Archived: Dudley Partnerships for Health LLP

Updated 5 September 2017

We inspected Dudley Wood Surgery under its previous practice name of Dudley Partnerships for Health LLP. This is because the practice had notified CQC of their name change which was being processed at the time of our inspection; this name change had taken place approximately three weeks before our inspection date.

Dudley Wood Surgery (formally known as Dudley Partnerships for Health LLP) is a long established practice located in the area of Dudley, in the West Midlands. There are approximately 2,615 patients of various ages registered at the practice. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. The practice has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

Dudley Wood Surgery is overseen by two directors who are based at another practice location within the wider partnership. Within the practice, the GP and the practice manager form the general management team; the GP had recently applied to become a partner. The GP and the two directors are responsible for the overall leadership of the practice. The clinical team includes a male GP, an advanced nurse practitioner, a practice nurse and a trainee health care assistant. A long term locum GP also supports the practice as part of their Saturday service. The practice is supported by a non-clinical team of four staff members who covered reception, administration, secretarial and cleaning duties.

The practice is open between 8am and 6:30pm during weekdays, with extended hours offered on Tuesdays between 6:30pm and 8pm and the practice is open for appointments on Saturdays between 9:30am and 12pm. During weekdays, appointments are available from 8:30am until 6:30pm and until a later time of 8:30pm on Tuesday evenings during extended opening hours. There is a GP on call between 8am and 8:30am each morning and until 6:30pm each weekday. There are also arrangements to ensure patients received urgent medical assistance when the practice is closed during the out-of-hours period.

Updated 5 September 2017

Letter from the Chief Inspector of General Practice

We previously inspected Dudley Partnerships for Health LLP on 12 October 2016. As a result of our inspection visit, the practice was rated as requires improvement overall with a requires improvement rating for providing effective and well led services; the practice was rated good for providing safe, caring and responsive services. A requirement notice was issued to the provider. This was because we identified a regulatory breach in relation to regulation 17, Good governance. We identified an area where the provider must make improvements and some areas where the provider should make improvements.

At the time of our inspection we inspected Dudley Wood Surgery under its previous practice name of Dudley Partnerships for Health LLP. This is because the practice had notified CQC of their name change which was being processed at the time of our inspection; this name change had taken place approximately three weeks before our inspection date.

We carried out an announced comprehensive inspection at Dudley Wood Surgery (formally known as Dudley Partnerships for Health LLP) on 19 July 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 Dudley Partnerships for Health LLP on our website at www.cqc.org.uk.

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

• Patients spoke highly of the care provided by the practice team. The practice had improved on some areas of the latest national GP patient survey in comparison to the July 2016 publication. This included improved telephone access, opening hours as well as improved aspects of care.

• Practice systems ensured compliance with the requirements of the duty of candour. The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.

• During our most recent inspection we saw that lines of accountability were clear. Staff roles were clearly structured and well defined at all levels within the practice. Staff felt supported at all levels and spoke positively about being part of the practice team.

• We saw that learning was shared locally and across the wider partnership. Items such as significant events, complaints, safeguarding and clinical audits were discussed during practice meetings and in partnership-wide clinical governance meetings.

• We found that although the most recent national GP patient survey results showed that some improvement had been made, performance remained below local and national averages across most areas in response to questions about care and involvement in decision making. We noted that the practice had worked on an action plan since the previous survey which was published in July 2016. However, there was limited evidence of improvement to patient outcomes when we compared the two surveys.

• We saw that audits were used to drive improvements in patient care and to improve systems and processes in the practice.

• The practice could demonstrate that they used the information collected for Dudley clinical commissioning group’s long term condition framework; Dudley Quality Outcomes for Health (DQOFH) to monitor outcomes for patients.

• We noted that specific processes had been strengthened and well embedded within the practice, such as the process for managing uncollected prescriptions, the management of practice correspondence and better embedded prescribing policies.

• During our inspection we found that records of the infection control audit and legionella risk management contained gaps. Additionally, there was no evidence of immunisation status in place for a member of staff where required.

