Dr Devadeep Gupta Also known as Pennine Surgery

Updated 11 January 2017

The practice had been previously inspected on 19 February 2015. Following that inspection the practice was rated requires improvement.

Dr Gupta is the lead GP at Pennine Surgery which, at the time of inspection, had a patient population of 3,016 patients within Littleborough and the surrounding areas. There is a larger than average population of patients over the age of 60 years and 50% of the patient population have a long term illness.. The practice delivers commissioned services under the Personal Medical Services (PMS) contract. The building complies with the Disability Discrimination Act 1995 (DDA). All consulting rooms are on the ground floor with corridors and doors wide enough for wheelchairs. Car parking is available on site. The practice offers an open list and welcomes new patients living in or moving to the area.

Services offered include chronic disease management, childhood vaccinations, six week baby assessments, travel vaccinations, extended hour surgeries, smoking cessation services and drug dependency and counselling services.

The practice have increased their complement of staff following the last CQC inspection. There is now a lead male GP who is supported by one male and one female salaried GP. The female GP is currently on maternity leave. The practice have a part time female advanced nurse practitioner who is able to prescribe medicines and a female practice nurse. The medical and nursing sessions have increased and the day to day clinical management has been reviewed and apportioned so that overall responsibility is shared. The clinical staff are supported by a small number of administration and reception staff and a practice manager.

The practice opening hours are as follows :

Reception and telephone lines :

Monday – Friday

8:00am – 6:30pm

GP and nurse Consulting Sessions :

Mon - Fri

8:30am – 11:00am

Mon, Tues, Thurs & Fri

3:00pm – 5:30pm

Monday - Evening surgery

6:30pm – 8:00pm

There is no surgery on Wednesday afternoons.

This is a teaching practice and both the provider and one of the salaried GPs were mentors for junior doctors. At the time of the inspection there was a fifth year medical student.

Updated 11 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Devadeep Gupta on 15 December 2016. Overall the practice is rated as good.

The practice was previously inspected on 19 Feb 2015. Following that inspection the practice was rated as good for caring, effective and responsive services and required improvement in safe and well led.

Three compliance actions were issued as the practice was not meeting the legislation in place at that time for the following:

• Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010 Assessing and monitoring the quality of service provision
• Regulation 21 HSCA 2008 (Regulated Activities) Regulations 2010 Requirements relating to workers
• Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting staff

Following this re-inspection on 15 December 2016 our key findings across all the areas inspected were as follows:

• The practice had reviewed the systems they had in place for communicating information within the practice. There was an open and transparent team approach where all practice issues were regularly discussed and reviewed.
• The number of staff had increased and the leadership structure had been reviewed and improved. There was a clear leadership structure and staff felt supported by management. The practice management team proactively sought feedback from staff and patients and acted on it.

• Staff had undertaken training to provide them with the skills, knowledge and experience they needed to deliver effective care and treatment.

• The provider was aware of and complied with the requirements of the duty of candour.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored and informally reviewed and addressed.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• 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.

The areas where the provider should make improvement are :

• In relation to managing reviews of medication the practice should consider using review dates to improve the system they currently have in place.

• In relation to health and safety which is managed by NHS property services, the practice should keep a record of all up to date documentation.

We saw an area of outstanding practice :

• The practice were involved in a CCG initiative to carry out C-reactive protein (CRP) testing at the surgery. This was a blood test marker for inflammation in the body providing an early indication of whether an infection was viral or bacterial. The test enabled the practice to immediately detect and offer reassurance to their patients when antibiotics would not be effective treatment and also to reduce the number of wrongly prescribed antibiotic medicines. The practice could evidence a reduction in the number of antibiotics that were prescribed and said that feedback from patients was positive in this respect.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 January 2017

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.
• 2015/2016 indicators for diabetes and other long term conditions were 10% above local and national averages at 100%.
• Longer appointments and home visits were available when needed.
• 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. This was an improvement from the previous inspection where patients did not always receive this structured approach.

Updated 11 January 2017

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 percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 82% compared to the CCG average of 80% and the national average of 82%. (2014/2015 data).
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 11 January 2017

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

• The practice had a high ratio of older patients and they offered proactive, personalised care to meet those patients’ needs.A member of administration staff had been given a lead role to provide a greater level of assistance to patients in this population group.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice had developed good relationships with residential and nursing homes in the area and the practice nurses communicated with district nurses where the practice’s patients required blood testing or medicine reviews to minimise duplication of work.

Updated 11 January 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.
• Appointments were pre-bookable up to four weeks in advance and we saw that the next pre-bookable on-line appointment was less than two weeks away.
• On the day and urgent appointments were available Monday to Friday and patients were offered seven-day access at four different sites if they were unable to get an immediate appointment.
• GP and nurse led appointments were available until 8.00pm every Monday evening.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

Updated 11 January 2017

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

• Indicators for the years 2015/2016 showed that 100%

• Indicators for mental health were 100% which was 9% and 7% higher (respectively) than the CCG and national averages.

• The practice carried out advance care planning for patients with dementia and pro-actively undertook dementia reviews at patients’ homes.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The lead GP made and monitored their own follow up appointments for patients with mental health to ensure appropriate action was taken if the patients did not attend.

• 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.

Updated 11 January 2017

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. They did not have any homeless people on their practice list.
• 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.