Archived: Dr N Mudigonda & Dr V Mudigonda

Updated 3 August 2016

Dr N Mudigonda and Dr V Mudigonda practice is registered with the Care Quality commission (CQC) as a two GP partnership. The practice has good transport links for patients travelling by public transport and parking facilities are available for patients travelling by car. The practice is a single floor building. There is level access to the building and all areas are easily accessible by patients with mobility difficulties, patients who use a wheelchair and families with pushchairs or prams.

The practice team consists of two GP partners and a salaried GP (all male). The clinical practice team include a nurse practitioner and a healthcare assistant. Clinical staff are supported by a practice manager, a practice coordinator and five administration / receptionist staff. In total there are 12 staff employed either full or part time hours to meet the needs of patients. The practice also use regular GP locums when needed to support the clinicians and meet the needs of patients at the practice. The practice is a training practice for GP trainees.

The practice is open between 8am and 6.30pm Monday and Friday, 8am to 7.30pm Tuesday, 8am to 7.15pm Wednesdays and 8am to 12.30pm on a Thursday. Appointments are from 9.30am to 12.30pm every morning, 4pm to 6pm Monday and Friday, 4pm to 7.30pm Tuesday and 4pm to 7.15pm on Wednesday. Extended hours appointments are offered at the following times 6.30pm to 7.30pm on Tuesdays and 6.30pm to 7.15pm on Wednesdays. The practice does not provide an out-of-hours service to its patients but has alternative arrangements for patients to be seen when the practice is closed . Patients are directed to the out of hours service, the NHS 111 service and the local Walk-in Centres.

The practice has a General Medical Services contract with NHS England to provide medical services to approximately 3,662 patients. It provides Directed Enhanced Services, such as the childhood immunisations, minor surgery and asthma and diabetic clinics. The practice is located in one of the most deprived areas of Wolverhampton. People living in more deprived areas tend to have greater need for health services. The practice has a slightly higher proportion of patients aged between five and nine, 20 to 24, female patients aged 45 to 49, male patients aged 50 to 69 and older patients aged 70 years and over when compared with the practice average across England. For example, the percentage of patients aged 65 and above at the practice is 31% which is slightly higher than the local Clinical Commissioning Group (CCG) and the national average of 27%. There is a significantly higher than national average representation of income deprivation affecting children (39% compared to 20%) and older people (31% compared to 16%).

Updated 3 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N Mudigonda and Dr V Mudigonda on 7 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.

• Feedback from patients about their care was consistently positive. 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 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 provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

• Review the arrangements to demonstrate the appropriateness of decisions taken following the receipt of criminal records checks that may identify negative outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 3 August 2016

The practice is rated as good for the care of people with long-term conditions. The GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice performance for five diabetes assessment and care related indicators varied slightly. For example the percentage of patients with diabetes, on the register, who had a record of a foot examination and a risk classification related to foot health completed, was 82% which was lower than the national average of 88%. The percentage of patients with diabetes, on the register, in whom the last blood pressure reading in the last 12 months was at or below a given measurement, was higher than the national average (84% compared to the national average of 78%). QOF is a system intended to improve the quality of general practice and reward good practice.

Daily emergency appointments, longer appointments and home visits were available when needed for these patients. A structured annual review to check their health and medicines needs were being met was carried out and patients had a named GP. The practice nurse had ensured that care plans were developed to support the ongoing effective management of patients with long term conditions. For those patients with the most complex needs, the named GP and nursing staff worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 3 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. 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 premises were suitable for children and babies. Protected appointments were allocated for children and appointments were available outside of school hours. We saw positive examples of joint working with midwives and health visitors. Child health surveillance which included postnatal and six week baby checks were offered at the practice. The practice’s uptake for the cervical screening programme was 77%, which was lower than the national average of 82%.

Updated 3 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 and all patients aged 65 years and under had a named GP. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered home visits and urgent appointments for those older patients who were housebound and with enhanced needs. The practice had a small number of older patients who lived in care homes and ensured that their needs were met through proactive contact with staff working at the three care homes. The local prescribing advisor linked to the practice carried out medicine reviews with patients over 65 years who were taking four or more medicines.

Updated 3 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. Extended hours were offered two evenings per week. The practice was proactive in offering online services which included repeat prescription ordering and access to patient records. A full range of health promotion and screening that reflected the needs for this age group were also available.

Updated 3 August 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The percentage of patients diagnosed with dementia whose care had been reviewed in a face to face review in the preceding 12 months was 83%, which was similar to the national average of 84%. The data related to mental health showed that 93% of patients on the practice register who experienced poor mental health had a comprehensive agreed care plan in the preceding 12 months. This was higher than the national average of 88%. The practice regularly worked with multi-disciplinary teams in the case management of people who experienced poor mental health, including those with dementia. The practice manager was qualified to provide non-clinical advice on how to make and put in place an advance decision plan for patients with dementia. The practice offered patients who experienced poor mental health continuity of care and  appointments with the senior GP partner who was qualified in and had experience in managing patients with complex mental health conditions. Staff had a good understanding of how to support people with mental health needs and dementia.

Updated 3 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. This included a register of patients who had problems with substance misuse. The senior partner held a fortnightly shared clinic at the practice in partnership with a local substance misuse recovery support service. The clinic was open to both patients registered at the practice and those not registered with the practice but who lived in Wolverhampton. The practice also had a register of patients who had been identified as homeless. These patients were regularly discussed at what the practice called a ‘Hotlist Clinic’.  A register of patients with a learning disability was held and all these patients were offered an annual health check with the support of the local community learning disability team. Longer appointments were offered to patients with a learning disability and an easy read (pictorial) letter was sent inviting them to attend the practice for their annual health check. Staff had been trained to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding confidentiality, information sharing, documentation of safeguarding concerns and how to contact relevant agencies. 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.