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Dr Dawes, Foster and Narasimhan Good

Inspection Summary


Overall summary & rating

Good

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ridgeway Surgery on 17 May 2016. Overall the practice is rated as good.

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

  • There were comprehensive records in place to the support the practices arrangements for identifying, recording and managing risks. The practice was proactive in identifying and managing significant events. All opportunities for learning from internal and external incidents were maximised.

  • We observed the premises to be visibly clean and tidy. The practice offered a range of clinical services which included care for long term conditions and services were planned and delivered to take into account the needs of different patient groups to ensure flexibility, choice and continuity of care.

  • Throughout our inspection we noticed a strong theme of positive feedback from staff. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • There was a systematic approach to working with other organisations to improve patient care and outcomes. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • The practice had a clear vision which had quality and safety as its top priority. We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect, and maintained confidentiality.

  • The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvement and improvements to patient care and treatment.

  • All patients who were registered with the practice had a named GP and patients could access appointments and services in a way and at a time that suited them.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 June 2016

The practice is rated as good for providing safe services.

  • The practice was proactive in identifying and managing significant events. There were robust systems in place to monitor safety. These included systems for reporting incidents, near misses and national patient safety alerts, as well as comments and complaints received from patients.

  • We saw that significant events were regularly discussed with staff during practice meetings and the practice used these as opportunities to drive improvements.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. One of the GPs was the lead member of staff for safeguarding; the GP was also the safeguarding lead for the local clinical commissioning group. The staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses.
  • There were adequate arrangements in place to respond to emergencies and major incidents.

Effective

Good

Updated 6 June 2016

The practice is rated as good for providing effective services.

  • Staff assessed needs and delivered care in line with current evidence based guidance. One of the GPs was the integrated care lead within the clinical commissioning group. Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

  • 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 understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005. We saw records to demonstrate that all staff at the practice had completed training which covered key principles of the Mental Capacity Act.
  • A programme of continuous clinical and internal audit was used to monitor quality and to make improvements. Results were circulated and discussed in the practice.

Caring

Good

Updated 6 June 2016

The practice is rated as good for providing caring services.

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

  • Information for patients about the services available was easy to understand and accessible. Notices in the patient waiting room told patients how to access a number of support groups and organisations.

  • Results from the national GP patient survey published in January 2016 showed that patients were happy with how they were treated and that this was with compassion, dignity and respect.
  • There was a practice register of all people who were carers and 1% of the practice list had been identified as carers. To improve this, the practice had liaised with the Dudley Carers Network to coach staff on how to identify carers. We saw that the practice had developed a carer’s board in one of the waiting rooms to encourage carers to seek support from the practice as well as local support services. The practice offered flu vaccines and annual reviews for anyone who was a carer.

Responsive

Good

Updated 6 June 2016

The practice is rated as good for providing responsive services.

  • The practice offered a range of clinical services which included care for long term conditions and services were planned and delivered to take into account the needs of different patient groups to ensure flexibility, choice and continuity of care.

  • There were longer appointments available for vulnerable patients, for patients with a learning disability, for carers and for patients experiencing poor mental health.
  • Urgent access appointments were available for children and those with serious medical conditions. Clinical staff carried out home visits for older patients and patients who would benefit from these.
  • The practice also used social media as a communication tool to promote and advertise some of the practices services. We saw that social media web pages were kept up to date and monitored regularly by the practice manager and IT lead.

Well-led

Good

Updated 6 June 2016

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

  • Throughout our inspection we noticed a strong theme of positive feedback from staff. Staff spoken with demonstrated a commitment to providing a high quality service that reflected the practices vision.

  • The practice encouraged a culture of openness and honesty. The practice had systems in place for managing notifiable safety incidents. Governance and performance management arrangements were proactively reviewed and reflected best practice.

  • There were comprehensive records in place to the support the practices arrangements for identifying, recording and managing risks. There was a systematic approach to working with other organisations to improve patient care and outcomes.
  • The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active patient participation group which influenced practice development.
Checks on specific services

People with long term conditions

Good

Updated 6 June 2016

The practice is rated as good for the care of people with long-term conditions.

  • The practice offered a range of clinical services which included care for long term conditions.

  • Performance for overall diabetes related indicators was 95%, compared to the CCG average of 88% and national average of 89%.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The percentage of patients with hypertension having regular blood pressure tests was 100%, with an exception rate of 0%. Staff we spoke with highlighted that they had approximately 1915 patients with hypertension; this was approximately 20% of the practices list size.

Families, children and young people

Good

Updated 6 June 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.

  • Childhood immunisation rates for under two year olds ranged from 93% to 100% compared to the CCG averages which ranged from 40% to 100%. Immunisation rates for five year olds ranged from 96% to 99% compared to the CCG average of 93% to 98%.

  • The practice offered urgent access appointments for children.
  • The practice’s uptake for the cervical screening programme was 81%, compared to the national average of 81%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test.

Older people

Good

Updated 6 June 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.

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

  • Clinical staff carried out home visits for older patients and patients who would benefit from these. Immunisations such as flu vaccines were also offered to patients at home, who could not attend the surgery.
  • The practice provided care to a number of patients across six local care and nursing homes. The GPs conducted regular ward round visits to these patients and the nurses regularly visited patients to carry out flu vaccinations. and for specific care needs such as diabetes checks for older patients who could not attend the practice.

Working age people (including those recently retired and students)

Good

Updated 6 June 2016

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

  • The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group. The practice offered a range of clinical services which included minor surgery, family planning, in-house Electrocardiograms (ECGs), travel and well person clinics.

  • Practice data highlighted that 2183 patients had been identified as needing smoking cessation advice and support; all of these patients had been given advice and 940 (43%) had successfully stopped smoking.

  • Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations with a GP at times to suit patients. The practice offered text messaging reminders for appointments to remind patients of their appointments in advance.
  • The practice offered extended hours on Mondays until 7:30pm and on Tuesday mornings from 7am. The practice nurses also offered nurse services during these times for those who could not attend the practice during core hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 June 2016

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

  • There were longer appointments available at flexible times for people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • Data showed that appropriate diagnosis rates for patients identified with dementia were 100%, with an exception rate of 0%. The data provided by the practice highlighted that 79% of their eligible patients had care plans in place. These patients were regularly reviewed and 87% had received a medication review in a 12 month period with ongoing reviews planned.

  • The practice also had a range of supportive information available for patients with dementia as well as carers and family members; we saw a wide range of examples which sign posted patients to various support groups.
  • Performance for mental health related indicators was 100%, with an exception rate of 0%. Data provided by the practice highlighted that they had 83 patients on the mental health register. The report also highlighted that 91% of these patients had care plans in place, these patients were regularly reviewed and 86% of their eligible patients had received a medication review in a 12 month period with further reviews planned. 

People whose circumstances may make them vulnerable

Good

Updated 6 June 2016

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

  • The practice offered longer appointments for patients with a learning disability. Information was available in a variety of formats including practice leaflets in large print and brail for people with a visual impairment.

  • There were 27 patients on the practices learning disability register, most of these patients had care plans in place and 98% had received a face to face review in a 12 month period. The practice also had a range of supportive information which was carefully designed in easy to read formats for patients with a learning disability.

  • There was a register which contained 52 patients from vulnerable groups, including patients with drug or alcohol dependency these patients were frequently reviewed in the practice and 85% had received a review in a 12 month period.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. It had told vulnerable patients about how to access various support groups and voluntary organisations.