Joshi Na Also known as Village Surgery

Updated 13 June 2016

The practice is located within Silksworth Health Centre in a residential area of Sunderland, south of the River Wear. The practice provides care and treatment to 4,014 patients from the Middle Herington, Tunstall, Hillview, Thornhill, Ryhope, East Herrington,Grangetown, Thorney Close, Farringdon, Silksworth, Leechmere and High Barnes areas of Sunderland. It is part of the NHS Sunderland Clinical Commissioning Group (CCG) and operates on a Personal Medical Services (PMS) contract.

The practice provides services from the following address, which we visited during this inspection:

Village Surgery, Silksworth Health Centre, Silksworth, Sunderland, SR3 2AN.

The practice is located in a purpose built building which it shares with another GP practice, a chiropodist and community based healthcare staff including health visitors, district nurses and the community midwife. All communal areas, waiting areas and consultation rooms are fully accessible for patients with mobility issues. Car parking facilities, including disabled car parking spaces and lockable bike storage are available on site.

The practice is open between 8.00am to 6.00pm on a Monday, Tuesday and Friday and from 7.00am to 6.00pm on a Wednesday and Thursday. The practice is also part of Sunderland’s West Locality Extended Hours Access Scheme meaning that their patients are able to access emergency out of hour’s appointments at Grindon Lane primary care centre between 6pm and 8pm weekdays and between 8.30am and 10.30am on a Saturday. The practice is also a member of the Sunderland GP Alliance. This is a federation of 40 GP practices representing approximately 85% of Sunderland’s patient population working collaboratively to achieve better health outcomes for the people of Sunderland.

The service for patients requiring urgent medical attention out-of-hours is provided by the NHS 111 service and Northern Doctors Urgent Care Limited.

Village Surgery offer a range of services and clinic appointments including chronic disease management clinics, antenatal clinics, baby clinics, well woman/well man clinics, travel vaccinations and childhood immunisations. The practice consists of:

• Two GP partners (both male)
• Two practice nurse (female)
• One nurse practitioner (female)
• Two health care assistants (who also provide administration and secretarial duties)
• A practice manager (who is also a partner in the practice)
• Four administrative/secretarial staff

The practice also employs a female locum GP for one session per week. This gave patients the ability to choose to see a doctor of a particular gender if preferred.

The practice is a teaching and training practice and provides training to third and fourth year medical students as well as GP trainees.

The area in which the practice is located is in the fifth most deprived decile. In general people living in more deprived areas tend to have greater need for health services.

The practice’s age distribution profile showed a lower percentage of patients aged 45 and over than the national average.

Updated 13 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Joshi, Village Surgery on 15 September 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing caring, effective, responsive and well-led services. We found the practice required improvement for providing safe services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses;
• Risks to patients and staff were assessed and well managed;
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and responsibilities;
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand;
• Patients said they were treated with compassion, dignity and respect and were involved in decisions about their care and treatment.
• The majority of patients who provided us with feedback did not raise any concerns over access to appointments. Results from the National GP Patient Survey showed that patient satisfaction with access to appointments, practice opening hours and appointment waiting times was broadly in line with local CCG and national averages;
• There was a clear leadership structure and staff felt well-supported by the management team. Good governance arrangements were in place;
• Staff had a clear vision for the development of the practice and were committed to providing their patients with good quality care. This was demonstrated by the steps staff were taking to develop additional services to meet the needs of their patients.

However, there was also an area where the practice must make improvements.

Importantly, the provider must:

• Ensure that the arrangements for storing and recording controlled drugs is reviewed and strengthened to comply with schedule 2 of the Misuse of Drugs (Safe Custody) Regulations 1973

In addition the provider should:

• Ensure that all staff receive comprehensive infection control training.

• Ensure that the practice has a regular schedule of meetings and that practice and multi- agency meetings are minuted more effectively

• Review the system currently in place for planning, carrying out, recording and reviewing clinical audits

• Make better use of the patient participation group and ensure that consideration is given to disseminating learning and information from speakers attending PPG meetings to the practice population on a whole

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 December 2015

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

The practice had systems in place to ensure patients with long term conditions were recalled for review when required. Home visit reviews were available for housebound patients. The nurse practitioner was a nurse prescriber which meant they were able to review and prescribe most medication following a long term condition review without GP intervention. This not only reduced the time patients waited for a prescription but also reduced pressure on the GPs.

