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Dr Hale and Partners Good Also known as Lister House Surgery

Reports


Inspection carried out on 31 August 2017

During an inspection to make sure that the improvements required had been made

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 carried out on 13 October 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Moss and Partners on 13 October 2016. Overall the practice is rated as good.

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

  • The practice had a clear vision which had quality and safety as its top priority. However, the arrangements relating to the safeguarding of children and vulnerable adults required improvement to ensure effective systems were established and operated effectively to protect them from abuse. In response to our initial findings, the practice had taken immediate action and made significant changes to address concerns relating to record keeping, coding of patient records, information sharing and identification of vulnerable adults at risk of abuse.

  • The practice received safety alerts issued by external agencies. However, the system in place for acting upon alerts was not embedded to ensure that staff had taken appropriate action in response to Medicines and Healthcare products Regulatory Agency (MHRA) alerts.

  • There was an effective system in place for managing significant events. Learning was shared widely across all staffing groups.

  • Most risks to patients were assessed and well managed including procedures for managing medical emergencies and health and safety.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. They had the skills, knowledge and experience to deliver high quality care and treatment. Effective systems were in place to ensure staff were supported with induction, training, supervision and appraisal.

  • Clinical audits were used to review patient care and improve services.

  • There was a systematic approach to working effectively as a whole practice team, involving patients and other stakeholders to deliver effective and integrated care for patients. This approach had resulted in a reduction in unplanned hospital admissions and attendance at accident and emergency.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • The clinical team had a wide range of skills which were tailored to meet the needs of patients. This included a mental health nurse to assess and support patients experiencing poor mental health and or bereavement, three advanced nurse practitioners who took a lead in managing the minor illness clinics, a care home specialist nurse, a pharmacist and a community support worker.

  • The practice had around 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.

  • The provider had developed and implemented a “medical assessment triage protocol” for use by non-clinical staff to direct patients to the most appropriate clinician in a timely manner without them making a clinical decision. Symptoms were prioritised according to the guidance and patients were given an urgent appointment according to their clinical need. We received positive feedback from both staff and patients regarding the triage system. The protocol had been commended by the clinical commissioning group (CCG) who were liaising with the provider to see whether it could be shared more widely.

  • Most 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 meet the needs of patients.

  • Improvements were made to the quality of care as a result of complaints, concerns and feedback from patients and the patient participation group.

  • The strategy to deliver the practice vision and governance arrangements were regularly reviewed and discussed with staff.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

  • 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 East Midlands and the CCG in developing the training and qualifications for advanced nurse practitioners and advanced care practitioners in Southern Derbyshire; being part of a training hub and taking part in CCG pilot projects which included employing a pharmacist and design of specific pathways for long term conditions such as diabetes.

We saw several areas of outstanding practice:

The practice was highly responsive to providing services that meet the needs of patients. For example,

  • The practice hosted and facilitated community based services which enabled care to be provided closer to home for patients. For example, since 2010, the practice has hosted a GP led community musculoskeletal assessment and treatment service which is accessible to patients registered with 26 local practices. Two of the practice GPs took a lead role in managing this service with support from another local GP. The impact of this service provision included a 50% to 60% reduction in orthopaedic referrals to secondary care services.

  • There was a strong emphasis on multi-disciplinary working within the practice. The practice worked in collaboration with two local practices and health professionals (from Derbyshire community health services) to identify the support needs and improve the management of patients who frequently accessed health and social care services with a view to reducing admissions. The practices received funding to support a dedicated GP resource to lead the weekly collaborative meetings with the community team where complex cases were discussed and plans agreed. The practice had evaluated the benefits of this project for the period November 2015 to July 2016 and quantitative data showed positive outcomes were achieved for patients and the practice. The findings showed: a reduction of 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 with significant cost savings for the CCG.

  • In addition, records reviewed showed a residential care home was requesting 13 to 16 GP visits each month for 10 residents registered with the practice. Initially, joint visits were undertaken by the GP lead and attached community matron to ensure patients received a comprehensive and holistic review of their care needs in their home. The community matron now visits the care home on a weekly basis to review the patients’ health needs reducing the number of home visits made by GPs.

  • The care of older people was prioritised in response to findings of a home visit audit. A care home specialist nurse was employed to coordinate the care of residents living in care homes. They worked closely with care home staff and practice GPs to achieve positive outcomes for patients. Within a six week period, the nurse had completed the following interventions: 62 medicine reviews; 40 dementia annual reviews, 19 diabetes reviews and 59 new care plans had been put in place for example. The visits undertaken by the nurse meant 67 face to face GP visits were not required and there had been significant cost saving with regards to improved prescribing of nutritional supplement drinks. Records reviewed (patient satisfaction questionnaires) showed patients were positive about the service received. They felt their health and care needs were fully met and excellent care was provided.

The areas where the provider must make improvement are:

  • Ensure improvements made to safeguarding arrangements operate effectively and are embedded within the practice to protect children and vulnerable adults from abuse. Specifically, record keeping, coding of patient records, information sharing and identification and communication with relevant agencies.

The areas where the provider should make improvement are:

  • Continue to proactively identify carers within the practice.
  • Strengthen the systems for managing patient safety alerts to ensure established and effective systems are in place to keep patients safe. This includes maintaining records to evidence the receipt of and actions taken in respect of Medicines Health and Regulatory Authority (MHRA) alerts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 27 August 2013

During a routine inspection

We spoke with six patients, three GPs, the nurse practitioner, a practice nurse and the deputy practice manager during our inspection. Patients told us they were satisfied with the care and treatment they received.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. Comments made by patients about the service included �The GPs don�t take risks with my health, and they ask for specialist advice� and �I�ve no complaints, it�s very good here.�

Staff had received training on safeguarding children and were currently completing training on vulnerable adults. Staff were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm. We saw that safeguarding referrals had been made where appropriate.

We saw staff received annual appraisals and developed their own individual personal training and development plan. We saw staff were supported to develop their skills and knowledge, so they met the needs of patients.

The provider had systems in place for monitoring the quality of service provision. There was an established system for obtaining opinions from patients about the standards of the services they received. This meant that on-going improvements were made by the practice staff.