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Dr Hale and Partners Good Also known as Lister House Surgery

Inspection Summary


Overall summary & rating

Good

Updated 12 March 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hale and Partners (formerly Dr Moss and Partners) on 13 and 18 October 2016. The overall rating for the practice was good. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Hale and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 31 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 13 and 18 October 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • The whole practice team were engaged in reviewing and improving safety and safeguarding systems and positive outcomes were achieved for patients.

  • Effective systems were in place for managing nationally available patient safety information to ensure patients were kept safe. This included maintaining detailed records to evidence the receipt of and actions taken in respect of Medicines Health and Regulatory Authority (MHRA) alerts.

  • Safeguarding arrangements operated effectively and were embedded within the practice to protect children and vulnerable adults from abuse and risk of harm.

  • Clinical audits and feedback received from the clinical commissioning group nurse lead was used to assess the improvements made to safeguarding arrangements and outcomes for patients.

  • The practice continued to proactively identify carers with approximately 1% of carers identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 March 2018

The practice is rated as good for providing safe services.

  • The practice team were engaged in reviewing and improving safety and safeguarding systems and positive outcomes were achieved for patients.

  • Safeguarding arrangements operated effectively which ensured children and vulnerable adults were protected from the risk of harm and abuse.

  • Audits reviewed demonstrated significant improvements had been made in identifying children and vulnerable adults, record keeping, coding of patient records, internal and external communication processes and information sharing.

  • An effective and embedded system was in place to address patient safety information issued by external agencies such as the Medicines and Healthcare products Regulatory Agency.

Effective

Good

Updated 27 February 2017

The practice is rated as good for providing effective services.

  • The 2015/16 quality and outcomes framework (QOF) data showed most patient outcomes were at or above local and national averages. The practice had achieved 96.4% QOF points compared to the local average of 97.2% and the national average of 95.3%.

  • Clinical audits were used to review patient care and drive quality improvement.

  • Staff assessed needs and delivered care in line with National Institute for Health and Care Excellence (NICE) and local guidelines.

  • Staff had the skills, knowledge and experience to enable them to deliver effective care and treatment. The practice employed a good skill mix of clinicians including GPs, advanced nurse practitioners, a mental health nurse and a pharmacist.

  • Staff were supported with an induction, training and appraisals including personal development plans.

  • Staff worked with other health and social care teams to understand and meet the range and complexity of patients’ needs. This included weekly multi-disciplinary meetings to review the care needs of vulnerable patients, those at risk of hospital admission and patients receiving end of life care. Care plans were routinely reviewed and updated.

Caring

Good

Updated 27 February 2017

The practice is rated as good for providing caring services.

  • Feedback from most patients and stakeholders was positive about the way staff treated people. Patients felt cared for, supported and treated with dignity, respect and kindness during their interactions with staff.

  • Most patients felt involved in decisions about their care and treatment and this included having access to an interpreter when needed.

  • Data from the national GP patient survey showed patients rated the practice in line with or marginally above local and national averages for several aspects of care. For example, 95% of patients found the receptionists helpful compared to the CCG average of 88% and the national average of 87%.

  • Information for patients about the services available was easy to understand and accessible in different formats. This included easy read pictorial format and other languages.

  • Collaborative working took place between the patient participation group, practice staff and other stakeholders to facilitate support for patients to cope emotionally with their care and treatment. Although the practice had identified 0.8% of its patients as carers, they hosted a dementia café and regular carer events to help direct patients to sources of help and advice if needed.

  • An invitation was sent to bereaved patients about one month after their loss, to speak with the mental health nurse about how they were coping.

Responsive

Outstanding

Updated 27 February 2017

The practice is rated as outstanding for providing responsive services.

  • The practice worked in collaboration with two local practices and Derbyshire community health services to deliver integrated and coordinated care; with a view to reducing hospital admission and attendances. Data reviewed and feedback from stakeholders showed positive outcomes were achieved for patients including residents living in care homes. The impact of this project included the reduction on acute GP visits by 38%; a reduction of GP appointments by 29%; a reduction of nurse appointments by 34% and an overall reduction in accident and emergency admissions.

  • The skill mix of staff had been tailored to meet the needs and services offered to patients. For example, the practice employed a specialist nurse who led on the management of care homes with support from the GPs, a mental health nurse and community support worker.

  • The practice offered community services which provided patients with care that was closer to home and reduced the burden on hospital services. This included a GP led community musculoskeletal assessment clinic which had resulted in at least 50% reduction in orthopaedic referrals to secondary care services and a consultant led first outpatient spinal clinic operated by Royal Derby Hospital.

