Archived: Dr M Hargreaves & Dr P Thakrar Also known as The Village Practice - Cowplain Surgery

Updated 4 July 2016

Dr M Hargreaves and Dr P Thakrar are also known as Village Practice. It is a general practice providing primary medical services under a General Medical Services (GMS) contract to people of Cowplain and Waterlooville. (GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice is situated close to bus links on a busy road into Waterlooville, on the edge of Cowplain village.

The practice provides services from a converted house, there are two consulting rooms, two treatment rooms and office space on the premises.

There is a car park at the front, with two disabled car parking spaces. A ramp is available for patients with limited mobility to enable them to access the building. The door can be seen by reception staff who are able to offer assistance if needed.

There are two GP partners, who are both male who provide between them 18 sessions per week.

The practice team includes two practice nurses, one of whom is a prescribing nurse practitioner for minor illness. The total nursing staff are equivalent to 1.2 whole time nurses.

The administrative team comprises one practice manager, a secretary, a clinical co-ordinator, and 7 reception staff. One receptionist has a dual role as a healthcare assistant.

The practice operates a personal list system. This means that the GP with whom patients are registered is the GP the patient will usually see. The GP manages and coordinates all their care and are able to know the patients’ social circumstances by developing a long standing relationship.

The practice is open between 8am and 6.30pm Monday to Friday. First appointments are 8am or 8.40am until 12noon. Then GP clinics recommence at 3pm. Patients requiring medical support between these times are advised to attend the surgery, where GPs cover each other during home visits.

Extended practice hours are offered at the following times: on alternate Tuesday and Thursday mornings from 7.10am to 08.00am and Wednesday evenings from 6.30pm to 8pm.

Additionally, once a month the practice provides a Saturday morning surgery from 9.00am to 11.30am. These are for routine pre-booked appointments.

The practice has opted out of providing out of hours service. When closed, the practice requests that patients contact the out of hours GP via the NHS 111 service. This is advertised on the patient noticeboard in reception and the patient leaflet and practice website.

The practice has a much higher population of people over 60, than the Clinical Commissioning Group and national average and there are a higher number of female patients in this age group. There is a low rate of deprivation in this practice population area.

We inspected the only location:

133 London Road

Waterlooville

Hampshire

PO8 8XL

The practice population is in one of the least deprived areas of the country with a higher percentage of patients over 65 years of age and a low ethnic mix of patients, the majority identify as white British.

Dr M Hargreaves & Dr P Thakrar was not inspected previously.

Updated 4 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr M Hargreaves and Dr P Thakrar on 22nd March 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 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.
• Information about services and how to complain was available and easy to understand.
• 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, apart from the availability of a defibrillator and a risk assessment for this.
• 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.

• Some staff were trained in child safeguarding to a higher level than required, including nurses to level 3. The practice manager had attended training at level 5 (managing staff who safeguard children).

We found areas of outstanding practice:

• Feedback from patients who use the service was continually positive with a strong visible patient centred culture.

• The practice delivered additional support for socially isolated older patients, for example, the practice telephoned socially isolated patients on Christmas day to provide support.

• The practice had implemented a local policy to ensure that patients received phone call support following bereavement at one, three, six and 12 months afterwards.

The areas where the provider must make improvement are:

• Review the arrangements for emergency care at the practice and consider purchasing a defibrillator or complete a risk assessment.

The areas where the provider should make improvement are:

• Ensure the staff at the practice undertake regular fire drills.
• Ensure prescriptions are tracked and managed safely in the practice, including when held in GPs own bags.
• Review the systems for tracking samples sent from the practice for testing to ensure that results are tracked and reported in a timely manner.
• Review the systems in place for clinical coding to make sure it accurately reflects care given to patients with specific medical condition and national guidelines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

The practice is rated as good for the care of patients 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. Care-plans were written with patients who had been identified as being of risk in order to support this and to ensure their wishes were known and recorded...
• Diabetes data for the practice was above or in line with national indicators.

The percentage of patients with a diagnosis of diabetes, on the practices register, whose latest blood pressure reading was at an acceptable level was 91%. This is higher than the Clinical Commissioning Group average of 80% and the NHS England average of 79%.

• Longer appointments and home visits were available when needed.
• All patients with a diagnosed long term condition 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.

Nurses at the practice had devised and implemented a template to support patients to take their medicines; this was known as the pill card. This acted as a prompt to support patients to take the correct medicine at the correct time of day, allowing patients to keep their own record.

Updated 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

The practice is rated as good for the care of families, children and young patients.

• 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• A total of 80 % of patients diagnosed with asthma, on the register, who had had an asthma review in the last 12 months this was above the national average of 75% and above the CCG average of 71%.
• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Cervical screening data was 82% of eligible women had been screened this is above the national average of 74% and above the CCG average 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.

The practice had trained all GPs and nursing staff to level 3 safeguarding children 

Updated 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. Specifically, the practice provided a year of support phone calls for patients who had suffered bereavement.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Home visits were made to those older patients who did not attend for routine regular appointments. This ensured that patients had access to emergency care
• Patients who were identified as without family or were socially isolated received a phone call on Christmas day to provide social support by staff.

Updated 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

The practice is rated as good for the care of working-age patients (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. For example, the Saturday clinic and early morning openings were aimed at working age patients.
• 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 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

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

• A total of 94 % of patients diagnosed with dementia that had had their care reviewed in a face to face meeting in the last 12 months, this was higher than the national average of 84%.
• 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.
• 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 4 July 2016

The provider was rated as outstanding for caring and good for responsive, effective and well-led and requires improvement for safe. The issues identified as outstanding affected all patients including this population group.

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams 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 practice had a policy of telephoning patients who had recently been discharged from hospital, to reassure them and to monitor their needs.