Dr N A Nayyar & Partners - Riverside Medical Centre

Updated 1 August 2016

The practice of Dr N A Nayyar and partners is located at the Riverside Medical Centre and provides services for around 10,800 patients in the Castleford area. The practice is part of the NHS Wakefield Clinical Commissioning Group.

The surgery is located in purpose built premises built in 1991. The building is accessible for those with a disability and on-site parking is available for patients.

The practice population age profile shows that it is similar to both the CCG and England averages for those over 65 years old (17% compared to the CCG average of 18% and England average of 17%). Average life expectancy for the practice population is 76 years for males and 81 years for females (CCG average is 77 years and 81 years respectively and the England average is 79 years and 83 years respectively). The practice population has significantly more patients with a long standing health condition at 65% compared to the CCG average of 58% and the national average of 54%. A higher than average population with a long standing health condition could mean increased demand for GP services. The practice serves some areas of higher than average deprivation. The practice population is predominantly White British.

The practice provides services under the terms of the General Medical Services (GMS) contract. In addition the practice offers a range of enhanced local services including those in relation to:

• Childhood vaccination and immunisation

• Influenza and Pneumococcal immunisation

• Rotavirus and Shingles immunisation

• Support to reduce unplanned admissions.

• Minor surgery

• Learning disability support

• Patient participation

As well as these enhanced services the practice also offers additional services such as those supporting long term conditions management including asthma, chronic obstructive pulmonary disease, diabetes, heart disease and hypertension, and other services including joint injections and counselling.

Attached to or closely working with the practice is a team of community health professionals that includes health visitors, midwives and members of the district nursing team.

The practice has six GP partners (four male, two female), a salaried GP(female), a nurse practitioner, a practice nurse manager, three practice nurses and three health care assistants (all female). The clinical team is supported by a practice manager, finance manager, office manager and a reception and administration team.

The practice is accredited as a training practice and supports GP registrars during their further training to become GPs.

The practice is open from 8am to 6.30pm Monday to Friday.

In addition through the local Federation patients can access Saturday morning appointments at Pontefract Hospital.

The practice offers a range of appointments which include:

• Pre-bookable appointments available to book up to four weeks in advance for a GP and up to eight weeks in advance for the nurse practitioner

• Same day sit and wait sessions on Mondays to Fridays between 8am and 10am, no appointment being required

• Book on the day appointments available in the afternoon

• Urgent appointments (the practice prioritises children under six years of age and anyone with a condition which requires urgent attention)

• Telephone consultations when patients can discuss their condition with a GP duty doctor from 8am to 6pm.

The practice also offers home visits to patients whose condition means that they are unable to attend the surgery.

Appointments can be made in person, on the telephone or online.

Out of hours care is provided by Local Care Direct Limited and is accessed via the practice telephone number or patients can contact NHS 111.

Updated 1 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N A Nayyar and Partners at Riverside Medical Centre on 17 May 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients had a variety of appointment options which included sit and wait sessions, pre-bookable and urgent appointments and telephone consultation and advice.

• The practice provided 30 minute appointments for new mums and babies for the six week post-natal check. This additional time allowed the practice to offer improved levels of support and better meet identified needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

• The practice had a dedicated learning disability nurse who worked closely with learning disability patients, carers and other health and social care professionals to provide effective and accessible services. The practice had been involved in the development of templates for health checks in association with the local learning disability team, and had provided training and awareness raising amongst other practices of learning disability health care. Of 88 patients on the practice register of patients with a learning disability 94% had a health action plan in place which is reviewed annually. In addition we were provided with examples of how staff had gone out of their way to help patients with a learning disability resolve personal and social problems.

An area where the provider should make improvement was:

• The practice should review its records in relation to the immunity and vaccination status of its staff to ensure that these were up to date.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 August 2016

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

• GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. For example, the practice offered an avoiding unplanned admissions service which provided proactive care management and support for those patients who were at high risk of an unplanned hospital admission, this included specific long term conditions. In addition the practice held clinics for a number of conditions which included:

  • Chronic Obstructive Pulmonary Disease (COPD)

  • Coronary Heart Disease

  • Prostate cancer

• Patients with long term conditions received information on disease management and were signposted to support groups and services. Patients also received regular reviews via the practice “Call and Recall” system. Wherever possible multi condition reviews were held to avoid repeated visits to the practice by patients. For example, in 2015/2016 140 patients with both cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) had received a multi condition review.

• The practice offered specialist diabetic clinics which included insulin initiation and complex needs care planning.

