Archived: Rishton and Great Harwood Surgery Also known as Dr's P and H Valluri

Updated 9 January 2018

Rishton and Great Harwood Surgery offers services from both a main surgery in Rishton (32 High Street, Rishton, BB1 4LA) as well as a branch surgery in Great Harwood Health Centre in Great Harwood (2b Water Street, Great Harwood, BB6 5QR). Patients can access services at either premises.

The practice delivers primary medical services to a patient population of 1075 under a general medical services (GMS) contract with NHS England. The practice caters for a higher proportion of patients experiencing a long standing health condition, 65%, compared to the local average of 58% and national average of 54%. The average life expectancy of the practice population is higher than the local average, but lower than the national average for both males and females (78 years for males, compared to the local average of 77 years and national average of 79 years. For females, 82 years, compared to the local average of 81 and national average of 83 years). The age distribution of the practice population closely mirrors the local and national averages.

Information published by Public Health England rates the level of deprivation within the practice population group as four on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

The practice is a partnership, with one male partner GP working full time and one female partner GP who works one afternoon per week. The practice does not employ any practice nurses, but patients can access appointments with nurses whose posts are funded by the Clinical Commissioning Group (CCG). These nurses run clinics based at Great Harwood Health Centre, which is in the same building that houses the practice’s branch surgery. The GPs are supported by non-clinical staff consisting of two part time senior administrators and six receptionists. The practice is also supported for half a day per week by the CCG’s advanced locality pharmacist. The practice has been supported on a part time basis by a newly appointed practice manager since February 2017.

The practice is open between 8:00am and 6:00pm Monday to Friday, apart from Wednesday and Friday when extended hours are offered until 7:00pm, and Thursday when it closes for the afternoon at 12:30pm. Appointments are from 9:00am to 5:30pm each day, although surgeries are split between the main and branch surgeries. Extended hours surgeries are offered until 7:00pm on Wednesdays and Fridays. When the practice is closed, patients are able to access out of hour’s services offered locally by the provider East Lancashire Medical Services.

The practice had previously been inspected on 23 September 2015, when a full comprehensive inspection was completed. This visit resulted in a Warning Notice being served against the provider on 26 October 2015. The Notice advised the provider that the practice was failing to meet the required standards relating to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe Care and Treatment.

On 17 June 2016 we carried out a focussed inspection of the Rishton surgery to check the provider had taken the required action in relation to the Warning notice which we issued on 26 October 2015. At this inspection we found that some improvements had been made, but that some concerns also remained.

A further full comprehensive inspection visit was completed on 7 September 2016 which resulted in the practice being rated inadequate overall, with inadequate ratings for the key questions of safe, effective and well led and requires improvement ratings for the key questions of caring and responsive. As a result the practice was placed into special measures and conditions were imposed on the provider’s registration due to breaches to regulations 12 (safe care and treatment), 17 (good governance) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

As per our inspection methodology, a further full comprehensive inspection visit was carried out in May 2017. This inspection found that improvements had been made. The practice was rated good overall and was brought out of special measures. However, the key question of well led was rated as requires improvement and a requirement notice issued for a breach to regulation 17 (Good Governance).

Updated 9 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rishton and Great Harwood Surgery on 7 September 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months, with conditions imposed on the provider’s registration. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Rishton and Great Harwood Surgery on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 23 May 2017. Overall the practice is now rated as Good.

Our key findings were as follows:

• There were improved systems around recognising, recording and learning from significant events.

• The practice had improved and embedded its systems to minimise risks to patient safety, although some further improvements around the documentation of recognised risks and thorough completion of mitigating actions was still required in some cases.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. We saw that there was improved managerial oversight of staff training.

• Patients were consistently and strongly positive about access to appointments at the practice.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.

• Communication channels in the practice, both internally between clinicians and non-clinical staff, and externally with other health and social care providers had improved.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

In addition, the practice should:

• Ensure consultation notes written into patient records contain sufficient detail to accurately record what took place during the appointment.

• Implement actions to encourage the uptake of breast cancer screening.

I am taking this service out of special measures and removing the conditions we had previously imposed on the provider’s registration. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 July 2017

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

• The GP led on the management of all patients with long term conditions in the practice.

• Patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was higher than the local and national averages.

• Longer appointments and home visits were available when needed.

• These patients had a named GP and were offered structured annual review to check their health and medicines needs were being met.

Updated 27 July 2017

The practice is rated as good for the care of families, children and young people.

• There were now systems in place to identify and follow up patients in this group who were living in disadvantaged circumstances and who were at risk.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We found that joint working arrangements with health visitors had improved, with the local health visitor invited to face to face meetings with the GP on a monthly basis.

Updated 27 July 2017

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

• The practice offered personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and home visits were facilitated via the over 75s nurse employed by the CCG. Urgent appointments were available for those with enhanced needs.

• Patients over the age of 75 were offered a care plan.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 27 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.

• 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.

• Extended hours appointments were offered two evenings per week for those patients who could not attend during normal working hours.

Updated 27 July 2017

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 100% compared to the CCG average of 85% and national average of 84%.

• 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 was 100% compared to the CCG average of 88% and national average of 89%.

• The practice worked regularly 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.

Updated 27 July 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There was evidence that 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. There were numerous information leaflets and posters displayed in the waiting room.

• Non-clinical staff told us they knew how to recognise signs of abuse in vulnerable adults and children. They demonstrated they were aware of their responsibilities in conversation regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. Previous gaps in documented training in this area were completed.