• On the day of our inspection we found that the security of patient notes was compromised due to a broken lock, staff assured us that the lock would be repaired as a priority. Shortly after our inspection took place the practice assured us that the notes were moved to a secure area of the practice in a lockable location.

• There were hearing loop and translation services available. There were some facilities in place for disabled people and for people with mobility difficulties. However, there was no evidence of any formal equality assessments carried out to determine how disabled patients and patients with mobility difficulties would access the health promotion room on the first floor in the absence of a lift. Shortly after our inspection the provider provided advised that patients with mobility difficulties were seen on the ground floor to avoid having to use the stairs.

The areas where the provider should make improvements are:

• Improve record keeping to support good governance arrangements across areas associated with infection control best practice guidelines.

• Formally assess and manage risk to ensure that patients with a disability and patients with mobility difficulties can safely access all areas of the practice required to suit their care and treatment needs.

• Consider working on areas to improve as identified from patient feedback and the national GP patient survey and assess the effectiveness of improvement as part of a continuous improvement cycle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 September 2017

• 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.
• Practice performance for diabetes care was ranked above 50% when compared to local practices under the Dudley Quality Outcomes for Health (DQOFH) framework.
• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. 

Updated 5 September 2017

• The practice offered urgent access appointments for children, as well as those with serious medical conditions.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk including children and young people who had a high number of A&E attendances.
• The practice operated an effective system for scheduling childhood immunisations and ensuring appropriate actions were taken if immunisation appointments were missed or risk factors identified.
• 2015/16 childhood immunisation rates for the vaccinations were above CCG and national averages. Unverified data provided by the practice on the day of our inspection highlighted that 91% of two year olds and 94% of five year olds had received the full course of recommended vaccines; both areas were above target.
• Data from 2015/16 showed that the practice’s uptake for the cervical screening programme was 78%, compared to the CCG average of 77% and national average of 81%. Unverified data provided by the practice on the day of our inspection highlighted that current screening rates for cervical screening was at 81%. 

Updated 5 September 2017

• The practice 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.
• Patients received continuity of care with a named GP and a structured annual review to check that their health and medicines needs were being met.
• Patients had access to appropriate health assessments and checks. These included health checks for new patients and NHS health checks for people aged over 75.
• We noted that targeted audits were used to drive improvements for specific patient groups. For instance, we saw that adherence to local prescribing guidelines and quality standards set by the National Institute for Health and Care Excellence improved the care provided to older female patients who had been diagnosed with a urinary tract infection (UTI).

Updated 5 September 2017

• Appointments could be booked over the telephone, face to face and online.
• The practice offered extended hours on Tuesday evenings between 6:30pm and 8pm. The practice was also open for appointments on Saturdays between 9:30am and 12pm.
• 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.
• Practice data showed that they had offered smoking cessation advice and support to 125 (5%) of their patients and 80 (64%) had successfully stopped smoking.

Updated 5 September 2017

• 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.
• Practice performance for mental health was ranked in the top 25% when compared to local practices under the Dudley Quality Outcomes for Health (DQOFH) framework.
• All patients diagnosed with dementia had been referred to a memory assessment service.
• Patients with complex needs and patients experiencing poor mental health were regularly discussed during MDT meetings. The practice also supported patients by referring them to a gateway worker who provided counselling services on a weekly basis in the practice.

Updated 5 September 2017

• There were hearing loop and translation services available. There were some facilities in place for people with a disability and for people with mobility difficulties. However, there was no evidence of any formal equality assessments carried out to determine how patients with a disability and patients with mobility difficulties would access the health promotion service located on the first floor, in the absence of a lift. Shortly after our inspection the provider advised that patients were given the option of being seen on the ground floor or the first floor and that patients with mobility difficulties were seen on the ground floor to avoid having to use the stairs.
• All patients on the practices learning disability register had received a health review and there were further reviews planned.
• Vulnerable patients were regularly reviewed and discussed as part of the Multi-disciplinary team (MDT) meetings to support the needs of patients and their families.
• The practice proactively utilised the local Integrated Plus scheme. This scheme was facilitated by the Dudley Council for Voluntary Service (CVS) team to help to provide social support to people who were living in vulnerable or isolated circumstances.