their wellbeing, where the patient had not contacted the surgery for medication or an appointment
• 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.