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The Dorchester Road Surgery Good

Inspection Summary


Overall summary & rating

Good

Updated 20 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dorchester Road Surgery on 14 October 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • The practice had carried out a number of risk assessments, action plans, and audits to ensure patient and staff safety. These related to areas such as safeguarding, infection control, medicines, emergency events, and health and safety.
  • A legionella risk assessment had been completed, but the practice had not completed all of the required actions identified in the assessment.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect.
  • The practice provided person centred, holistic services to patients, and particularly patients with mental health and substance misuse difficulties who were living in circumstances that made them vulnerable.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • The practice was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and open culture and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice:

  • The practice provided a service for patients experiencing substance misuse difficulties. They offered appointments to patients living in the whole of the county and from other practices. They also offered services to patients who had just left prison and to temporary residents until they were registered with a permanent practice. The practice had 103 patients receiving substitute prescribing. Over the past year, GPs at the practice had seen 159 patients for substitute prescribing in total and 116 were patients from other practices. An audit in September 2015 showed that 28% of patients using the substance misuse service at the practice tested negative for opiate use.

The areas where the provider should make improvements are:

  • The practice should review their risk management policy and processes for legionella and fire safety to meet best practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received reasonable support, truthful information, and a verbal or written apology. Where appropriate, they were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had conducted numerous risk assessments, audits, and implemented action plans, systems, and policies to improve patient safety. These related to areas including safeguarding, infection control, medicines, emergencies, and health and safety.
  • However, not all actions had been implemented from the legionella risk assessment.
  • Fire safety procedures were not always carried out.

Effective

Good

Updated 20 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • 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 staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. For example, they had led in the development and delivery of a substance misuse programme provided in collaboration with local substance misuse services.

Caring

Good

Updated 20 December 2016

The practice is rated as good for providing caring services.

  • We observed a strong patient-centred culture.
  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Patients said they were treated with compassion, dignity and respect.
  • 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.
  • There was a carers’ lead at the practice. Staff were proactive in identifying carers and providing them with health promotion and information about the support services available.

Responsive

Outstanding

Updated 20 December 2016

The practice is rated as outstanding 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 to secure improvements to services where these were identified. For example, the practice had obtained funds to complete a renovation of the premises to meet patient needs.
  • The practice had carried out a patient survey on satisfaction with appointments. As a result they had reviewed the appointment system and recruited additional members of staff with the aim of ensuring more appointments were available.
  • The practice was well equipped to treat patients and meet their needs.
  • The practice had carried out a patient survey on access to the practice for patients with difficulties with eyesight, hearing, and mobility. As a result they had developed an action plan to further increase accessibility and usability. Staff told us that actions had been carried out including increasing staff awareness of methods to communicate with patients with hearing difficulties.
  • The practice provided a patient centred service to patients who had a dual diagnosis of substance misuse difficulties and mental health problems, and regularly worked with multidisciplinary teams to offer support. They provided a substance misuse service for patients living in the whole of the county and from other practices. They also offered support to patients who had just left prison and to temporary residents until they were registered with a permanent practice.
  • 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.

Well-led

Good

Updated 20 December 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 it.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of accessible 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 20 December 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.
  • Performance for diabetes related indicators was similar to the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, who had an influenza immunisation in the preceding 1 August to 31 March was 100% compared to the CCG average of 97% and national average of 94%.
  • 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.

Families, children and young people

Good

Updated 20 December 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 and the practice carried out audits to improve immunisation rates.
  • 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 participated in a project with a local school where children with high levels of sickness were provided with priority appointments to enable them to return to school more quickly.
  • The practice’s uptake for the cervical screening programme was 88%, which was high compared to the CCG average of 84% and the 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, health visitors and school nurses.
  • Findings were used by the practice to improve services. For example, a recent audit identified 11 pregnant women who had not received flu immunisation. A letter was sent explaining the benefits of flu immunisation and this resulted in three further women receiving the immunisation.
  • The practice promoted breast feeding, and had provided an additional area where mothers could breast feed if they wanted greater privacy.

Older people

Good

Updated 20 December 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.
  • The practice was involved in a pilot scheme with a local care home where systems were being put in place so GP patient notes could be accessed by authorised care home staff. Care home staff could also add relevant basic patient information to GP notes if appropriate.
  • The practice participated jointly with other practices in the area to provide a dedicated elderly care service aimed at hospital admission avoidance and supporting patients living in residential homes. The practice provided funds to provide a GP and nurse to visit patients in their own homes to provide proactive and preventative care.

Working age people (including those recently retired and students)

Good

Updated 20 December 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 offered some early morning and early evening appointments for patients who could not attend in usual hours.
  • Telephone consultations were available.
  • Online appointment booking and prescription services were available.
  • Patient communications could take place by text message and email if appropriate.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 December 2016

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

  • 84% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average of 85% and national average of 84%.
  • The practice had conducted an audit to improve the rates of dementia diagnosis to 78%.
  • Performance for mental health related indicators was similar to the CCG and national averages. The percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented, in the preceding 12 months was 95% compared to the CCG average of 92% and 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 and those with dual diagnoses of substance misuse difficulties and mental health difficulties.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • 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 20 December 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 and other vulnerable groups.
  • 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 had led in the development and delivery of a holistic substance misuse programme provided in collaboration with local substance misuse services. They provided a substance misuse service for patients living in the whole of the county and from other practices. They also offered support to patients who had just left prison and to temporary residents until they were registered with a permanent practice.