Longer appointments were available for patients with long term conditions and those with life limiting long term conditions were discussed at weekly practice meetings. In conjunction with the palliative care team, comprehensive end of life care plans were offered to palliative care patients. Palliative care patients were prescribed anticipatory medication following consultation with the palliative care team.

Updated 24 December 2015

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 looked after children or children subject of a child protection plan. The practice had identified one of the GPs as safeguarding lead who was responsible for providing information to and attending multi-agency safeguarding meetings. The practice also held regular meetings with health visitors to discuss safeguarding cases and concerns.

The practice had a recall system in place for childhood immunisations and rates were in line with or above local averages for all standard childhood immunisations. The parents/carers of children who did not attend for immunisations were contacted to establish a reason for the non-attendance and ascertain whether there were any safeguarding concerns. Appointments were available outside of school hours, starting at 7:00am one day per week and up to 6:00pm each weekday. Cervical screening rates for women aged 25-64 were above local and national averages.

The practice was in the process of developing a separate clinic for young and adolescent patients where the focus would be on maintaining sexual health and contraception. Young and adolescent patients were offered the choice of either a GP or nurse appointment.

Updated 24 December 2015

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

Nationally reported data showed the practice had achieved good outcomes in relation to the conditions commonly associated with older people. Patients over the age of 75 (7.87% of the practice population) had a named GP and were routinely invited to attend an over 75 health check which was carried out as a home visit for housebound patients. Elderly patients who had been discharged from hospital were seen within two weeks of discharge to try to avoid re-admission. The practice employed a prescribing nurse practitioner who specialised in the care of the elderly. The practice had also established effective working relationships with the four nursing homes and two residential homes in the practice area.

The percentage of patients aged 65 and older who had received a seasonal flu vaccination was in line with the national average and the practice offered annual flu clinics with a take up rate of over 70%.

The practice actively identified and flagged palliative care patients to ensure they were supported appropriately and multi-agency palliative care meetings were held on a quarterly basis.

Updated 24 December 2015

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

Nationally reported data showed that 55.8% of the practice population either worked or was in full time education (national average 60.2%). The practice was proactive in meeting the needs of these patients by offering online services such as being able to order repeat prescriptions, book appointments and view parts of their medical records. The practice was open from 8.00am to 6.00pm on a Monday, Tuesday and Friday and from 7.00am to 6.00pm on a Wednesday and Thursday and the practice offered telephone appointments with their triage service on request. The practice was part of Sunderland’s West Locality Extended Access Team which meant that patients could access emergency appointments at a local primary care centre between 6.00pm and 8.00pm weekdays and from 8.30am to 10.30am on a Saturday. Repeat prescriptions could be ordered at any time either online, in person or by telephone. The practice also used the choose and book scheme which enabled patients referred to a hospital or clinic to choose the provider of their choice and at date and time which was convenient.

Updated 24 December 2015

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

The practice had exceeded the national average in ensuring comprehensive and agreed care plans were in place for patients with schizophrenia, bipolar affected disorder and other psychoses (100% compared to an England average of 86%) and for ensuring patients diagnosed with dementia had received a face-to-face review within the preceding 12 months (94.4% compared to an England average of 83.8%).

Practice staff had undertaken dementia awareness training to ensure they had a greater understanding of the needs of patients with dementia. Patients with dementia received annual reviews and patients on the practice mental health register were offered health and other appropriate checks. Care plans were in place for patients with dementia and mental health conditions and this group of patients and their carer's were signposted to appropriate support services.

Practice clinicians were aware of their responsibilities under the Mental Capacity Act (2005) in respect of gaining consent to care and treatment.

Updated 24 December 2015

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

The practice had a register of patients aged 18 or over with a learning disability, people receiving palliative care and carers. A recall system was in place to ensure patients with a learning disability were offered an annual health check.

Staff knew how to recognise signs of abuse in vulnerable adults and children and how to raise safeguarding concerns with the relevant agencies. The practice had identified a clinical lead for dealing with vulnerable adult and vulnerable children cases and all practice staff had undertaken safeguarding training at a level appropriate to their role. Clinicians had received training on their responsibilities in relation to the Mental Health Act.

The practice was proactive in identifying and responding to the needs of carers and a comprehensive carer’s pack was available. Carers were routinely signposted to Sunderland Carers’ Centre, the Essence Service (for people with dementia and their carers) and to the local adult care service for a carer’s needs assessment.

The practice offered an interpretation service for their non-English speaking patients.