• Longer appointments and home visits were available when needed.

• Clinicians within the practice had experience to deliver a wide range of specialist services which included those in relation to dermatology and musculoskeletal problems.

Updated 1 August 2016

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 and the practice held regular monthly meetings with health visitors to discuss safeguarding issues.

• Immunisation rates were relatively high for all standard childhood immunisations and were between 99% and 100%.

• We were told that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 87%, which was above the CCG average of 83% and the national average of 82%. In addition the practice had an effective “Call and Recall” system in place to invite women aged 24-65 years for their screening appointment.

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

• The practice provided 30 minute appointments for new mums and babies for the six week post-natal check. This additional time allowed the practice to offer improved levels of support and better meet identified needs.

• The practice had recently registered as a c-card distribution centre which gave improved access to contraceptives to young people.

Updated 1 August 2016

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. The practice offered care planning and reviews for older patients with chronic diseases, these reviews were usually annual but could be as frequent as every three months if deemed appropriate to the needs of the patient. If appropriate multi-condition reviews were also available.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. All home visit requests were triaged to determine the necessity and urgency of visits.

• All patients over 75 years old had a named GP and had been informed of this by letter.

• The practice had contributed to a Wakefield Vanguard programme which sought to develop an approach to joined up health and social care services and to reduce emergency admissions.  The practice had 31 patients in homes covered by the programme and provided services which included advanced care planning and reviews, vaccinations and dementia screening.

Updated 1 August 2016

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. For example, the practice offered a range of patient access options which included:

  • Walk in sessions

  • Pre-booked and on the day appointments

  • Telephone consultations

  • Online services (27% of patients had signed up for practice on-line services).

• The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group such as NHS health checks.

Updated 1 August 2016

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

• All patients with mental health issues were offered annual reviews, and a number received monthly reviews to meet their specific needs. This allowed the practice to monitor their symptoms and avoid deterioration in their mental health and wellbeing.

• The practice kept registers of those with poor mental health and dementia and used these to plan reviews. At the time of inspection the practice had 126 patients on its mental health register and 80 patients on its dementia register, these were slightly above the national prevalence figures.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out care planning for patients with dementia.

• Practice staff had a high level of knowledge of how to support those with poor mental health, this included being able to tell them about how to access various support groups and voluntary organisations.

• The lead GP had a special interest in mental health and was accredited to carry out Deprivation of Liberty Safeguards (DoLs) assessments.

• The lead GP also ensured that all staff had a good understanding of the Mental Capacity Act 2005 and DoLs. The GP also shared this knowledge through training and awareness raising with staff from other practices.

• The practice had worked closely with other network colleagues and the Clinical Commissioning Group (CCG) to establish a local “Talking Shop”. When operational this would allow patients to quickly access a local, low level mental health service.

• 70% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months; this was below the CCG average of 89% and the national average of 88%.

Updated 1 August 2016

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and those with poor mental health.

• 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.

• The practice had a dedicated learning disability nurse who worked closely with learning disability patients, carers and other health and social care professionals to provide effective and accessible services. The practice had been involved in the development of templates for health checks in association with the local learning disability team, and had provided training and awareness raising amongst other practices of learning disability health care. The practice took a person centred approach in relation to consultations with the learning disability nurse using appropriate communication methods which included the use of pictures and easy access formats. Patients with a learning disability were given annual reviews; some of these were delivered in the patient’s own home if they were unable to attend the surgery. Of 88 patients on the practice learning disability register 94% had a health action plan in place. In addition we were provided with examples of how staff had gone out of their way to help patients with a learning disability resolve personal and social problems.

• The practice worked closely with staff from learning disability residential settings and provided advice and guidance. They tailored appointments to meet the needs of the patient as some patients found it difficult to attend the surgery when there were large numbers of other patients around.

• The practice used a computer protocol for patients with autism to remind staff that they may need to adapt their communication methods to aid understanding. In addition they were in the process of identifying other patients with disabilities to ensure that their preferred communication requirements were met.

• The practice was registered under the Wakefield Safer Places Scheme. This voluntary scheme seeks to assist vulnerable people feel safer when travelling independently. Registered sites have agreed to offer support to the individual and would contact a named relative, carer or friend if the person was in distress. In addition we were told that the practice took into account the needs of patients with dementia and held ” Working Towards Dementia Friendly” status (this meant the practice had registered for the recognition process for dementia friendly accreditation and was working towards the named standards to become fully dementia friendly).