Archived: Dr Sinha, Rischie, Sinha, Shanker

Updated 5 March 2015

Dr Sinha, Rischie, Sinha, Shanker is a registered provider of primary medical services with the Care Quality Commission (CQC) and has two registered locations (practices). They are Dr Sinha, Rischie, Sinha, Shanker practice also known as ‘Pleck Health Centre’ and more recently New Invention Health Centre. This inspection focused on Dr Sinha, Rischie, Sinha, Shanker,Pleck Health Centre,16 Oxford Street, Pleck,Walsall,West Midlands,WS2 9HY.

The practice is based in a purpose built GP health centre. The practice is a training practice for GP Registrars (fully qualified doctors who wish to become general practitioners) and an approved teaching practice for medical students in their final year. The registered patient list size is approximately 7625 patients. The practice is opened Monday, Tuesday, Thursday and Friday 08:00am to 6:30pm. However, the practice is closed every Wednesday from 1:00pm until Thursday morning 0800am. During this period of time when the practice is closed in normal working hours the practice subcontracts GP access for patients through a local GP provider. There is extended opening hours on Monday from 6:30pm to 8.20pm.

There are four permanent GPs (three male and one female) who are also partners at the practice, two GP registrars (one male and one female) and one sessional locum GP (male). The practice employs a nurse prescriber (female), a practice nurse (female) and a health care assistant (female) who also undertake phlebotomy (the taking of blood). There are also eight administrative staff and a practice manager

The practice has a General Medical Service contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as for example, chronic disease management and end of life care. The practice also provides some enhanced services such as minor surgery. An enhanced service is a service that is provided above the standard GMS contract.

We reviewed the most recent data available to us which showed that the practice is in one of the most deprived areas in Wasall with the 13th highest deprivation score in the CCG area. The practice has an above average patient population who are aged 0-4 years old and lower than average practice population of older patients aged 75 years and over in comparison to other practices in the CCG area. The practice is only one of two practices that achieved 100% points for the Quality and Outcomes Framework (QOF) for the last financial year 2012-2013. The QOF is the annual reward and incentive programme which awards practices achievement points for managing some of the most common chronic diseases, for example asthma and diabetes.

The practice has opted out of providing out-of-hours services to their own patients. This service is provided by an external out of hours service contracted by the CCG.

Updated 5 March 2015

Letter from the Chief Inspector of General Practice

We inspected Dr Sinha, Rischie, Sinha, and Shanker on 6 October 2014 as part of a comprehensive inspection.

We found that the practice was safe, effective, caring, responsive and well-led. We rated the practice overall as good.

Our key findings were as follows:

• There were systems in place to ensure patients received a safe service.
• There was evidence of completed audit cycles undertaken to ensure patients care and treatment was effective and achieved positive outcomes.
• Patients were complimentary about the staff at the practice and said they were caring, listened and gave them sufficient time to discuss their concerns.
• The practice had arrangements in place to respond to the needs of the practice population. This included services aimed at specific patient groups.
• Leadership roles and responsibilities were well established with clear lines of accountability.

 We saw an area of outstanding practice this was:

• A clinic every Thursday where patients with high blood pressure were reviewed by the pharmacist. The clinic targeted high risk patients to ensure early intervention and achieve positive outcomes for patients.

However, we also identified areas that the practice should improve.

The practice should:

• Ensure fire policies and procedures are reviewed so that regular fire drills take place and fire training for staff is up to date.
• Review the impact on patients when the practice is closed every Wednesday afternoon and the high number of patients who do not attend their appointments, to assess if this affects the accessibility of appointments for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 March 2015

Patients with long term conditions were reviewed by the GPs and the practice nurses to assess and monitor their health condition so that any changes could be made. The nurses contacted patients with long term conditions by telephone or letter and invited them to attend a review.

There was evidence of specialist clinics to review patients with long term conditions. This included   a dedicated diabetes clinic and a clinic every Thursday where patients with high blood pressure were reviewed by the in house pharmacist. We spoke with the pharmacist, they told us that the communication with the GPs was very good. The clinic targeted high risk patients to ensure early intervention and achieve positive outcomes for patients. The practice also provided services such as weight management and smoking cessation to support patients live healthier lives.

Patients with long term conditions such as dementia and learning disability had annual reviews undertaken by the GPs and nurses. There were arrangements to review patients in their own home if they were unable to attend the practice. This included visits to care homes. Health checks and medication reviews took place and repeat prescriptions were accessible. These arrangements help to minimise unnecessary admissions to hospital.

Updated 5 March 2015

Antenatal care was provided by the midwife who undertook a clinic at the practice twice a week. The post natal check was completed by the practice nurse to ensure a holistic assessment of a women’s physical and mental wellbeing following child birth.

The practice had an allocated health visiting team, although they were not based within the practice, children under the age of 5 years had access to the Healthy Child Programme. Priority was given to appointment requests for babies and young children to ensure they were assessed promptly. The GPs undertook eight week checks for babies and childhood vaccination programme was undertaken by the practice nurse.

Updated 5 March 2015

The practice population included 476 patients over the age of 75 years. The practice was in the process of allocating these patients a designated GP. This is an accountable GP to ensure patients over the age of 75 years received co-ordinated care.

Patients over the age of 75 years were offered health checks at dedicated clinics that took place every Monday and Thursday. This included a clinic held by a pharmacist once a week for those patients who were identified with high blood pressure. The aim was to review and monitor the patients health needs.

Updated 5 March 2015

The practice opened extended hours on Monday evenings from 6:30pm to 8:20pm to accommodate the needs of working age patients. Patients were able to book non urgent appointments around their working day by telephone or on line. Telephone consultations were available so patients could call and speak with a GP or a nurse where appropriate if they did not wish to or were unable to attend the practice.

NHS checks were available for people aged between 40 years and 74 years. The practice offered a range of health promotion and screening services which reflected the needs for this age group. Opportunistic health checks and advice was offered such as blood pressure checks advice on, smoking and obesity and there were nurse led weight management and smoking clinics. 

Updated 5 March 2015

Patients with serious mental illnesses were offered an annual review of their physical and mental health needs, including a review of their medicines.

Staff worked closely with local community mental health teams to ensure patients’ mental health needs were reviewed, and that appropriate risk assessments and a care plan was in place. A mental health counsellor held a clinic twice a week at the practice to support patients and referred them to specialist service if necessary.

Updated 5 March 2015

The practice had a registration policy in place which enabled people without a permanent address to register at the practice; this could often be people who are living in vulnerable circumstances.

Patients who were vulnerable due to their health or social circumstances were offered health checks. Some of the staff at the practice were multilingual and one member of staff was a trained interpreter. The practice also had access to an interpreting service for patients whose first language was not English, this included telephone translation service for urgent appointments. If a translator was required a double appointment was booked to allow sufficient time for the consultation.  

The practice was due to start a scheme to avoid unplanned hospital admissions by providing an enhanced service. This focused on coordinated care for the most vulnerable patients and included emergency health care plans. The aim was to avoid admission to hospital by managing their health needs at home. An enhanced service is a service that is provided above the standard general medical service contract (GMS).