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Dr William Porter Good Also known as St James's Medical Practice

Inspection Summary


Overall summary & rating

Good

Updated 14 July 2017

Letter from the Chief Inspector of General Practice

We previously inspected Dr William Porters practice on 2 August 2016. As a result of our inspection visit, the practice was rated as requires improvement. Specifically, the practice was rated as inadequate for providing safe services and requires improvement for providing effective and well led service. A requirement notice was issued to the provider. This was because we identified regulatory breaches in relation to regulation 12, Safe care and treatment, regulation 17, Good governance and regulation 18, Staffing. We identified some areas where the provider must make improvements and some areas where the provider should make improvements.

We carried out an announced comprehensive inspection at Dr William Porters practice, also known as St James’s Medical Practice on 13 June 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. You can read the reports from our previous inspections, by selecting the 'all reports' link for Dr William Porter on our website at www.cqc.org.uk.

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

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. We noted improvements with regards to the management of safety alerts during our most recent inspection and evidence demonstrated that clinicians received and acted on alerts when needed.

  • Significant events and audits were used as opportunities to drive improvements. Some audits were completed in response to the findings from our previous inspection, including audits focussing on the effectiveness of failsafe systems for cytology results.

  • When we inspected the practice in 2016 we found that some areas of monitoring high risk medicines required improvement. During our most recent inspection we saw that patients prescribed high risk medicines were monitored and reviewed.

  • We noted significant improvement to staff files during our most recent inspection. The files showed that appropriate recruitment checks had been undertaken prior to employment, overall we found that the files were organised. A locum induction pack was also implemented following our previous inspection.

  • Most recently we saw that more formal supervision was in place for the practice nurse prescriber, with support from the practice GP. The nurse had also attended prescribing updates relevant to the areas they prescribed in.

  • We observed the premises and medical equipment to be visibly clean. Previously we found that records were not kept to reflect the cleaning of specific medical equipment. Most recently we saw records to demonstrate that the equipment used for ear irrigation was cleaned, but there were no records in place to support the cleaning of other medical equipment.

  • Although the practices cervical screening uptake had improved by 2% since our previous inspection, cervical screening and bowel cancer screening rates remained below local and national averages.

  • When we inspected the practice in 2016 we found some patients at risk of hospital admission did not have personalised care plans in place. During our most recent inspection we saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews.

  • Since 2016, the practices carers register had increased from 18 to 26 carers; this was 1% of the practices list. Although there was some support in place for carers, there was no information available to take away or on display in the practice to support carers.
  • There was information about how to complain on the practice website and the practice displayed this information in the waiting area following our inspection.
  • During our most recent inspection we saw improvements in governance, risk management and record keeping across areas including the management of the cold chain (for the safe storage and handling of vaccinations).

The areas where the provider should make improvements are:

  • Continue to focus on improving cancer screening rates overall.

  • Ensure that carers are able to easily access supportive information and continue to identify carers in order to offer them support where needed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 July 2017

The practice is rated as good for providing safe services.

  • Significant events, incidents and complaints were used as opportunities to drive improvements. Staff shared learning during practice meetings and clinical meetings.

  • During our previous inspection we found that nurses did not receive medical alerts, such as medicines alerts from the Medicines and Healthcare Products Regulatory Agency (MHRA). Additionally, the practice was unable to demonstrate how they took action in relation to specific alerts.

  • We noted improvements during as most recent inspection. There was a system in place to keep a record of alerts and action taken and we saw evidence to support that clinicians received alerts and appropriately acted on them when needed.

  • There was a system in place for the prescribing of high risk medicines. When we inspected the practice in 2016 we found that some areas of monitoring high risk medicines required improvement. During our most recent inspection we saw that patients prescribed high risk medicines were monitored and reviewed.

  • When we viewed staff files as part of our previous inspection, we did not see evidence of appropriate recruitment checks for some staff prior to employment. We noted significant improvement during our most recent inspection. The files showed that appropriate recruitment checks had been undertaken prior to employment.

  • Previously we found that records were not kept to reflect the cleaning of specific medical equipment. Most recently we saw records to demonstrate that medical equipment was cleaned.

Effective

Good

Updated 14 July 2017

The practice is rated as good for providing effective services.

