Archived: Dr Peter Scott Also known as Chester Road Surgery

Updated 14 July 2017

Dr Peter Scott’s practice is registered with the Care Quality Commission to provide primary medical services. The practice has a General Medical Services contract (GMS) with NHS England. A GMS contract ensures practices provide essential services for people who are sick as well as, for example, chronic disease management and end of life care. The practice also provides some directed enhanced services such as childhood vaccination and immunisation schemes.

The practice is based in a detached property that has been converted and extended. The practice provides primary medical services to approximately 3900 patients in the local community. The

practice was originally run by a lead male GP (provider) with a full-time salaried female GP; however since April 2017 the GPs have formed a practice partnership. The nursing team consists of a practice nurse and healthcare assistant. The non-clinical team consists of two practice managers, administrative and reception staff.

The practice had seen a 13% increase in the past three years of patients registering at the practice. The increase in patients had caused considerable strain on current resources. The area served has higher deprivation compared to England as a whole and ranked at two out of ten, with ten being the least deprived.

The practice is open between the hours of 8am to 6pm on Monday, Tuesday, Thursday and Friday. The practice closed on Wednesday afternoons from 12.30pm. During the day

reception closes from 12.30pm to 1.30pm and the surgery telephone is diverted from 12.30pm to 3.30pm to 'Badger' who are an external out of hours service provider, contracted by the practice. Extended opening hours were provided by the practice on Wednesday mornings from 7am to 8am and Thursday evenings from 6:30pm to 7:30pm.

The practice is part of NHS Solihull Clinical Commissioning Group (CCG) which has 27 member practices. The CCG serve communities across the borough, covering a population of approximately 238,000 people. A CCG is an NHS Organisation that brings together local GPs and

experienced health care professionals to take on commissioning responsibilities for local health services.

Updated 14 July 2017

Letter from the Chief Inspector of General Practice

We first inspected Dr Peter Scott’s surgery also known as Chester Road Surgery on 17 April 2015 as part of our comprehensive inspection programme. During the inspection we found the practice was in breach of legal requirements and placed into special measures. Following the inspection the practice wrote to us to say what they would do to meet the regulations. We undertook a comprehensive follow up inspection on 20 April 2016 to check that they had followed their plan and to confirm that they met the legal requirements. Overall we found improvements had been made to the concerns raised and as a result of the inspection findings the practice was rated as Good. The full comprehensive reports can be found by selecting the ‘all reports’ link for Dr Peter Scott on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 23 June 2017 to confirm that the practice had continued to meet the legal requirements. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall we found the practice continued to meet all the legal requirements and continues to be 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 a system in place for reporting and recording significant events. Staff had regular monthly meetings to discuss significant events and lessons learnt. The practice carried out an analysis of each event with a documented action plan.
• The practice had clearly defined and embedded systems to minimise risks to patient safety, this included an effective process for monitoring and actioning safety alerts.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment and the practice had set up a training matrix to monitor that all staff were receiving the appropriate training and updates for their role.
• Clinical audits demonstrated quality improvement and the practice carried out regular audits to monitor patient outcomes.
• Results from the July 2016 national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment and there was continuity of care, with a sit and wait service available each morning and urgent appointments available the same day.
• The premises proved a challenge due to lack of space, which the staff managed well.
• 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 GPs encouraged a culture of openness and honesty. The practice had a well established governance framework to support the delivery of safe and effective care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 July 2017

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. The latest published QOF results (2015/16) showed performance for diabetes related indicators was 90% which was comparable to the CCG average of 93% and the national average of 90%.
• Patients with long-term conditions received annual reviews of their health and medication. 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. We saw evidence that meetings were held every three months.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• One of the staff members, was the practice’s named Public Health Champion whose role was to promote local initiatives and organise displays and information in the waiting room to advise patients of support and services available.

Updated 14 July 2017

• 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 accident and emergency (A&E) attendances.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group. For example, the midwife held ante-natal clinics once a week and meetings with the health visitors and midwife were held every three months.
• Childhood immunisation rates remained relatively high for all standard childhood immunisations. There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice offered a range of family planning services including intrauterine contraceptive device (IUCD) fittings.
• The practice’s uptake for the cervical screening programme was 82% which was comparable to the national average of 81%.

Updated 14 July 2017

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• The practice held weekly meetings with the Care Navigator Service, in conjunction with Age UK Solihull. The Care Navigator Service offered support to older people to find solutions to issues they may face and assists them to navigate and access relevant services that could meet their needs. Since November 2016 the practice had referred 18 patients to the service for further support and assistance.
• Older patients were provided with advice and support to help them to maintain their health and independence for as long as possible. For example, the practice had proactively started to review patients with moderate and severe frailty in conjunction with the Community Matron.
• Documentation provided by the practice showed that patients on the palliative care register were discussed at quarterly meetings and their care needs were co-ordinated with community teams.

Updated 14 July 2017

• The needs of these populations 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, extended opening hours were available early morning and late evening.
• 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. In February 2017 the practice uptake for online services was at 2%. Following a proactive approach to encourage the benefits of using the online facilities the practice had seen an increase to 8% of patients using this service.
• The practice offers NHS health checks for patients aged 40-70 years and has a very successful attendance rate. Data provided by the practice showed 325 patients had received a health check in the past 12 months.
• The health care assistant ran an inhouse stop smoking service and 89% of smokers had received smoking cessation advice and data provided by the practice showed that 14 patients had quit smoking in the past six months.
• The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

Updated 14 July 2017

• Patients at risk of dementia were identified and offered an assessment. The latest QOF data (2015/16) showed 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%. Unverified data provided by the practice showed 88% of patients had received a face to face review and 100% of patients had a care plan and medication review documented in their records.
• Patients requiring support with mental health needs were referred to Improving Access to Psychological Therapies (IAPT) which is a local counselling team.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• Data provided by the practice showed 23 patients on the mental health register and the latest QOF data (2015/16) showed 94% of patients on had had their care plans reviewed in the last 12 months, which was higher than the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 14 July 2017

• The practice held a register of patients living with a learning disability, frail patients and those with caring responsibilities and regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice offered longer appointments and annual health checks for people with a learning disability. Unverified data provided by the practice showed 24 patients on the learning disability register and 83% had care plans in place and 94% had received a medication review.
• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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’s computer system alerted GPs if a patient was also a carer. There were 55 patients on the practices register for carers; this was 1% of the practice list.