  • The provider had developed and implemented a step by step triage protocol for use by non-clinical staff. The protocol enabled staff to direct patients to the most appropriate clinician in a timely manner without them making a clinical decision.

  • The citizens’ advice bureau offered on-site appointments for patients at the practice.

  • The practice had a population of about 4000 patients from the Romani Slovak community. In response to this, an interpreter was employed five days a week to cater for their communication needs.

  • Most patients said they found it easy to make an appointment and valued the continuity of care received. This was reinforced by the national GP patient survey data which showed patient satisfaction with accessing care and treatment was rated in line with or above local and national averages: 73% of patients described their experience of making an appointment as good compared to the local average of 72% and the national average of 73%.

  • The practice was located in purpose-built premises and was well equipped to meet the needs of patients including people with disabilities and impairments.

  • Information about how to complain was available and easy to understand. Records reviewed showed the practice responded in a timely manner to complaints and learning was shared with staff.

Well-led

Good

Updated 27 February 2017

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

  • The practice had a clear vision with quality and safety as its top priority. However, the systems and processes in place for managing safety alerts and safeguarding children and vulnerable adults did not always operate effectively at the time of inspection.

  • Following our inspection, the provider submitted evidence to demonstrate improvements had been made, however this required embedding to ensure changes were sustained.

  • The business development plans and strategy to deliver the vision had been produced with stakeholders and was regularly reviewed and discussed with staff. This included a commitment to providing positive outcomes for patients and staff at all four GP premises managed by the provider (Dr Moss and Partners).

  • A systematic approach was taken to collaborative working with other stakeholders to improve patient care, tackle health inequalities and obtain best value for money. This included being active members of Derby commissioning network .

  • There was a clear leadership structure in place and staff felt respected, valued and supported. High standards were promoted and owned by practice staff, and teams worked together across all roles.

  • The practice had a well engaged patient participation group (PPG) which influenced practice development. This also included patient education and fundraising activities.

  • There was a strong focus on continuous learning, improvement and education at all levels. Staff were proactively supported to acquire new skills and share best practice. This included: engaging with Health Education England Midlands and the clinical commissioning group (CCG) in developing the training and qualifications for advanced nurse practitioners and advanced care practitioners in Southern Derbyshire; taking part in CCG pilot projects and the design of specific pathways for long term conditions such as diabetes.

Checks on specific services

People with long term conditions

Good

Updated 27 February 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 regular clinics were held for patients with conditions such as asthma and diabetes.

  • Patients with diabetes could have their insulin treatment initiated at the practice and where appropriate, patients were referred for a six week education programme to equip them with the skills and knowledge to better manage their diabetes.

  • Patients with a diagnosis of chronic obstructive pulmonary disease were offered anticipatory medicines to reduce incidences of exacerbation where appropriate.

  • An effective recall system was in place to ensure patients were offered a structured annual review to check their health and medicines needs were being met.

  • Patients with more complex needs and at risk of hospital admission were identified as a priority. The named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

  • The in-house pharmacist carried out medicine reviews supported by the GPs and an in-house phlebotomy service was also provided.

Families, children and young people

Good

Updated 27 February 2017

The practice is rated as good for the care of families, children and young people.

  • We received positive feedback from the midwife and, health visitor about the joint working and multi-disciplinary working with practice staff.

  • The practice was proactive in promoting health education in children and young people in a “fun and welcoming environment”. For example, careers in general practice were promoted to sixth form students by offering them work experience and an annual event was facilitated where children from the local primary school visited Lister house surgery.

  • A flexible appointment system ensured that children could be seen on the same day when this was indicated. Appointments were available outside of school hours and a telephone triage was utilised to ensure those with urgent requirements were dealt with promptly.

  • The practice website included “new parent information” which included guidance on registering the new baby and immunisations. Immunisation rates were broadly in line with local and national averages for most standard childhood immunisations.

  • Ante-natal appointments were available with community midwives and post-natal checks were provided within the practice by the nurse and GP.

  • Family planning services were provided including the fitting and removal of intrauterine devices (coils).

  • The practice had baby changing facilities and welcomed mothers who breast feed.

Older people

Good

Updated 27 February 2017

The practice is rated as good for the care of older people.

  • Patients aged 75 years and over had a named GP and were offered vaccinations in line with national guidance.

  • Older patients at risk of admission to hospital, living with dementia and / or frail were discussed at multi-disciplinary meetings hosted by the practice. Care plans were put in place for patients with complex needs.

  • Feedback from care homes confirmed the practice team offered proactive and personalised care to meet the needs of older people in its population.

