Avon Road Surgery

Updated 16 August 2016

Dr Immaneni Sudha, also known as Avon Road surgery, is located on Avon Road in Upminster, Essex RM14 1RG. The practice is based within Cranham Health Centre and shares the premises with a number of local health services including midwives, health visitors and community matrons. The building is a modern, purpose built building with good disabled access. There is limited car parking at the practice, however other car parks are available nearby. Cranham health centre is located in a residential area, away from Upminster town centre and is served by a local bus route.

Upminster is a town in the London Borough of Havering to the east of London. The practice profile shows a higher than average proportion of patients aged 40 to 49 and 75 upwards. The locality is in the least deprived decile in terms of deprivation score. At 81 for males and 85 for females, life expectancy is above the CCG and national averages of 79 and 79 years for males and 84 and 83 years for females. According to 2011 Census data the majority of residents of the London Borough of Havering are white (including non-British white) at 88%, followed by people of Asian (4.9%) and then black ethnic groups (4.8%).

The practice staff consists of two GP partners and a salaried GP, two GP registrars, a trainee (F2) doctor, two practice nurses and a health care assistant. The total number of GP principal sessions is 20 with 14 registrar sessions and seven F2 sessions per week. Non-clinical staff include a practice manager, three administrators, five receptionists and a medical secretary. All staff at the practice are female. The practice is a training practice.

The practice is open between 8am and 7pm everyday except Wednesday when it closes at 6.30pm. It closes for an hour from 12.30pm to 1.30pm. The practice also opens and on alternate Saturdays from 9am to 11am.

GP appointments in the morning are from 8.30am to 11.30am on Monday to Friday. In the afternoon they are from 1.30pm to 5.30pm on Monday and 4pm to 5.30pm every day except on Wednesday when there are no afternoon GP appointments.

Nurse appointments are available Monday to Friday 9am to 6pm with a break between 12.30pm and 2pm. Appointments are available with both GPs and nurses between 9am and 10am on alternate Saturdays. In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are also available for people that need them.

Outside of these hours, services are provided by the local GP cooperative and the GP hub which is open from 6.30pm to 10pm on weekdays and 12pm to 5pm on a Saturday and 12pm to 4pm on a Sunday. There are also a number of local walk in centres open until 7pm and the NHS 111 service.

The practice is registered with the Care Quality Commission to carry on the following regulated activities from Avon Road in Upminster, Essex RM14 1RG: Diagnostic and screening procedures, Family planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

Updated 16 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Immaneni Sudha on 23 May 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.
• 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.
• 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.

We saw one area of outstanding practice:

The practice had reviewed its levels of chlamydia screening and found six recorded in 2014. The practice employed methods such as opportunistically targeting at risk groups and inviting them for chlamydia screening. They also provided free educational sessions about chlamydia in local schools. As a result, the number of patients screened rose from six in 2014 to 327 in 2015. The practice was awarded a Certificate of High Achievement for its performance in the Chlamydia screening programme for the year 2014/15.

The areas where the provider should make improvements are:

• The business continuity plan should include emergency contact number of all staff. Copies of the business continuity plan should be kept off site.

• All staff should receive an annual appraisal, including the practice manager.

• The practice should review their process for taking minutes at meetings and ensure processes are in place to share discussions at meetings with all staff.

• The practice should take reasonable steps to form a patient participation group (PPG) and consider other ways to gain patient’s views and encourage patient participation in the running of practice.

• Notes taken at staff interviews should be kept on file for future reference.

• Regular fire drills should be carried out.

• Review their immunisation rates for children aged five years to support improvement.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 16 August 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 with diabetes, on the register, who had an influenza

  Immunisation in the preceding 1 April 2014 to 31 March 2015 was 99% against the national average of 94%.

• Clinical specialists in diabetes were available which meant fewer referrals and better choice for patients.

• Longer appointments and home visits were available when needed.

• All patients on the long term conditions registers 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.

Updated 16 August 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. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 72% to 86% and five year olds from 64% to 76%.

• Immunisation and child health checks were booked on notification of birth.

• Health visitors were based on site and there was evidence of good communication sharing of information between services.

• 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 has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 84% against the national 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. For example, district nurses were consulted as to whether a Doppler scan (a form of ultrasound scan that helps to assess a baby's health) was appropriate for a patient, rather than referring them.

• Postnatal checks and contraceptive services were provided. This included emergency contraception for which a triage system operated.

• Chlamydia testing was actively promoted. The practice provided free educational sessions at local schools to promote the screening process.

Updated 16 August 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.

• Specific care plans were prepared for patients with multiple conditions.

• The practice maintained a palliative care list and all staff were aware of the patients on the list. Palliative care meetings took place every three months.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had an over 75s scheme which included prioritisation for on the day telephone consultations and processes to avoid admissions using the appropriate multi disciplinary team (MDT). Patients were able to speak to the GP of their choice.

• The practice actively promoted dementia screening and memory tests.

• The practice had a number of patients at a local care home where they visited every two weeks

Updated 16 August 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.

• Saturday morning and late evening appointments were available.

• Telephone consultations and electronic prescribing was available for patients as an alternative if they could not attend in person.

Updated 16 August 2016

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

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  The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 100% against the national average of 88%.

• The practice achieved 100% in all mental health related indicators for the period 01/04/2014 to 31/03/2015.

• 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.

• Carers details were included in patient notes.

Updated 16 August 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, travellers 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.

• 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.

• Patients who did not attend appointments were contacted to ascertain if they had any particular support requirements.