The Yadava Practice

Updated 24 July 2017

The Yadava practice is located in Thurrock and has a list size of approximately 5,853 patients. The practice has agreed with NHS England to temporarily stop registering new patients due to service demand and pressures. The practice provides limited parking at the rear of the building with unrestricted parking on nearby streets. There are good transport links in the locality.

• The practice operates from a single location: 34 East Thurrock Road, Grays, Thurrock, RM17 6SP

• Services provided include: a range of clinics for long term conditions, child immunisations and health promotion.
• At the time of inspection, the practice had two female GP partners. Locums were used to cover GPs when they are away.
• There is one full time practice nurse, one part time general nurse and a part time healthcare assistant
• The non-clinical team comprises of a practice manager and five reception and administrative staff.

• The practice opens between 8am and 6.30pm Monday to Friday. The practice offers patients walk-in open appointments (where no pre booked appointment was needed) to see a doctor every morning. These sessions start from 9.30am to 1pm. Pre-booked afternoon appointments are available from 3.30pm to 5.30pm Monday to Friday.
• On weekends, evenings and bank holidays, appointments are available through the local GP ‘hub’ at four other local GP practices. Patients can access out of hours care which is provided by IC24 by ringing the practice or dialling 111.
• The practice has a comprehensive website providing information on opening times, appointments, services, staff and patient group information.

Updated 24 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Yadava Practice on 16 May 2017. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an effective system in place for reporting and recording significant events. Staff confirmed discussions had been held and lessons learnt. We found evidence to demonstrate how learning had been shared and changes embedded into practice.
• Patient safety and medicine alerts had been appropriately responded to.
• 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.
• We found the practice had allowed non-prescribers who had not received appropriate training, to carry out medicine reviews. The practice was reviewing their staff access and authorisation for non-prescribers.
• All staff had received a Disclosure and Barring Service (DBS) check and an appraisal within the last 12 months.
• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
• We found that staff had a good understanding of key issues such as safeguarding, mental capacity act and consent.
• All practice policies and protocols were practice specific, updated and reviewed.
• The practice had identified 44 patients as a carer which was 0.8% of their patient list.
• Information about how to complain was available and easy to understand. Complaints were responded to at the time of reporting where possible. Learning from complaints was shared with staff.
• The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
• The practice worked with their clinical commissioning group (CCG) to provide essential primary care to vulnerable adults within a domiciliary setting.
• The practice proactively sought and valued feedback from staff and patients, which it acted on. The patient participation group was engaging and active.
• There was a clear leadership structure and staff felt supported by management. The practice held regular staff meetings. We found clinical meetings were not being carried out regularly.
• The practice had reviewed their national GP survey results and was reviewing areas of improvement.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

Actions the practice SHOULD take to improve:

• Ensure only qualified prescribers conduct medicine reviews and where appropriate staff have suitable training to carry out prescribing duties.
• Ensure only qualified prescribers conduct medicine reviews and where appropriate staff have suitable training to carry out prescribing duties.
• Strengthen quality improvement processes relating to national guidelines for gestational diabetes.
• Review process and methods for identification of carers and the system for recording this to enable support and advice to be offered to those that require it.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 July 2017

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.
• Patients with long term conditions had a dedicated nurse.
• Reviews were booked according to patient’s severity and needs.
• Longer appointments and home visits were available when needed.
• All patients were offered a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 24 July 2017

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.
• The practice provided a six week baby check, post-natal check and immunisation appointment.
• Immunisation rates were high for all standard childhood immunisations.
• The practice offered contraceptive advice for patients.
• Relevant support information was provided for children and young people such as weight loss advice.
• The practice promoted the cervical screening programme. The practice’s uptake for the cervical screening programme was 84% which was higher than the CCG average of 80% and the national average of 81%.

Updated 24 July 2017

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.
• Care plans were reviewed annually by a GP or practice nurse.
• Longer appointments were available for older people if required.
• Where appropriate, the practice actively invited patient’s relatives to be involved with their care.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice worked in partnership with their CCG to ensure patients were aware of support services such as the rapid response team.
• The practice worked closely with their team that dealt with patients care to avoid admission into hospital and allowed them access through a priority telephone number.

Updated 24 July 2017

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.
• Routine pre-bookable evening and weekend appointments were offered to all patients via the Thurrock GP Hub (Alternative location within Thurrock that provided out of hours care).
• The practice offered online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• Telephone appointments were available with the GP or nursing team.
• Patients 65 and over were offered a care plan appointment with the GP. This includes routine health checks including dementia/memory screening, blood screening and social circumstances.

Updated 24 July 2017

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

• The practice’s data showed 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG and national average of 84%.
• The practice was comparable to the CCG and national average for their management of patients experiencing poor mental health. For example, 90% of their patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in their records within the last 12 months compared with the CCG average of 84% and the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. Staff had a good understanding of how to support patients with mental health needs and dementia.
• The practice carried out advance care planning for patients with dementia and provided home visits for those unable to attend.
• 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.
• Patients and their family members were offered longer appointments to discuss concerns. Carers were highlighted on their patient record and offered appropriate vaccinations and health checks.

Updated 24 July 2017

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 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.