  • The GP lead and / or attached community matron carried out care home visits and home visits to people who were housebound as part of a collaborative community services project, to ensure patients received a comprehensive and holistic review of their care needs.

  • The practice employed a specialist nurse practitioner who coordinated the care of residents living in care homes with support from the GPs. The nurse carried out regular home visits which ensured continuity of care and also undertook a wide range of health reviews.

  • The practice employed a community support worker whose role included signposting patients to appropriate clinical or social care.

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

  • Nationally reported data showed patient outcomes for conditions commonly found in older people, including osteoporosis and heart failure were in line with or above local and national averages. Lower values were achieved for rheumatoid arthritis.

Working age people (including those recently retired and students)

Good

Updated 27 February 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • Lister House surgery was open from 7am to 7pm Monday to Friday within which extended hours were provided. Patients were reminded about their appointments via text messages if they had signed up for the service.

  • Patients could book GP appointments online and request repeat prescriptions at a time that was convenient for them. The practice also undertook electronic prescribing so that prescriptions could be sent directly to the pharmacy of the patient’s choice.

  • Telephone consultations were available each day for patients who had difficulty attending the practice due to work or educational commitments.

  • The practice was proactive in offering a full range of health promotion and screening service that reflected the needs for this age group. This included healthy lifestyle advice, cancer screening and NHS health checks for patients aged 40-74.

  • Health promotion information was available in the waiting room and on the practice website. This included information on minor illnesses and first aid.

  • The practice provided travel clinic services and was a registered yellow fever centre.

  • Two of the GPs were instrumental in facilitating the community musculoskeletal triage and treatment service from the practice. This service was accessible to patients registered with other practices and was supported by an onsite physiotherapy services. This was an outstanding feature of the practice.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 February 2017

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

  • The 2015/16 data showed all (100%) patients diagnosed with dementia had their care reviewed in a face to face meeting compared to the local average of 85% and the national average of 84%. The exception reporting rate for this indicator was 7% which was in line with the local average of 8% and the national average of 7%.

  • The practice team and patient participation group had a good understanding of how to support patients with dementia and their carers. This included hosting a dementia café within the practice, carrying out advanced care planning where appropriate and engaging in the dementia screening pilot in collaboration with specialist nurses. The dementia diagnosis rate was 70% compared to a local average of 59%.

  • The 2015/16 data showed 99.3% of patients on the practice’s mental health register had received an annual health check compared to the local average of 92.8% and the national average of 88.7%. The exception reporting rate for this indicator was about 10% which was below the local average of 20% and the national average of 13%.

  • The practice employed a mental health nurse and a community support worker who were able to see patients for extended appointments and at their home. Follow up appointments were organised where appropriate to establish continuity of care and a supportive service.

  • Patients were given advice and / or signposted to various support groups and voluntary organisations for support.

  • The practice regularly worked with multi-disciplinary teams and care home providers in the case management of patients experiencing poor mental health including people with dementia. This included following up patients who had attended accident and emergency and participating in a locally commissioned services framework project on psychosis.

People whose circumstances may make them vulnerable

Good

Updated 27 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • Staff had received training in how to recognise signs of abuse in vulnerable adults and demonstrated awareness of the appropriate action to take if concerns were noted. However, improvements were required to ensure the practice had  identified vulnerable adults within the practice population and effective systems were embedded in respect of information sharing and documentation of safeguarding concerns.
  • The practice had 172 patients on its learning disability register and longer appointments were offered for their health reviews. At the time of inspection, 68 patients (40%) had received an annual health check and a further 21 (12%) patients had appointments planned.
  • The reception team maintained a ‘special patient list” which included patients that had particular challenges accessing services. For example, people with hearing impairments or from the deaf community, those experiencing poor mental health or at risk of isolation. At the time of inspection about 50 patients had been identified and arrangements were in place to help them access services when needed.
  • Homeless people in Derby city could access services at this practice and were signposted to other agencies for support if needed.
  • In liaison with other stakeholders, the patient participation group (PPG) and practice had hosted an alcohol and drug awareness drop in session in August 2016 and regular carers events. The practice had identified 0.8% of its practice population as carers.
  • Patients and their carers were informed about how to access various support groups and voluntary organisations.
  • Translation services were available for patients and this included a practice employed Slovak Romani interpreter to cater for communication needs of about 4000 patients.
  • The citizens’ advice bureau offered on-site appointments for patients at the practice.
  • The practice’s registration booklet took account of the accessible information standard and asked patients if they had any specific needs. For example; British sign language, braille, large print, as well as their preferred contact method and other support needed.
  • Clinical staff regularly worked with other health and social care professionals in the case management of vulnerable patients.