Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Alagu Rajkumar on 19 April 2016. Overall the practice is rated as good.

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. Significant events had been investigated and action had been taken as a result of the learning from events.
• Systems were in place to deal with medical emergencies and all staff were trained in basic life support.
• There were systems in place to reduce risks to patient safety. For example, infection control practices were good and there were regular checks on the environment and on equipment used.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Data showed that outcomes for patients at this practice were similar to outcomes for patients locally and nationally.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff felt well supported in their roles and were kept up to date with appropriate training.

• Feedback from patients about the care and treatment they received was very positive.

• Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.
• Patients told us they found it easy to get an appointment. This included urgent and routine appointments.
• The practice had good facilities, including disabled access. It was well equipped to treat patients and meet their needs.
• Information about services and how to complain was available. Complaints had been investigated and responded to in a timely manner.
• The practice had a clear vision to provide a safe and high quality service.
• There was a clear leadership and staffing structure and staff understood their roles and responsibilities.
• The practice provided a range of enhanced services to meet the needs of the local population.
• The practice sought patient views about improvements that could be made to the service. This included the practice having and consulting with a patient participation group (PPG).

We saw areas of outstanding practice including:

• Nurse practitioners visited patients in a large nursing home on a daily basis to provide clinical oversight of the residents. This was supported by regular GP visits and oversight. This resulted in a decrease in unplanned hospital admissions for the residents. Nurse practitioners had also provided training to staff to enable them to support residents with some of their health related needs.

• The practice provided primary care to homeless people in central Warrington. An ‘outreach nurse’ and other designated leads (including a lead GP) were designated to support homeless patients. This work was set up following engagement with homeless people and some of the local agencies supporting homeless people. The practice worked alongside other agencies to provide the service which had resulted in greater uptake of screening and treatment for these vulnerable patients and avoidance of attendance at A&E.

• A patient co-ordinator made regular contact with older or housebound patients who had not had any other form of contact with the practice. They used a screening tool as part of this to establish if there was any cause for concern for the patient’s health.

• The practice had established a group of Polish and Kurdish speaking volunteers to support new patients in response to an increase in patients from Eastern Europe. They had also established a working group with the Clinincal Commissioning Group (CCG) and Local Authority with an aim to address social isolation amongst this group.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice