Archived: Doclands Medical Centre

This practice is rated as Good overall. (Previous rating 16/02/2018 – Requires Improvement)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services well-led? - Good

We carried out an announced focused inspection at Doclands Medical Centre on 14 September 2018 to follow up breaches of regulations identified at our inspection in February 2018 and to see whether our recommendations for improvements at our February inspection had been addressed. We inspected evidence relating to the Safe and Well-led key questions.

At this inspection we found:

• The practice had improved their systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and changed their processes.
• The practice proactively developed and reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment were delivered according to evidence- based guidelines. Quality improvement was central to the practice service delivery.
• Practice policies and procedures had been reviewed and improved.
• The governance of the practice had been strengthened. Leaders had introduced new systems to assure themselves policies and procedures were operating as intended.
• There was a new system in place for managers to ensure staff training was appropriate and up-to-date.
• Communication within the practice with all staff was comprehensive.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw two areas of outstanding practice:

• The practice had implemented several quality improvement projects related to patient clinical care. These allowed for patient-centred care and staff training and development. We saw the implementation of a complex care patient pathway that gave patients access to a healthcare assistant, a practice nurse and a GP on the same visit. The practice was monitoring outcomes for these patients and early indications showed a decrease in attendance at the hospital accident and emergency department.
• The practice had introduced easy to read bulletins to share practice developments with all staff. We saw bulletins produced following clinical meetings to share clinical developments and future plans with administrative staff and vice versa. There was also a “New Developments” bulletin to share headline general practice development information with all staff.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as Requires Improvement overall. (Previous inspection 22 April 2015 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

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 – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students - Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

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

We carried out an announced comprehensive inspection at Doclands Medical Centre on 16 February 2018 as part of our inspection programme to inspect 10% of practices before April 2018 that were rated Good in our previous inspection programme.

At this inspection we found:

• The practice generally had clear systems to manage risk so that safety incidents were less likely to happen, although some risk assessments for staff working and emergency medicines were absent and some risks had not been managed well. When incidents did happen, the practice learned from them and improved their processes.
• The practice system for dealing with communications into the practice and for urgent patient referrals needed review as did the process for dealing with uncollected patient prescriptions. Loose prescriptions were not monitored. Policies and procedures for these processes had not been documented.
• 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. We saw evidence of clinical audit although there was no agreed programme of quality improvement and audits were not always shared with all staff.
• Practice policies and procedures were not comprehensive. Some policies were lacking, such as the safeguarding adults policy, some were inaccurate and some were out of date.
• Practice governance systems required improvement. There was a lack of oversight of actions taken in respect of patient safety alerts, professional indemnity and staff training.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the practice telephone system made appointments difficult to book although they 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 lead advanced nurse practitioner was leading on the practice transformation programme although there was no dedicated time allotted for this work to ensure that it was sustainable.

We saw two areas of outstanding practice:

• The practice had worked to develop a new patient referral-checking template based on King’s Fund recommendations for producing high-quality referrals. We saw a letter from the Lancashire deputy medical director of NHS England that confirmed use of this template had increased the quality of referrals from the practice significantly and allowed for referrals to be directed appropriately and in a timely manner.
• The practice offered a weekly drop-in baby clinic run by the healthcare assistant. This had reduced the number of appointments with GPs, improved communication with new families, improved child safeguarding, increased the uptake of childhood vaccinations and immunisations and offered necessary and timely support. We were told that Doclands Medical Centre was the only practice in the Preston CCG to offer this service.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Allow for clinical audits undertaken to be agreed by and shared with the practice to best inform and share learning.
• Consider the provision of protected time for staff strategic improvement work undertaken in the practice to better sustain this work.
• Implement plans to improve patient telephone access to the surgery.
• Take steps to better identify patients on the practice list who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice