Archived: Dr Terence Johnson Also known as Park House Surgery

Updated 19 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Terence Johnson on 14 April 2016. The practice had been rated as good for effective, caring, responsive and well-led, however they required improvement in safe. After the comprehensive inspection, the practice sent to us an action plan detailing what they would do to meet the legal requirements in relation to the following:-

• Ensuring that staff took the relevant action when fridge temperatures were out of the advised range for the storage of vaccines.

We undertook this announced focused inspection on 4 August 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements. The provider was now meeting all requirements and are rated as Good under the safe domain.

This report only covers our findings in relation to those requirements.

• The provider had reviewed the cold chain policy and all staff had been re-trained on the procedure. A new thermometer had been installed in the vaccine fridge. Staff were routinely recording the daily temperatures including the maximum and minimum temperatures reached. Staff were aware of what to do if the fridge temperature was out of the required range for the storage of vaccines.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 13 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and 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.
• The practice offered regular anticoagulation clinics for patients on warfarin.
• The practice provide spirometry and smoking cessation services for chronic obstructive pulmonary disease(COPD) patients.
• Performance for diabetes related indicators was higher than the Clinical Commissioning Group (CCG) and national average. For example, 94% of patients on the diabetes register, had a record of a foot examination and risk classification within the preceding 12 with the national average being 88%.

Updated 13 June 2016

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. Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the national average of 82%.
• 77% of female patients aged 50-70, had attended a breast cancer screening within 6 months of invitation which was comparable to the CCG average of 74%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives and health visitors.
• Practice staff had received safeguarding training relevant to their role and knew how to respond if they suspected abuse.
• Safeguarding policies and procedures were readily available to staff.
• The practice ensured that children needing emergency appointments would be seen on the same day.

Updated 13 June 2016

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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Older patients with complex care needs and those at risk of hospital admission all had personalised care plans that were shared with local organisations to facilitate the continuity of care.
• The practice was proactive in inviting patients to the practice for an over 75 health check.
• Patients over the age of 75 were allocated a GP and were encouraged to see the same GP for continuity of care.

• The practice worked with community nurses and the community pharmacies to provide dosset box pre-packed daily medicine to improve compliance and safety.
• The practice worked closely with local support groups. For example, a local group who could help provide transport for elderly patients and with a local Day Centre.

Updated 13 June 2016

The practice is rated as good 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.
• The practice had reviewed patient access and was able to offer evening appointments every week day until 8pm. This service was jointly run with two other local practices.
• Electronic Prescribing was in place to start in June 2016 which would enable patients to order their medicine on line and to collect it from a pharmacy of their choice, which could be closer to their place of work if required.
• The practice offered NHS health-checks and advice for diet and weight reduction.

Updated 13 June 2016

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

• 83% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.
• 91% of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 which was comparable to 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.
• A ll staff had received training in the Mental Capacity Act 2005.

Updated 13 June 2016

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 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 could accommodate those patients with limited mobility or who used wheelchairs.
• Carers and those patients who had carers, were flagged on the practice computer system and were signposted to the local carers support team.