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Dr Leszek Piechowski and Partners Good Also known as Dryland Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 9 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Leszek Piechowski and Partners on 7 June 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Dr Leszek Piechowski and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 February 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The provider had resolved the concerns for safe and well-led services identified at our inspection on 7 June 2017 which applied to everyone using this practice, including the population groups. The population group ratings have been updated to reflect this. Overall the practice is now rated as good.

Our key findings were as follows:

  • A process was in place to record and monitor the collection of controlled drugs prescriptions.
  • There was a clinical supervision policy and a process to ensure all staff received an annual appraisal. Personal development and training plans were in place for all staff members. With the exception of the practice manager all staff had received an annual appraisal.
  • Patient engagement was via a virtual Patient Participation Group (vPPG). Communication with the group had been strengthened since the last inspection. The practice now responded to feedback received indirectly, for example, via the NHS Choices website.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

  • Thermostatic mixer valves had been fitted to the hand wash facilities in the patient toilets. This ensured the water remained within a set temperature to avoid the risk of scalding.
  • Hot water temperature checks were all within recommended levels to mitigate the risk of Legionella in the water system.
  • A fire drill had been completed and future drills were scheduled. There was recorded evidence of the drill and actions had been taken following feedback from the staff members involved.
  • All clinical staff had completed Deprivation of Liberty Safeguards (DoLS) training.
  • The practice completed an audit of all deceased patients that included whether the patient had been on the palliative care register and the condition that had led to their death. However, this did not include whether the patient had died in their preferred place of death.
  • Health promotion information and leaflets were available in the patient waiting areas. A prototype of the new practice website showed that it would include health information and links to external sites such as NHS Choices, counselling and well-being services.
  • Ten appointments per week were made available to complete new patient and NHS health checks for people aged 40 to 74 years of age. Since the inspection in June 2017 338 NHS health checks had been completed. The practice had run three flu clinics that were held on Saturdays and were open access for all eligible patients to attend. These were advertised to patients on the practice website, in the patient waiting area and on repeat prescriptions. Any eligible patients that had not attended the flu clinics were contacted and offered an alternative date to receive their vaccination.
  • Carers were supported in the practice by an identified carers lead. There was a carer’s noticeboard with useful information regarding support available in the patient waiting area. The practice informed us that information for carers was also made available at the designated flu clinics. The carers lead had introduced carer’s packs that could be taken away. They contained information on referrals to Northamptonshire Carers and of local drop in cafes and the contact details of the carers lead including telephone number and email address. The practice had identified 127 patients who were carers which equated to approximately 1.2% of the practice list.
  • A new baby changing unit had been fitted. This had a wipe clean surface and straps to secure babies when in use.
  • The practice policies and procedures were in hard copy format and available to all staff in the reception area of the practice. Pertinent information that may be required by staff such as contact numbers for local authority safeguarding leads and flow charts for what to do in case of a needle stick injury were available in the clinical rooms.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

  • Complete the appraisal for the practice manager.
  • Consider including whether a patient has died in their preferred place of death as part of the audit of deceased patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 March 2018

Effective

Good

Updated 25 July 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were similar to local and national averages. For example, performance for diabetes related indicators was similar to the CCG and national averages. The practice achieved 94% of the points available with 7% exception reporting compared to the CCG average of 94% with 14% exception reporting and the national average of 90% with 12% exception reporting.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • The systems and processes in place for identifying the learning needs of nursing and non-clinical staff, appraising their competencies and performance and providing clinical supervision for nursing staff were informal. Despite this, we found staff at the practice were competent in their roles and had access to and completed the training they needed to undertake their roles effectively.
  • Staff worked with other healthcare professionals and multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.
  • End of life care was well coordinated with other services involved. However, the practice did not complete an audit of its deceased patients (commonly referred to as a death audit).

  • Staff sought patients’ consent to care and treatment in line with legislation and guidance. However, most GPs and nurses at the practice had little or no knowledge of the Deprivation of Liberty Safeguards (DoLS). (The Deprivation of Liberty Safeguards is a process used to lawfully deprive a person in a care home or hospital of their liberty in certain circumstances).
  • A range of services were available to support patients to live healthier lives. However, at the time of our inspection uptake of the flu vaccination among those aged over 65 years was low. Access to new patient health checks and NHS health checks for people aged 40 to 74 years was limited.

Caring

Good

Updated 25 July 2017

The practice is rated as good for providing caring services.

  • Data from the most recent National GP Patient Survey published in July 2016 showed that patients rated the practice similar to or above local and national averages for all 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. However, the practice website was basic and links to information about health advice, support groups and organisations were limited.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice had identified 136 patients on the practice list as carers. This was approximately 1.2% of the practice’s patient list. At the time of our inspection the practice did not proactively invite carers for or offer them an annual health review. The practice’s provision for carers was limited and relied upon GPs taking responsibility for supporting and providing relevant information to the carers on their own patient lists.

Responsive

Good

Updated 25 July 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example, the practice provided an open access nurse treatment room service from 9am to 1pm Monday to Friday. The same service was provided on a pre-bookable basis from 2pm to 6pm Monday to Friday and also from 8am to 9am every weekday except Wednesday.

  • Data from the most recent National GP Patient Survey published in July 2016 showed that patients rated the practice above local and national averages for access to the practice.
  • Almost all patients were positive about access to the practice and appointments. Two of the 41 patients who left comments for us and one of the three patients we spoke with said getting an appointment in advance could be difficult. However, those patients said access to urgent and same day appointments was good.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. However, the baby changing facility was unsuitable and a potential safety risk to those using it.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised directly with them. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 9 March 2018

Checks on specific services

People with long term conditions

Good

Updated 9 March 2018

Families, children and young people

Good

Updated 9 March 2018

Older people

Good

Updated 9 March 2018

Working age people (including those recently retired and students)

Good

Updated 9 March 2018

People experiencing poor mental health (including people with dementia)

Good

Updated 9 March 2018

People whose circumstances may make them vulnerable

Good

Updated 9 March 2018