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Inspection Summary


Overall summary & rating

Good

Updated 25 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of St Davids Practice on 24 October 2016. The overall rating for the practice was good with requires improvement in Safe. Breaches of legal requirements were found relating to the Safe domain. The registered person did not have a clear process in place for analysing significant events, incidents and near misses. The provider did not ensure that there was a defibrillator available at the practice or conduct a risk assessment to indicate the risks of not having one had been assessed.

After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The full comprehensive report can be found by selecting the ‘all reports’ link for St Davids Practice on our website at www.cqc.org.uk.

This inspection was a document-based review carried out on 12 September 2017 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 24 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated as Good for providing Safe services, and overall the practice remains rated as Good.

Our key findings were as follows:

  • The practice had reviewed its policy on safeguarding and its process for recording and reporting safeguarding concerns. We saw a revised policy, we saw comprehensive safeguarding minutes, detailing all safeguarding cases, including a description, action plan and learning points.

  • The practice had reviewed its policy on significant events we saw a revised policy detailing the process for recording and reporting all significant events. We saw comprehensive minutes of significant events and analysis meeting minutes detailing five significant events that had occurred between May and July 2017, including case discussions, reflection, actions taken and lessons learnt.

  • The practice had carried out a risk assessment on 14 April 2017 to demonstrate that they had considered and mitigated against the risk of not having access to their own defibrillator.

  • The practice also submitted a written agreement to confirm arrangements were in place to borrow a defibrillator from the practice they shared premises with. However, whilst it was signed by both parties there was no date.

  • The practice had reviewed its policy on carers. We saw a revised policy detailing the process for identifying and registering new carers. The practice had now identified (47 patients) as carers 0.6% this had increased by 0.1% since the last inspection.

The area where the provider should make improvements are:

  • Continue to review arrangements in place to ensure that patients with caring responsibilities are identified and their needs met.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 October 2017

The practice is rated as good for providing safe services.

  • The provider now ensured there was a clear process in place for analysing significant events, incidents and near misses.

  • The provider had carried out a risk assessment on 14 April 2017 to demonstrate that they had considered and mitigated against the risk of not having access to their own defibrillator.

Effective

Good

Updated 30 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the local and national average for diabetes and mental health.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 30 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice as

    comparable

    to the local and national average for several 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.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 30 March 2017

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. For example, the practice provided home visits to monitor the international normalised ratio (INR) for patients with limited mobility.

  • 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 30 March 2017

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 it.

  • 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 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 patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 30 March 2017

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.

  • 74% of patients diagnosed with asthma had an asthma review in the last 12 months; this was comparable to the local average of 76% and national average of 75%.

  • Performance for diabetes related indicators was comparable to the local and national average, for instance:

  • 69% of patients with diabetes on the register had their blood sugar recorded as well controlled (local average 69%, national average 77%).
  • 73% of patients with diabetes on the register had their cholesterol measured as well controlled (local average 74%, national average 81%).
  • 92% of patients with diabetes on the register had a recorded foot examination and risk classification (local average 85%, national average 88%).
  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and were offered an 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.

Families, children and young people

Good

Updated 30 March 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. 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.

  • 73% of women aged 25-64 had it recorded on their notes that a cervical screening test has been performed in the preceding five years; this was comparable to the local average of 77% and national average of 82%.

  • 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.

Older people

Good

Updated 30 March 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.

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

  • These patients had a named GP and were offered an 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.

Working age people (including those recently retired and students)

Good

Updated 30 March 2017

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 offered extended opening hours on Tuesday evenings which suited working age people.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 March 2017

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

  • Performance for mental health related indicators was comparable to the local and national average:

    • 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months (local average 91%, national average 90%).

  • 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the last 12 months (local average 88%, national average 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.

People whose circumstances may make them vulnerable

Good

Updated 30 March 2017

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.