Archived: Stonydelph Medical Centre

Updated 21 September 2016

Dr Vije Rajput is registered with the Care Quality Commission as a single handed provider. The provider holds a Personal Medical Services (PMS) contract with NHS England. A PMS contract is a locally agreed alternative to the standard General Medical Services (GMS) contract used when services are agreed locally with a practice which may include additional services beyond the standard contract. At the time of our inspection 2,050 patients were registered at the practice. The practice has a lower proportion of patients aged 65 years and over compared with the practice average across the Clinical Commissioning Group (CCG) and nationally. For example, the percentage of patients aged 65 and above at the practice is 9%; the local CCG practice average is 20% and the national practice average, 17%. The practice population has a higher percentage of patients aged 18 years and under. The percentage of patients aged 18 years and under at the practice is 27%; the local CCG practice average is 20% and the national practice average 21%.

Dr Vije Rajput’s practice is located in the town of Tamworth, Staffordshire. The premises are a purpose built building owned by NHS properties and shared with two other GP practices and community healthcare service providers.

As well as range of primary medical services, the practice provides additional services including:

• Childhood vaccination and immunisation.
• Venepuncture (blood sample taking)

The building also houses two other GP practices and members of the community health team including an emergency dental service and speech therapy clinic.

The practice is open each weekday from 8am to 6.30pm. Extended hours are provided from 7am on a Tuesday. The practice has opted out of providing cover to patients outside of normal working hours. The out-of-hours services are provided by Staffordshire Doctors Urgent Care.

Staffing at the practice includes a GP, a Physician’s Associate (self-employed) and a practice nurse. The practice administration team includes a practice manager, a practice administrator, a reception supervisor and three reception staff. There are 8 staff in total, working a mixture of full and part times hours.

Updated 21 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Vije Rajput’s Practice on 11 July 2016. Overall the practice is rated as good.

Our key findings 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 found two outstanding features:

• The provider had an effective management system process that delivered high quality patient care. This quality management system is recognized by the International Organisation for Standardisation (ISO) and was evident throughout the inspection particularly in relation to the comprehensive, systematic programme of completed audits.
• The provider had been proactive in identifying how patient's physical and mental health could deteriorate due to social isolation. The practice engaged with community services to gain an understanding of how they operated. An in-house counselling service was offered to any patient presenting with signs of loneliness or social isolation.    

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 21 September 2016

The practice is rated as good for the care of people with long-term conditions.

• Patients at the highest risk of unplanned hospital admissions were identified and care plans had been implemented to meet their health and care needs.
• 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 medicines needs were being met. For people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• There was a robust recall system that ensured patients with long term conditions were regularly reviewed by a clinician.

Updated 21 September 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 generally similar to local and national averages 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 practice’s uptake for the cervical screening programme was 79% which was comparable with the CCG average of 81% and national average of 82%.
• The practice was young person-friendly and offered condoms, pregnancy testing and chlamydia testing for all patients aged 15-24.
• The practice nurse ran immunisation clinics and patients who did not attend these clinics were followed up by the practice and referred to the health visitor.

Updated 21 September 2016

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

• All patients over 75 years of age had a named GP.
• The practice offered proactive, personalised care to meet the needs of the older people in its population. They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice participated in the local enhanced service for the avoidance of unnecessary admissions to hospital. Care plans for these patients were reviewed every three months. Patients were discussed at regular multi-disciplinary team meetings.
• The practice had an assigned care coordinator for each patient with a care plan. They were able to refer patients who were isolated and in need of support, provide information and signposting to other services and could organise day centre and support for carers.
• The practice engaged with Age UK, Staffordshire Cares and Community Together, three local support services for elderly patients.
• The practice carried out planned and opportunistic pulse checks on patients over 65 years of age to reduce the risk of a stroke through a pro-active approach to detecting asymptomatic atrial fibrillation (an irregular heart beat not detectable by the presence of other symptoms).

Updated 21 September 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The practice offered appointments outside of core working hours on a Tuesday between 7am and 8am.
• The GP contacted the working age group when a blood test result was abnormal to prevent the need to take time off work to attend a face to face consultation.
• The practice provided online services to enable patients to book appointments, order repeat medicines and access some parts of their health records online.
• Health promotion and screening services reflected the health needs of this group.
• Patients were able to request telephone advice/consultation and the response to this was made the same day, or the evening of the request.
• 57% of eligible patients had been invited for an NHS health check and 39% of eligible patients had attended to date.

Updated 21 September 2016

The practice is rated as good for the care of people experiencing poor mental health (including people 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 identify and support patients with mental health needs and dementia.
• Patients experiencing poor mental health were offered longer appointments and subject to their consent could bring a carer, family member or friend. Flexible appointments were offered to support attendance.
• The practice had 15 patients on their mental health register, 93% had care plans agreed and had received an annual review. All patients prescribed a particular medicine used to treat bipolar disorder; manic-depressive illness had appropriate blood tests completed.
• There were six patients on the patient dementia register. All of these patients had their care plan reviewed in the previous 12 months.
• Patients experiencing poor mental health were identifiable to all staff that used the clinical software system. Staff meetings had been used to raise awareness of the extra care potentially required for patients with memory loss or dementia. Leaflets in the waiting area signposted patients and their carers to services for advice and support.
• Having highlighted suicide as the third largest cause of premature death in the country, the practice implemented a proactive approach to prevention, recording and monitoring any patient known to have self-harmed.

Updated 21 September 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 known vulnerable adults, those who were housebound and 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 held a register of the practices’ frail and vulnerable patients and had identified patients who may be at risk of unplanned hospital admissions.
• The practice facilitated patients requiring GP services with drug and alcohol rehabilitation needs.
• The practice had a planned, proactive approach to suicide prevention which included a significant event being raised for any instance of a patient self-harming and annual reviews were carried out on those patients.