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OHP-The Dove Medical Practice Good

The provider of this service changed - see old profile

Reports


Review carried out on 1 January 2020

During an annual regulatory review

We reviewed the information available to us about OHP-The Dove Medical Practice on 1 January 2020. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 20 Februray 2019

During a routine inspection

We carried out an announced comprehensive inspection at OHP-The Dove Medical Practice on 20 February 2019.

At the last inspection in May 2018 we rated the practice as requires improvement for providing safe, responsive and well led services. The practice was rated good for providing effective and caring services. At this inspection the practice had made improvements in a number of areas however, patients ability to access the service in a timely manner required further improvement.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected

  • information from our ongoing monitoring of data about services and

  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

We rated the practice as requires improvement for providing effective care to population group working age people (including those recently retired and students) because:

•The practice did not have an effective system in place to follow up patients who did not attend for further investigation of their cervical screening test result.

We rated the practice as requires improvement for providing responsive services overall and across all population groups because:

•Patients were not always able to access timely care and treatment.

We rated the practice as good for providing safe, effective, caring and well led services because:

•The practice had adequate systems to manage most risks so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

•Care and treatment was delivered according to evidence based guidelines.

•Staff dealt with patients with kindness and respect and involved them in decisions about their care.

•There was a strong focus on continuous learning and improvement. Systems and processes were in place to support good governance.

The areas where the provider should make improvements are:

•Have appropriate risk assessments in place for staff who are unable to provide documentary evidence of vaccinations relevant to their role and in line with current Public Health England (PHE) guidance.

•Ensure comprehensive risk assessments are in place for the storage of hazardous substances for example, liquid nitrogen and chemicals used for cleaning.

•Ensure staff are trained on the use of the emergency fire evacuation chair.

•Have an effective in place to follow up patients who do not attend for further investigation of their cervical screening test result.

•Review how care and treatment for patients with a learning disability may be improved.

•Consider a formal process to evidence in house training and supervision for staff in advance roles.

•Continue to explore ways to improve access for patients.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 30/05/2018

During a routine inspection

This practice is rated as Requires Improvement overall.

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Requires Improvement

We carried out an announced comprehensive inspection at OHP-The Dove Medical Practice on 30 May 2018 as part of our inspection programme. The practice last received a comprehensive inspection under the previous provider in December 2015 and received an overall rating of requires improvement. The practice received a focussed follow up inspection in June 2016 and was subsequently rated as good overall.

The current provider of this practice registered with CQC in August 2017. This is the first inspection under the current registration.

At this inspection we found:

  • The practice had 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. However, systems were not always well established. We identified areas where there was a lack of clear oversight and effective monitoring of risks. These included, risks relating to the premises, administration of vaccinations and injections and locum recruitment.
  • The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.
  • Patient outcomes were comparable to other practices locally and nationally. Staff worked with other health and social care services to provide person-centred care and treatment.
  • Staff received appropriate training and development for their roles.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • The practice had developed services to meet the needs of their practice population. However, patients reported that they found access to appointments difficult.
  • Results from the National GP patient survey and other feedback received showed patients were satisfied with their consultations with clinical staff but not with access. This had continued to be an issue since our previous inspections. The practice had recently implemented new initiatives to try and address this.
  • There was a strong focus on continuous learning and improvement, some staff had attended a leadership course and brought the learning back to help develop and improve the practice.

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:

  • Review information available to support staff working on a temporary basis.
  • Review support for reception staff ensure they are aware of ‘red flag’ symptoms and action they should take.
  • Review systems for reporting incidents to ensure learning opportunities are maximised.
  • Review how care and treatment for patients with a learning disability may be improved.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice