You are here

Drs Davies, Taylor & Golton Good

Inspection Summary


Overall summary & rating

Good

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 23 February 2016. Breaches of Regulatory requirements were found during that inspection within the safe and effective domains. After the comprehensive inspection, the practice sent us an action plan detailing what they would do to meet the regulatory responsibilities in relation to the following:

  • To ensure staff appraisals are undertaken for all staff on an annual basis.
  • To ensure that appropriate training for staff is completed and monitored to ensure that time frames for re-training are met. This includes training in respect of fire safety, infection control, safeguarding (adults and children) and information governance.
  • To ensure that all safety assessments are undertaken and reviewed as required.
  • To ensure the provider takes action to address issues identified in the infection control audit.

We undertook this focused inspection on 29 September 2016 to check that the provider had followed their action plan and to confirm that they now met regulatory requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Drs Davies, Taylor & Golton on our website at www.cqc.org.uk.

This report should be read in conjunction with the last report published in June 2016. Our key findings across the areas we inspected were as follows:-

  • We saw that there was a system in place to ensure staff undertook an appraisal and that this meeting detailed objectives for the staff member and documented any training requirements.
  • We saw that there was a system in place to ensure all staff undertook required training and that there was an effective system in place to monitor this.
  • We saw evidence that all required safety assessments had been completed and a plan in place to ensure these took place as required.
  • We saw that action had been undertaken to remedy issues identified in infection control audits.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 November 2016

The practice is rated as good for providing safe services.

  • On our previous inspection on 23 February 2016, we found that the practice could not demonstrate that they had a robust system for remedying issues documented in infection control audits and also could not provide evidence that risk assessments regarding the practice building had been completed at the required intervals.
  • During our visit on 29 September 2016 it was noted that there was a robust system that monitored the issues found during infection control audits and that actions had been undertaken to resolve these concerns.
  • Evidence was also seen that all required risk assessments had been undertaken and a plan put in place to ensure that these could be monitored to ensure that assessments took place in a timely manner.

Effective

Good

Updated 3 November 2016

The practice is rated as good for providing effective services.

  • During our previous inspection in February 2016 we found that the practice could not demonstrate that all staff had received appropriate training or that they had an effective system in place to monitor this area. At this inspection evidence was seen that showed all staff had undertaken the required training commensurate with their role and that there was a monitoring system in place to ensure that there were no breaches of staff not completing refresher training as required.
  • On our previous inspection we found that some staff had not received an annual appraisal. During our visit on 29 September 2016 it was noted that staff had undergone appraisals and that there was an action plan in place for ensuring all further appraisals were undertaken at the required time for that staff member.

Caring

Good

Updated 24 June 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published January 2016 showed patients rated the practice higher than others for several aspects of care. For example, data shows the percentage of respondents who stated that the last time they saw or spoke to a GP, the GP was good or very good at involving them in decisions about their care was 87% compared to a national average of 82%.
  • 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.
  • We observed a strong patient-centred culture.

Responsive

Good

Updated 24 June 2016

The practice is rated as good 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 (CCG) to secure improvements to services where these were identified. The practice had identified that telephone access to the practice had been a problem for patients and at the time of inspection a new telephone system had been planned to be installed at the beginning of March 2016.
  • 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.
  • Appointments at the practice were of 15 minutes duration to enable patients to discuss any issues they had thoroughly.
  • The practice regularly referred frail elderly patients to a local charity group that offered them use of a day centre including lunch and also day trips so as to ease their possible isolation.
  • A GP undertook a clinic for adolescents at the branch surgery to focus on areas of concern to these patients. The practice had the highest testing rate for chlamydia in the CCG area.
  • Information about how to complain was available and easy to understand. Evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders. However, the final response letter did not contain information on what the complainant could do if they were unhappy with the response from the practice.

