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Inspection Summary


Overall summary & rating

Good

Updated 9 February 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection February 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We undertook a comprehensive inspection of Dr Eric Paul on 6 January 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as requires improvement for providing safe, effective, caring and well led services and good for providing responsive services. Overall the practice was rated as requires improvement and Requirement Notices were issued in respect of breaches in:

  1. Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment;

  2. Regulation 17 HSCA (RA) Regulations 2014 Good governance;

  3. Regulation 18 HSCA (RA) Regulations 2014 Staffing.

The full comprehensive report following the inspection in January 2017 can be found by selecting the ‘all reports’ link for Dr Eric Paul on our website at www.cqc.org.uk.

We undertook a comprehensive inspection of Dr Eric Paul on 1 December 2017 to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

During our visit we:

  • Spoke with a range of staff including the principal GP, Practice Nurse, Practice Manager and reception staff and spoke with patients who used the service.
  • Observed how patients were being cared for in the reception area.
  • Reviewed a sample of the personal care or treatment records of patients.
  • Reviewed comment cards where patients and members of the public shared their views and experiences of the service.
  • Looked at information the practice used to deliver care and treatment plans.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Clinical audit had a positive impact on quality of care and outcomes for patients.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Ensure that infection prevention control audits are completed annually.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 February 2018

Effective

Good

Updated 9 February 2018

Caring

Good

Updated 9 February 2018

Responsive

Good

Updated 9 February 2018

Well-led

Good

Updated 9 February 2018

Checks on specific services

Older people

Requires improvement

Updated 7 February 2017

The practice is rated as requires improvement 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.
  • However, there was no evidence of care plans for older people.

People with long term conditions

Requires improvement

Updated 7 February 2017

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

  • The nurse supported the GP in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Quality and Outcomes Framework (QOF) performance for diabetes related indicators was 63% which was significantly below the CCG average of 79% and the national average of 90%.
  • 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.

Families, children and young people

Requires improvement

Updated 7 February 2017

The practice is rated as requires improvement 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 comparable to others 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • However, the practice’s uptake for the cervical screening programme was 76%, which was slightly below the CCG average of 79% and the national average of 82%.

Working age people (including those recently retired and students)

Requires improvement

Updated 7 February 2017

The practice is rated as requires improvement 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. 

People whose circumstances may make them vulnerable

Requires improvement

Updated 7 February 2017

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

  • The practice held a register of patients living in vulnerable circumstances those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • 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.
  • However, non-clinical staff had not received training in safeguarding children and not all staff had received training in safeguarding vulnerable adults.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 7 February 2017

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

  • 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG and national average. However, exception reporting was high at 25%.
  • 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 an understanding of how to support patients with mental health needs and dementia.