  • When we inspected the practice in 2016 we found that whilst treatment plans were in place for patients who were at high risk of admission to hospital, some of these patients did not have personalised care plans in place.

  • During our most recent inspection we saw evidence to support that adequate care plans were in place and there was an effective recall system in place for patients needing medication and general health reviews.

  • During our previous inspection we found that the practice did not have an induction pack for locum clinicians to use when working at the practice, we saw that an induction pack was in place during our most recent inspection.

  • When we inspected the practice in 2016, the practice was unable to demonstrate how the nurse prescriber stayed up to date with prescribing guidelines for the areas that they prescribed in. Most recently we saw that more formal supervision was in place with support from the practice GP, the nurse had also attended prescribing updates relevant to the areas they prescribed in.
  • We saw that audits were used to drive improvements in patient care and to improve systems and processes in the practice. Some audits were completed in response to the findings from our previous inspection, including audits focussing on monitoring specific high risk medicines and the effectiveness of failsafe systems for cytology results. 

Caring

Good

Updated 14 July 2017

The practice is rated as good for providing caring services.

  • We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect.

  • There was a strong theme of positive feedback from patients we spoke with on the day, throughout the completed CQC comment cards and on the results from the national GP patient survey (published in July 2016).

  • Since 2016, the practices carers register had increased from 18 to 26 carers; this was 1% of the practices list. Staff explained that they felt they had more carers registered with the practice and the practice was planning to complete a piece of cleansing work to ensure that carers were captured on the practices patient record system, in order to offer them support where needed.

  • Although there was some support in place for carers, such as flu vaccinations and annual reviews, there was no information available to take away or on display to support carers. Staff explained that information was usually printed from online searches however members of the management team explained that to improve this they would develop some carer’s packs.
  • Staff told us that if families had suffered bereavement, the GP contacted them and followed up with a consultation at a flexible time and location to meet the family’s needs. The GP also had a background in Psychiatry and offered bereavement counselling.

Responsive

Good

Updated 14 July 2017

The practice is rated as good for providing responsive services.

  • There were a number of additional services and organisations situated in the premises shared by the practice; this included a pulmonary rehab service and a physiotherapy service which patients could access through referral from a healthcare professional. There was also a chemist based in the premises shared by the practice.

  • Results from the national GP patient survey published in July 2016 highlighted that responses in relation to access were above local and national averages. The patients we spoke with during our inspection and many of the completed comment cards gave positive feedback with regards to the service provided.

  • The practices NHS Choices webpage contained mostly positive feedback about care and treatment although we noted that some comments highlighted negative experiences with regards to accessing the practice by telephone. Staff were encouraging use of online registrations and text messaging cancellation services to ease telephone traffic.
  • The practice had not received any formal complaints since March 2016; patients we spoke with on the day said they never needed to make a complaint. There was information about how to complain on the practice website and the practice displayed this information in the waiting area following our inspection. 

Well-led

Good

Updated 14 July 2017

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

  • Staff spoke positively about working at the practice, they commented that they felt valued and part of a close practice team. Staff spoken with demonstrated a commitment to providing a high quality service to patients.

  • During our most recent inspection we saw improvements across governance arrangements. For example, record keeping had significantly improved with regards to staff recruitment, training, fire drills and the management of the cold chain (for the safe storage and handling of vaccinations).

  • Where risks were identified, actions were implemented and recorded to help manage and mitigate risks. This included improved management of risks associated with legionella.

  • At the time of our previous inspection we found that the practice no longer had an active PPG and staff explained that they were in the process of re-establishing a PPG. We saw that a small PPG had been developed following our inspection.
  • During our inspection we saw that the provider had displayed the ratings from their previous CQC inspection in 2016. We noted that the practice had also outlined what action they had taken in relation to the areas identified for improvement. This was a suggestion from a PPG member so that patients could see how the practice was taking steps to improve.
Checks on specific services

People with long term conditions

Good

Updated 14 July 2017

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

  • We saw evidence that multidisciplinary team meetings took place on a regular basis with regular representation from other health and social care services. We saw that discussions took place to understand and meet the range and complexity of people’s needs and to assess and plan ongoing care and treatment.

  • The clinical team had a mixture of enhanced skills including long term condition and chronic disease management.