Well-led

Good

Updated 24 June 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.
  • 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.
  • 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 knowing about 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 response from the Friends and Family Test for January 2016 had 73 responses of which 68 documented that the respondents were “extremely likely” or “likely” recommend the practice. There were no negative responses.
  • There was a focus on continuous learning and improvement at all levels.
  • The practice had a very active league of friends but had been unsuccessful in developing a patient participation group.
Checks on specific services

People with long term conditions

Good

Updated 3 November 2016

The practice is now rated as good for the care of people with long-term conditions. Our previous inspection in February 2016 rated this practice as requires improvement for the care of people with long-term conditions, as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Data from 2014/15 showed that the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 87% which was comparable to the national average of 88%.
  • Longer appointments and home visits were available when needed.
  • Nurses had received the appropriate training in order to take ownership and review the needs of all diabetic patients. This would include home visits for housebound diabetic patients by the practice nurse. Systems were in place to maintain continuity of care to patients with diabetes which avoided fragmentation of care.
  • 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.
  • Patients with chronic obstructive pulmonary disease (COPD) were given “rescue packs” where appropriate. These packs contained antibiotics to be used at the onset of chest infections for example.

Families, children and young people

Good

Updated 3 November 2016

The practice is now rated as good for the care of families, children and young people. Our previous inspection in February 2016 rated this practice as requires improvement for the care of families, children and young people, as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

  • 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 high for all standard childhood immunisations.
  • Data for 2014/15 showed the percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months that includes an assessment of asthma control was 73%; this is comparable to the national average of 75%.
  • 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.
  • Data for 2014/15 showed that the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 79%; this is comparable to the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. A separate waiting area with books and toys were available for younger children.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. Multidisciplinary team meetings were held quarterly to discuss relevant cases.

Older people

Good

Updated 3 November 2016

The practice is now rated as good for the care of older people. Our previous inspection in February 2016 rated this practice as requires improvement for the care of older people, as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. Patients that had not seen a GP in the last year are prioritised for this service.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Patients and their carers are given telephone numbers appropriate for their needs to enable them to obtain advice and support.
  • The practice offered continuity of care with a named GP.
  • Patients were encouraged to have their flu vaccine to prevent severe flu related illnesses.

Working age people (including those recently retired and students)

Good

Updated 3 November 2016

The practice is now rated as good for the care of working-age people (including those recently retired and students). Our previous inspection in February 2016 rated this practice as requires improvement for the care of working-age people (including those recently retired and students)., as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

  • 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 provided extended hours appointments on the first, second and fourth Monday evening each month and the third Thursday evening of each month. There were also early morning appointments every Wednesday morning and Saturday morning appointments on the second and fourth Saturday of the month.
  • The practice offered advice by telephone, where appropriate, each day for those patients who had difficulty in attending the practice.
  • We saw that the practice was implementing electronic prescribing in April 2016 so as to enable patients to have their prescriptions sent to the pharmacy of their choice.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 November 2016

The practice is now rated as good for the people experiencing poor mental health (including people with dementia). Our previous inspection in February 2016 rated this practice as requires improvement for the care of people experiencing poor mental health (including people with dementia), as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

  • 77% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%. Evidence was seen that the practice had increased their activity regarding dementia care resulting in a further thirty care plans being composed in the previous six months.
  • Data from 2014/15 showed that the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 84%; this was comparable to the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people 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.
  • There was counselling available at the practice provided by the local mental health care service.
  • 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

Good

Updated 3 November 2016

The practice is now rated as good for the care of people whose circumstances may make them vulnerable. Our previous inspection in February 2016 rated this practice as requires improvement for the people whose circumstances may make them vulnerable, as the issues identified as requiring improvement for providing safe and effective services affected all patients including this population group. The practice has made significant improvement and is now rated as good for providing safe and effective services and overall.

  • 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 multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • The practice actively referred frail, elderly patients to a local charity group which could offer these patients day trips and visits to their day centre which would also include lunch.
  • 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 has two counsellors who are able to take referrals direct from the GPs working at the practice. These were provided by the local mental health services.
  • A GP from the practice attends local school assemblies to give advice regarding issues such as body image, disabilities and risk taking.
  • Carers and those patients, who had carers, were flagged on the practice computer system and were signposted to the local carers support team.
  • The practice could accommodate those patients with limited mobility or who used wheelchairs.