Archived: Dr Sanjeev Saxena Also known as Ashurst Primary Care

Updated 8 September 2016

Dr Sanjeev Saxena is located at Ashurst Primary Care Centre a health centre in the centre of Ashurst in a residential area. There is easy access to the building and disabled facilities are provided. There is ample car parking adjacent to the practice. Primary medical services are provided under a General Medical Services (GMS) contract with NHS England and the practice is part of the West Lancashire Clinical Commissioning Group.

There is one GP working full time at the practice. He is the provider of the service. There are also two part time regular locum GP’s one female working six sessions and one male working four sessions per week. There is one full-time female practice nurse, a part time Health Care Assistant, a full time practice manager and a team of administrative staff.

The practice opening times are 8.30am to 6.30pm Monday, Tuesday, Thursday, Friday and 8.30-1pm Wednesday.

The practice appointment times are Monday, Tuesday, Thursday, Friday 8.30am to 12.30 and 2-5.30pm. Appointment times on Wednesday are 8.30-12.30 only. Extended hours are available Monday and Tuesday 6.30-8pm.Patients requiring a GP outside of normal working hours are advised to call Out of Hours West Lancashire GP Services CIC Ltd (OWLS) using the usual surgery number and the call will be re-directed to the out-of-hours service.

There are 4920 patients on the practice list. The majority of patients are white British with a high number of working age patients and families.

Updated 8 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sanjeev Saxena on 7 June 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. However on the day of our inspection the practice did not demonstrate an effective system for ensuring the safe recruitment of staff.

• Systems were 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 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.

• Patients said they found it easy to make an appointment with the GP and that 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 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.

The areas where the provider should make improvements :

• Ensure the staff recruitment policy and procedure is revised and followed to include take up of written references and police (DBS) checks and keeping interview notes on file.
• Ensure that analysis of significant events is recorded and action plans are put in place and monitored regularly.
• Revise the business continuity plan to include emergency contact numbers for staff within the document.
• Strengthen systems and processes to improve governance and demonstrate continuous learning and improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 September 2016

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

• The practice had a robust chronic disease programme which included:

• Annual review call and recall programme with a clinician for all patients with chronic disease.
• The Practice nurse undertook the review of patients with chronic disease and had a special interest in diabetes and chronic obstructive pulmonary disease. (COPD).
• Annual medication reviewed for all patients on repeat medication, with robust procedures for non-compliant patients.
• Longer appointments were offered for patients with multiple conditions.
• Home visits carried out by the GP and practice nurse for house bound patients with chronic disease.
• The practice nurse ran a weekly anticoagulation clinic to monitor levels of warfarin in patients’ blood.
• Flu immunisations were available for all patients with long term conditions. 97% of people with diabetes had this immunisation in comparison with 93% across the CCG and 94% the England average.
• The practice offered diabetic foot screening call and recall. CQC data indicated that the practice achieved 62% for annual foot checks in patients with diabetes compared to the national average of 88%.
• Post-hospital discharge care plan reviews were carried out with patients who attended A&E unnecessarily.
• Continuity of care was delivered by patients seeing the same GP thereby reducing consultation time and allowing more time for the presenting problem that day. The GP had experience of what previous treatments had been the most effective with that patient.
• The practice medicines coordinator ran the repeat dispensing scheme where patients were prescribed a six month supply of medicine and were then reviewed before the prescription was renewed. This meant patients could collect their medicine from the pharmacy once a month.

Updated 8 September 2016

The practice was rated as good for the care of families, children and young people.

• The practice had high achievement with their childhood immunisation programme achieving for immunisations. These were discussed with the safeguarding lead and the health visitor.

• There were safeguarding procedures in place for children who were vulnerable. All staff received regular safeguarding training. The GP was the lead for child & adult safeguarding.

• Childhood flu immunisations were offered and promoted via posters in the waiting room.

• The community midwife undertook all midwifery checks at the surgery at a time most convenient to the patient.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and younger patients who had a high number of A&E attendances.

• 75% of patients with asthma, on the practice register, had an asthma review in the preceding 12 months that included an assessment of asthma control using the 3 RCP questions. This compared to a CCG average of 75% and a national average of 75%.

• 81% of women aged 25-64 were recorded as having had a cervical screening test in the preceding 5 years.This compared to a CCG average of 82% and a national average of82%.There was emergency access to same day appointments for all children where required.

• There were pre-bookable appointments x weeks in advance to help families plan ahead

• Extended hours appointments were available with both the GP and the nurse so that families could attend before or after school hours.

• A family planning service was available and smears were carried out at the surgery.

Updated 8 September 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 patients.
• The practice offered home visits and same day appointments for those with enhanced needs.
• Care plans and health checks were provided as needed with regular medicine reviews carried out.
• The practice supported patients who lived in nursing and residential homes by undertaking home visits when needed and providing advice over the telephone.
• The practice offered flu, pneumonia and shingles vaccination programmes.

• Referrals to other services were made regularly, for example to antenatal clinics and the mental health team.

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• Where the patient was at risk of Emergency Admission to hospital a Care Plan was created for them as part of the Alternative to Unplanned Admission Enhanced Service. The patient was given a copy of the plan to keep by the phone in case they need medical assistance urgently.
• 2% of practice population were on the Avoiding unplanned Admission register (AUA), which included older people. These patients who had urgent clinical enquiries, could have same day telephone consultation and, where required, follow-up arrangements would be made for specialist referrals.
• The practice worked closely with the Palliative Care Nurse Specialist, Community Nurse Team and Community Matron.
• Very elderly/Housebound patients were able to order repeat medication over the phone and home delivery of medication by the pharmacist was promoted.

Updated 8 September 2016

The practice was rated as good for the care of working-age people (including those recently retired and students).

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• Routine appointments started at 8.30 every day and evening surgeries ran to 5.30pm on Monday, Tuesday, Thursday and Friday. Extended hours were available on Monday and Tuesday from 6.30-8pm thus enabling people with daytime commitments to access their GP.
• Patients could book routine appointments up to six weeks in advance online.

• The practice promoted online services to make it easier for patients who worked to access services outside of practice hours.

• Health Checks were available to patients over 40 years.
• Telephone consultation was available during working hours.
• Electronic Prescription Services (EPS) and a repeat dispensing service helped patients to get their prescriptions easily.
• Travel health and vaccination appointments were available.

Updated 8 September 2016

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

• The practice had leaflets and posters in the waiting room with information regarding dementia, mental health and carer support.

• Patients were monitored as part of QOF to check that they had an up-to-date care plan from the Mental Health Team. These plans were scanned on to the patient’s record to ensure the GP was fully aware of the most recent diagnosis and support plan.

• 88% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months.This compares to a CCG average of 86% and a national average of 88%.

• 76% of patients diagnosed with dementia had their care reviewed in a face-to-face review in the preceding 12 months. This compared to a national average of 84.01%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

Updated 8 September 2016

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

• Patients with a learning disability or other significant disability were known to the practice nurse and GP which meant staff could quickly identify when dealing with a patient that they may require additional assistance. They were offered an annual health check often with a support worker present. Picture cards were used to support people with poor understanding of language.
• The practice had a register of vulnerable adults and children so that staff were alerted when they attended for appointments.
• Clinical staff were trained in the mental capacity act. There were procedures in place for identifying patients with a DOLS in place.

• The practice regularly worked with multi-disciplinary teams in the case management of patients deemed to be vulnerable.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• The practice had a hearing loop to assist patients with hearing loss.

• Language line was used with patients where English was not their first language and they were given appointments at the end of surgery to allow more time for their consultation.

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