Archived: Dr N Raichura & Dr J Mehta

Updated 7 September 2016

Dr N Raichura and Dr J Mehta are a GP partnership based in the village of Hodnet, Shropshire. The practice has strong and historic links within the locality. The roots of the practice can be traced back to the year 1850. The GP partnership is one of longstanding; one partner has been at the practice for 28 years and the other 18 years. The practice is authorised to dispense medicines to registered patients who chose to receive medicines in this way.

The practice currently has approximately 4,000 patients registered and has a higher than national average population in all age groups above 45 years. The practice holds a contract with NHS England to provide Personal Medical Services to their registered patients.

Demographically the practice has a high proportion of registered patients who live in nursing care homes. This equates to over 150 patients in total and when compared with statistics from Public Health England the practice has three times the local, and six times the national, rate of patients who live in a nursing home. It would be expected that patients who require nursing care would increase the demand on a practice due to their increased care needs.

Two male GPs work as GP partners with a further part time GP providing locum cover. Two female practice nurses undertake a range of nursing duties including the provision of minor illness triage, long-term condition review and cervical cytology. The administrative team of five are led by a practice manager. The practice dispensary has a manager and trained dispensers.

The practice is open from 8:30am to 1pm and 2pm to 6pm on Monday, Tuesday, Thursday and Friday and 8:30am to 12:30pm on a Thursday. During 1-2pm on weekdays the practice reception is closed, urgent requests are still accepted by telephone and responded to as necessary. The practice holds an open morning surgery weekdays between 8.30am and 9.45am. Out-of-hours and marginal cover is provided by Shropshire Doctors Cooperative Ltd (Shropdoc). Marginal cover relates to times when the practice is closed and is not in the out-of-hours period of 6:30pm until 8am on weekdays and all other times at weekends and bank holidays.

Updated 7 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N Raichura and Dr J Mehta on 29 June 2015. After the comprehensive inspection, the practice was rated as good with requires improvement in safe services. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr. N Raichura & Dr. J Mehta on our website at www.cqc.org.uk. We undertook a focussed follow up inspection on 22 July 2016 to check that improvements had been made. The practice is rated as good for providing safe services and rated good overall.

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. These included regular infection control audits and actions were taken/planned to address any improvements identified as a result.
• The practice had ensured that risks associated with dispensing medicines were robustly recorded and mitigated. Medicines were stored securely and the security for the issue and tracking of blank prescription forms reflected nationally accepted guidelines as detailed in NHS Protect.
• The practice had ensured practice recruitment guidance included all members of staff including those classed as locums.
• 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.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 August 2015

The practice is rated as good for the care of people with long-term conditions. All staff took a lead role in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication 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. The practice had a strong performance in providing care and treatment to this group of patients. For example, 100% of eligible patients with chronic pulmonary obstructive disease (COPD) had received a seasonal influenza vaccine.

Updated 20 August 2015

The practice is rated as good for the care of families, children and young people. 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. Immunisation rates were in line or higher than the local average for all standard childhood immunisations. For example, 100% of children aged one had received the pneumococcal vaccine (PCV) to help reduce the risk of acquiring the bacteria that can cause pneumonia, blood poisoning and meningitis. This was higher than the CCG average of 97.1%.

Updated 20 August 2015

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

The number of patients registered at the practice and who lived in a nursing home was six times the national average. Many of these patients were older, although some patients also had conditions that would place them within the other population groups we look at. We saw that the practice had a long track record of providing a responsive service to ensure that the care needs of patients who were older were met. A GP told us that on first coming to live at a nursing home, the patient would be visited within days by a regular GP and a full holistic health assessment would be carried out including blood tests. All patients in the nursing home were part of the avoiding unplanned admissions enhanced service and had comprehensive care plans in place that were regularly reassessed. We spoke with a registered manager from one of the nursing home and a pharmacist from the clinical commissioning group (CCG) who told us that the practice worked with them to improve patient care and experience. A regular GP visited each nursing home at least twice a week and more often if required. The nursing home registered manager told us that the practice responded quickly to any requests for advice or visits and that all medicines were dispensed within 24 hours or sooner if required. The practice received no extra remuneration for providing this level of service and did so as they believed it provided good and caring clinical care.

Updated 20 August 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 reflects the needs for this age group.

Updated 20 August 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Eighty per cent of patients on the practice register dementia had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia. It 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 and had employed an in house counsellor to provide support to patients. 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.

Updated 20 August 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.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. 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 how to contact relevant agencies in normal working hours and out-of-hours.