Dr Rajiv Goel Also known as The Riverside Practice

Updated 27 March 2017

Dr Rajiv Goel provides GP primary care services to approximately 4,000 people living in Clapton, London Borough of Hackney. The practice has a General Medical Services (GMS) contract for providing general practice services to the local population. General Medical Services (GMS) contract is the contract between general practices and NHS England for delivering primary care services to local communities.

Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to ten. Level one represents the very highest levels of deprivation and level ten the lowest. This information also shows that Income Deprivation Affecting Older People (IDAOPI) is 46% which is higher than the CCG average of 41% and significantly higher the national average of 16%. Income Deprivation Affecting Children (IDACI) is 36% (CCG average 32%, national average 20%).

There are currently two GPs, both male, one of whom is full time and one part time. The practice provides a total of 15 GP sessions per week.

The clinical team is completed by a practice nurse and an assistant practitioner, both of whom work part time. (Assistant practitioners are qualified health care assistants who have undertaken additional training to allow them to take on a wider range of responsibilities using clearly defined protocols under the supervision of GPs and registered nurses). The assistant practitioner is also trained as a phlebotomist (Phlebotomists are specialist healthcare assistants who take blood samples from patients for testing in laboratories). There are is also a full-time practice manager and a total of four administrative and reception staff.

The practice is registered with the Care Quality Commission as a sole provider, to provide the regulated activities of maternity and midwifery services, diagnostic and screening procedures and treatment of disease, disorder or injury.

The practice is located in a modern, purpose built two storey health centre and shares the premises with another, separately registered GP practice. The practice has a well maintained lift which is accessible by wheelchairs.

The practice opening hours for the surgery are:

Monday 9:00am to 7:30pm

Tuesday 8:30am to 6:00pm

Wednesday 9:00am to 7:30pm

Thursday 9:00am to 1:00pm

Friday 9:00am to 6:00pm

Saturday Closed

Sunday Closed

Appointments are available between 9:00am and 12:00pm every weekday and between 3:00pm and 6:00pm every weekday except for Thursday. The practice provides extended hours clinics between 6:30pm and 7:30pm on Mondays and Wednesdays.

Patients can book appointments in person, on-line or by telephone. Patients can access a range of appointments with the GPs and nurses. Face to face appointments are available on the day and are also bookable up to four weeks in advance. Telephone consultations are offered where advice and prescriptions, if appropriate, can be issued and a telephone triage system is in operation where a patient’s condition is assessed and clinical advice given. Home visits are offered to patients whose condition means they cannot visit the practice.

The practice has opted not to provide out of hours services (OOH) to patients and these were provided on the practice’s behalf by CHUHSE ((City & Hackney Urgent Healthcare Social Enterprise). The details of the how to access the OOH service are communicated in a recorded message accessed by calling the practice when it is closed and details can also be found on the practice website.

The practice provides a wide range of services including clinics for diabetes, weight control, asthma, contraception and child health care and also provides a travel vaccination clinic. The practice also provides health promotion services including a flu vaccination programme and cervical screening.

The practice is registered as a training practice for qualified doctors who are training to become general practitioners although there were no trainees at the practice at the time of our inspection.

The practice had not previously been inspected.

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rajiv Goel on 20 January 2017. 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 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 improvement are:

• Ensure that actions are taken to bring about further improvements in the documenting of vital parameters for children presenting with symptoms which were indicative of the presence of infection.
• Continue to monitor uptake rates for national health screening programmes, including those for bowel and breast cancer and consider ways to improve uptake rates.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 27 March 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.
• Performance for diabetes related indicators were comparable to CCG averages and the national average. For instance, 77% of patients had well controlled blood sugar levels (CCG average of 78%, national average 78%). Longer appointments and home visits were available when needed.
• The practice engaged with a local pharmacy advisor to review treatments for patients who required four or more medicines to ensure that they were used to best effect and to help patients manage side effects.
• 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 27 March 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 practice’s uptake for the cervical screening programme was 81%, which was the same as the national average and comparable to the CCG average of 80%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had a policy to invite patients for a health review on their 16th birthday. The practice told us this was to encourage and help younger patients to begin taking greater responsibility for their own health as well as providing an opportunity for younger people to address any concerns or questions around the transition from childhood to adulthood.

Updated 27 March 2017

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

• The practice offered 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.
• The practice carried out quarterly, pro-active home visits for frail and housebound patients. These appointments were used to undertake health reviews, give seasonal vaccinations, identify any unmet or new needs and review care plans.
• Outcomes for conditions frequently associated with older people were above the national average. For instance, 91 % of patients with hypertension had well controlled blood pressure compared to the national average of 83%.

Updated 27 March 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.
• 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.
• Telephone consultations were available for patients who were unable to attend in person or who were unsure if their condition required a visit to the surgery.

Updated 27 March 2017

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

• 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.

• 93% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 89%.

• 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.
• 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 27 March 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 including homeless people and those with a learning disability.
• Residents who lived on canal boats in the vicinity could register using the practice address. This include transient residents who could register as temporary residents. These patients were encouraged to engage with public health screening programmes whilst they were registered at the practice.
• 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.
• Information about support for victims of domestic violence was available in the waiting area as well as in the privacy of toilet cubicles where patients could engage with the details unobserved. This information was presented in a range of locally prevalent community languages.