  • Performance for overall diabetes related indicators was 93%, compared to the CCG average of 86% and national average of 89%. This had improved from 82% following our previous inspection.
  • The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. 

Families, children and young people

Good

Updated 14 July 2017

The practice is rated as good 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.

  • The percentage of children aged two with pneumococcal conjugate booster vaccine was 95% compared to the national standard of 90%. Additionally, 96% of children aged two had received a Measles, Mumps and Rubella vaccine (MMR vaccine) compared to the national standard of 90%.

  • The practice offered urgent access appointments for children, as well as those with serious medical conditions. The practice also had good access to the health visitor team who were also based in the premises shared by the practice; this supported them to regularly liaise and communicate with health visitors.

  • At the time of our previous inspection, the practice’s uptake for the cervical screening programme was 65%. To improve this, the practice created a cervical screening display board in the patient waiting area to encourage uptake and education patients.
  • Data from 2015/16 indicated that this had increased to 67% compared to the CCG average of 71% and national average of 72%. Staff explained that local uptake was generally low but that the practice was continuing to actively encourage screening and educate patients to improve uptake. More recent data was provided shortly after the inspection, this highlighted an improvement in cervical screening rates at 69%.

Older people

Good

Updated 14 July 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. All these patients received good continuity of care with a named GP and a structured annual review to check that their health and medicines needs were being met.

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Immunisations such as flu and shingles vaccines were also offered to patients at home, who could not attend the surgery. A phlebotomy service (taking blood for testing) was available in the practice and at home for patients who were housebound.
  • Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for people aged 40–74 and for people aged over 75.

Working age people (including those recently retired and students)

Good

Updated 14 July 2017

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

  • Appointments could be booked over the telephone, face to face and online. The practice offered extended hours on Monday mornings at an earlier time of 7:30am and then on Monday evenings between 6:30pm and 7:30pm.

  • The practice encouraged its patients to attend national screening programmes for bowel and breast cancer screening. Data from 2015/16 highlighted that breast cancer screening rates were at 70% compared to the CCG and national averages of 72%; this had improved compared to the 2014/15 when breast cancer screening rates were 60%.

  • However, bowel cancer screening rates remained at 48% when compared to the data from 2014/15, compared to the CCG and national averages for bowel cancer screening of 57%.
  • Patients had access to appropriate health assessments and checks. Practice data highlighted that they identified and offered smoking cessation advice to 127 patients and 3% had successfully stopped smoking.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 July 2017

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

  • The practice regularly worked with other health and social care organisations in the case management of people experiencing poor mental health, including those with dementia. The GP also had a background in psychiatry and had a special interest in mental health.

  • Data provided by the practice during our inspection highlighted that 40% of these patients had care plans in place and 68% of their eligible patients had received a health review and there were further reviews planned.

  • 90% of the practices patients diagnosed with dementia had care plans in place and 91% of their eligible patients had received a health review and there were further reviews planned.
  • The practices multidisciplinary team meetings contained examples of where patients were supported by the GPs and referred to the Integrated Plus scheme, the practice utilised the scheme for some of their patients who were experiencing poor mental health. The practice supported patients by referring them to a gateway worker who provided counselling services on a weekly basis in the practice.

People whose circumstances may make them vulnerable

Good

Updated 14 July 2017

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

  • The practice regularly worked with other health and social care organisations in the case management of vulnerable people. Multi-disciplinary team (MDT) meetings took place on a regular basis with regular representation from other health and social care services.

  • The practice had a register of patients from vulnerable groups, this included patients with a drug or alcohol dependency. These patients were frequently reviewed in the practice and 73% of their eligible patients had received a health review and there were further reviews planned.

  • We saw that the practices palliative care register was regularly reviewed; practice data highlighted that 76% of these patients had a care plan in place and 92% of their eligible patients had received a health review and there were further reviews planned.

  • The practice worked with the local Dudley Council for Voluntary Service (CVS) team to help to provide social support to their patients who were living in vulnerable or isolated circumstances. The practice worked with the local Dudley Council for Voluntary Service (CVS) team to help to provide social support to their patients who were living in vulnerable or isolated circumstances.
  • There were disabled facilities, hearing loop and translation services available.