Raj Medical Centre

Updated 10 June 2016

Raj Medical Centre occupies GP premises purpose built in 2011 in Grimsby, North East Lincolnshire. They have a Primary Medical Services (PMS) contract and also offer enhanced services, for example, childhood vaccination and immunisation scheme, facilitating timely diagnosis and support for people with dementia, providing annual health checks for people with learning disabilities, risk profiling and case management and unplanned hospital admissions.

There are 5758 patients on the practice list and the majority of patients are of white British background. The practice population in the 0-29 years age group is greater than the England average. The practice population in the 30-45 years age group is slightly lower than the England average. The proportion of the practice population in the 65 years and over age group is lower than the England average. The practice scored one on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. The overall practice deprivation score is higher than the England average, the practice is 47.4 and the England average is 21.8 People living in more deprived areas tend to have a greater need for health services.

The practice is a teaching practice for year four and five medical students.

The practice has one female and two male GPs; there are two partners and one sessional GP. There is a practice nurse, a chronic disease specialist nurse and a health care assistant. There is a practice manager, a deputy manager, clinical director, two medical secretaries, one administrator and five receptionists.

The practice is open Monday to Friday from 8am to 6.30pm (Thursday until 8pm).

GP appointments are available Monday to Friday 9am to11.30am and 3pm to 6pm. The practice offers extended hours Thursday 5.30pm to 7.30pm. Urgent GP appointment requests are triaged Monday to Friday 8am to 11am.

When the practice is closed, patients’ calls are transferred to the Out Of Hours provider. Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website. 

Updated 10 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Raj Medical Centre on 13 April 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 said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was strong and visible clinical and managerial leadership and governance arrangements. 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 (i.e. any patient harmed by the provision of a healthcare service was informed of the fact and an appropriate remedy offered, regardless of whether a complaint had been made or a question asked about it).

We saw one area of outstanding practice:

• Early dementia referral rates were twice the Clinical Commissioning Group (CCG) average; the practice rate was 124 compared to CCG average of 62. The practice achieved higher than average QOF figures for mental health indicators (practice achievement ranged from 93% to 100% compared to the national range of 84% to 90%).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 10 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable to the national average.
• The percentage of patients ,on the diabetes register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 80%. This is similar to the national average of 78%.
• The percentage of patients on the diabetes register, with a record of a foot examination and risk classification was 93% which is higher than the national average of 88%.
• Longer appointments and home visits were available when needed.
• The practice held monthly Saturday clinics for those patients with diabetes who were unable to attend during the week.
• 75% of patients with asthma, on the register, have had an asthma review in the preceding 12 months. (01/04/2014 to 31/03/2015) similar to the national average of 75%.
• 91% of patients with Chronic Obstructive Airways Disease (COPD) have had a review undertaken in the preceding 12 months (01/04/2014 to 31/03/2015) similar to the national average of 90%.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 10 June 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, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us 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 80% which was comparable to the national average of 82%.
• Appointments with nurse and GP were available outside of school hours and the premises were suitable for children and babies.
• The practice offer extended clinics for new-born babies along with post-natal checks.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice had a Child Not Brought In policy which identified follow-up action should a child fail to keep an appointment. This policy was being adopted by the CCG.

Updated 10 June 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 was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• All patients in nursing and residential care homes had an individual care plan and were reviewed as part of a ‘ward round’ in each home.

Updated 10 June 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. An examplewas the introduction of diabetes review clinics on Saturdays which helped people to attend after working hours.
• 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.

Updated 10 June 2016

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

Performance for mental health related indicators was better than the national average with

• 100% of patients diagnosed with dementia have care plans and had their care reviewed in a face to face meeting in the last 12 months, which is higher than the national average of 84%

• 96% of patients with psychoses have had a comprehensive, agreed care plan which is higher than the national average of 88%
• 93% of patients with psychoses have had their alcohol consumption recorded compared to the national average of 90%
• 96% of patients with physical and/or mental health conditions have their smoking status recorded in the preceding 12 months (01/04/2014 to 31/03/2015) comparable to the national average of 94%.

The practice had identified there was limited services for young people with mild to moderate mental health issues so started a project through the CCG to develop a service to meet the needs of these patients.

• People contacting the practice with a mental health issue were triaged the same day and offered an appointment that same day if needed.
• 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 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.
• There was an in-house counselling service at the practice.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• All staff have been trained in dementia awareness and Mental Capacity Act.
• The dementia diagnosis rate for the practice during 2014/15 is twice that of the CCG average (practice was 124 compared to the CCG average of 62).
• The practice had planned a dementia and Mental Capacity Act training event for families and carers to increase their awareness and understanding of the issues.

Updated 10 June 2016

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• A range of booklets in Easy Read format were available to help patients understand treatments and services. An example was a leaflet about having a smear test.
• 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.