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Archived: Dr Mark Deverell Outstanding Also known as The Old Dispensary

The provider of this service changed - see new profile

Inspection Summary


Overall summary & rating

Outstanding

Updated 9 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mark Deverell (The Old Dispensary) on 17 August 2016. Overall the practice is rated as Outstanding

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The practice employed a healthcare assistant to specifically look after patients aged over 75 years where they had been discharged from hospital, attended the local accident and emergency department or had frequent contact with the practice. This was to facilitate any changes with their medicines, address their concerns and/or improve their situation to avoid further crises.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and 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. The practice was clean, tidy and hygienic. We found that arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.
  • 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 provider was aware of and complied with the requirements of the duty of candour.
  • The practice had focussed on patient education and empowerment for more than fifteen years as a way of promoting active citizenship. This had led to a sustained improvement in the health of the population and a reduction in resource utilisation. Through active commissioning through the practices PMS contract this had led to increased investment in the practices facilities.

We saw areas of outstanding practice:

There were comprehensive systems in place to keep people safe, which took into account the current best practice. The whole team was engaged in reviewing and improving safety and safeguarding systems. Innovation was encouraged to achieve sustained improvements in safety and continual reductions in harm. Examples being, all clinical staff were trained to level three in safe guarding children and all surfaces for example, walls, flooring, blinds and seating had contained or been treated with an antibacterial substance for hygienic cleaning.

Staff were consistent in supporting people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill health, and every contact with patients has been used for many years to do so. For example, this had resulted in lower patient numbers with chronic diseases and a low smoking prevalence of 9% of their patient population.

People who used the services were active partners in their care and patient feedback was continually positive about the way staff treat them, for example nationally reported data was consistently higher than national average. For example, 92% of patients said the last GP they saw was good at involving them in decisions about their care compared to the national average of 82%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events, patients were protected by a strong comprehensive safety system and a focus on openness, transparency and learning when things went wrong.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

  • Recruitment procedures and checks were completed as required to ensure that staff were suitable and competent.

  • There were appropriate arrangements for the efficient management of medicines.

  • Health and safety risk assessments; for example, a fire risk assessment, infection control audit and legionella risk assessment, had been performed and were up to date.

  • The practice was clean, tidy and hygienic. We found that suitable arrangements were in place that ensured the cleanliness of the practice was maintained to a high standard.

Effective

Outstanding

Updated 9 November 2016

The practice is rated as outstanding for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average However the exception reporting rate was higher than the CCG and national averages

  • The number of Emergency Admissions for 19 Ambulatory Care Sensitive Conditions per 1,000 population was 11.5 which were better than the national average of 14.6.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality

  • Staff had the skills, knowledge and experience 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.

Caring

Outstanding

Updated 9 November 2016

The practice is rated as outstanding for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • 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 easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice adopted active citizenship in care, patients who used the service were active partners in their care. Staff always empower patients to take responsibility and respect their patient’s individual preferences and needs which reflected how care was delivered.

Responsive

Outstanding

Updated 9 November 2016

The practice is rated as outstanding for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.

  • Patients said they found it easy to make an appointment with a named GP and 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 easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Outstanding

Updated 9 November 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. The approach had been supported by a contracting arrangement through a PMS contract, which had ensured that the strategy and supporting objectives were stretching, challenging and innovative , while remaining achievable. 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 a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. As a result, reducing referral rates, prescribing rates, home visiting rates, use of emergency services and consulting rates had been stabilised or reduced consistently.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 9 November 2016

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

  • The practice had retained a team approach for chronic disease management with GPs and nurses undertaking this role and patients at risk of hospital admission were identified as a priority.

  • The practice offered portable ultrasound, digital photography and professional imaging software, spirometry and Doppler testing to support clinical decision making.

  • Nationally reported data from the Quality and Outcomes Framework showed that outcomes for patients were good for patients with long term conditions. For example, patients diagnosed with hypertension whose last blood pressure reading measured in the preceding 12 months was 150/90mmHg or less was 86% which was better than the national average of 84%.

  • The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months was 100% which was better than the national average of 89%.

  • The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less (01/04/2014 to 31/03/2015) was 87% which was higher than the national average of 78%.

  • Longer and flexible appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual 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

Outstanding

Updated 9 November 2016

The practice is rated as outstanding 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 relatively high for all standard childhood immunisations.

  • The practice offered online appointments and repeat prescriptions, telephone consultations and comprehensive information on the practice website to allow working people to easily access the service.

  • Equipment such as the automated BP, 24hr BP and 24hr ECG machines were available to save time in accessing these elsewhere

  • All staff were aware of safeguarding responsibilities, through training and accessing polices, including what warning signs to look for. GPs attended safeguarding case conferences whenever possible and appreciated the impact their attendance had on the effectiveness of decision making because of their knowledge and understanding of the family concerned.

  • Reception staff prioritised and added ‘extra’ appointments in the event of a sick child needing attention, even if the appointment book was full.

  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 84%, which was comparable to the national average of 82%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Outstanding

Updated 9 November 2016

The practice is rated as outstanding 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.

  • The practice employed a healthcare assistant to specifically look after patients aged over 75 years where they had been discharged from hospital, attended the local accident and emergency department or had frequent contact with the practice. This was to facilitate any changes with their medicines, address their concerns and/or improve their situation to avoid further crises.

Working age people (including those recently retired and students)

Outstanding

Updated 9 November 2016

The practice is rated as outstanding 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 experiencing poor mental health (including people with dementia)

Good

Updated 9 November 2016

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

  • 93% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was higher than the national average of 84%.

  • The practice was accredited as a Dementia friendly practice and had a dementia champion.

  • 100% of patients diagnosed with mental health issues had received a face to face review within the last 12 months. This was significantly better 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 with dementia.

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

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

People whose circumstances may make them vulnerable

Outstanding

Updated 9 November 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • 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 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.

  • The practice had video surveillance of their entrance so that staff could help enhance access for the disabled.