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Dr Davis's Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 10 May 2018

We carried out an announced comprehensive inspection at Dr Davis’s Medical Practice on 29 June 2017. The overall rating for the practice was good with safe as requires improvement. The full comprehensive report on the Month Year inspection can be found by selecting the ‘all reports’ link for Dr Davis’s Medical Practice on our website at .

This inspection was an announced focused inspection carried out on 10 April 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 29 June 2017. In addition to the breaches, we identified some areas where the practice should make improvements. This report covers our findings in relation to those requirements and also the additional improvements made since our last inspection.

Overall the practice remains rated as Good and ‘safe’ is now also rated as Good.

Our key findings were as follows:

  • The practice now held a log to keep track of blank prescription forms and a policy was in place for this process.
  • Medical equipment had been calibrated and was safe to use.
  • The practice now had a risk assessment in place for the checking of medical emergency equipment; specifically the defibrillator.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 May 2018

At our previous inspection on 29 June 2017, we rated the practice as requires improvement for providing safe services as the arrangements in respect of logging blank prescription forms, equipment calibration and risk assessments being in place for medical emergency equipment were not adequate.

These arrangements had significantly improved when we undertook a follow up inspection on 10 April 2018. The practice is now rated as good for providing safe services.

Safety systems and processes

  • The practice now held a log book to log and keep track of blank prescription forms and a policy was in place to support this process.
  • Medical equipment had been calibrated and was safe to use. A service agreement was in place to ensure this happened annually.
  • The practice now had a risk assessment in place for the checking of shared medical emergency equipment; specifically the defibrillator.

Effective

Good

Updated 8 August 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or below average compared to the national average.
  • Staff were aware of current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 8 August 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others for several aspects of care.
  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 8 August 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population.
  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.
  • Patients we spoke with said 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.
  • Information about how to complain was available and evidence from the examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 8 August 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.

Checks on specific services

People with long term conditions

Good

Updated 8 August 2017

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

  • The diabetes indicators we reviewed from the Quality and Outcomes Framework (QOF) data were generally below local and national averages.
  • 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.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for 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.

Families, children and young people

Good

Updated 8 August 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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.
  • Immunisation rates were relatively low for all standard childhood immunisations.
  • 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.
  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 8 August 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • 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 identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice shared summary care records with local care services.

Working age people (including those recently retired and students)

Good

Updated 8 August 2017

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

  • 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.
  • 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 experiencing poor mental health (including people with dementia)

Good

Updated 8 August 2017

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

  • The practice carried out advance care planning for patients living with dementia.

  • The practice specifically considered the physical health needs of patients with poor mental health and dementia.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • 83% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 8 August 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 those with a learning disability.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • 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 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.