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Dr Akester and Partners Good

Inspection Summary


Overall summary & rating

Good

Updated 31 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Akester and Partners on 17 November 2016. The overall rating for the practice was good. However, a breach of the legal requirements was found which resulted in the practice being rated as requires improvement for providing safe services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Akester and Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection and took place on 16 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach of regulation that we identified in our previous inspection on 17 November 2016. This report covers our findings in relation to those requirements.

The practice has made the required improvements to meet the legal requirements in the key question of safe and is rated as good.

Our key findings were as follows:

  • The practice had ensured that sufficient arrangements were in place for the safe management of medicines, including the recording and dispensing of controlled drugs.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 May 2017

This inspection was conducted to review issues that were found at the comprehensive inspection carried out on 17 November 2016. The issues at the previous inspection included:

  • The provider did not have a lone worker policy specifically for staff working in the dispensary.

  • Staff working in the dispensary did not have ongoing documented checks of their competency.

  • Staff did not keep a “near miss” record (a record of errors that have been identified before medicines left the dispensary).

  • The Standard Operating Procedure (SOP) was not consistently followed as staff did not undertake a physical inspection to check for expired stock.

  • On the day of the inspection the door to a room containing a medicines cupboard was found to be unlocked.

  • Prescriptions for use in printers were not tracked through the practice in accordance with national guidance.

  • Entries were made in the controlled drugs register before medicines had been supplied to patients, which was not in accordance with relevant legislation.

At this inspection in May 2017 we found:

  • The provider had made all of the required improvements and fully implemented the action plan sent to us following the previous inspection.

Effective

Good

Updated 25 January 2017

The practice is rated as good for providing effective services.

  • Data showed that the practice was performing highly when compared to practices nationally. The most recent (2015/2016) published Quality Outcome Framework (QOF) results were 98.5% of the total points available, above the England average of 95%. (QOF is a system intended to improve the quality of general practice and reward good practice).

  • 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.

  • Staff consistently supported people to live healthier lives through a targeted and proactive approach to health promotion and prevention of ill health.

Caring

Outstanding

Updated 25 January 2017

The practice is rated as outstanding for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for all aspects of care. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Feedback from people who used the service was continually positive about the way staff cared and treated them. There was a high level of praise for staff. There was a strong, visible, person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Relationships between people who used the service, those close to them and staff was strong, caring and supportive. These relationships were highly valued by all staff and promoted by leaders.

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

  • Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 25 January 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 to secure improvements to services where these were identified.

  • The practice demonstrated a proactive and responsive approach to understanding the needs of vulnerable patients and to deliver care in a way that met their needs. For example, the practice had well established shared care arrangements for patients who had drug and alcohol dependence. The practice was able to demonstrate the significant benefit this service had had for these patients.

  • The practice was proactive in identifying and responding to patients who were carers or who experienced social isolation. They worked closely with volunteer groups. For example The Red Cross.The practice was able to demonstrate the positive impact this work had had for 2.4% of their population.

  • The practice worked closely with patients in planning how services were provided to ensure that they meet patients’ needs. Patients could access appointments and services in a way and at a time that suited them. For example, the practice offered eleven ‘open surgery – sit and wait’ surgeries per week across both sites including two evening surgeries and one weekend surgery every week. Pre-booked face to face and telephone appointments were also used. 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. For example the practice was reviewing how the sit and wait service could remain but improved to reduce patient waiting times.

  • The practice had good facilities at Kirkby Malzeard. The facilities at Masham were in the process of being upgraded as part of extensive refurbishment and redesign works, including an extension to the practice.

  • 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.

Well-led

Good

Updated 25 January 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.

  • High standards were promoted and owned by all practice staff and teams worked together across all roles.

  • 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 partnership and practice management arrangement was relatively new. There was clear evidence this practice was on a significant improvement pathway.

  • 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 well established and an active part of the practice.

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

Checks on specific services

People with long term conditions

Good

Updated 25 January 2017

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

  • GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for the ten diabetes related indicators was higher than the England average in all areas. For example the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less (01/04/2015 to 31/03/2016) was 91.6% compared to the national average of 80.3%. 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 25 January 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.

  • 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.

  • Childhood immunisation rates for the vaccinations given were high when compared to the England average for under two year olds and for five year olds. For example childhood immunisation rates for the vaccinations given to under two year olds ranged from 91% to 100% compared to the England average of73% to 96% and five year olds from 85% to 96% compared to the CCG average of81% to 95%.

  • The practice’s uptake for the cervical screening programme was 81%, which was equal to the England average of 81%.

  • Open access ‘sit and wait’ surgeries provided patients with access to a GP daily; outside of school hours.

  • A full range of sexual health screening and contraceptive services were officered via the same day access service.

  • We saw positive examples of joint working with midwives, health visitors and healthy child team.

Older people

Good

Updated 25 January 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. For example the practice was proactive in identifying and responding to older patients who experienced social isolation. They worked closely with volunteer groups such as The Red Cross.

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

  • Outcomes for patients in this age range were good.

Working age people (including those recently retired and students)

Good

Updated 25 January 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. For example access to online appointment and prescription ordering.

  • Open access ‘sit and wait’ surgeries including two evening surgeries and weekend access provided patients with access to a GP daily outside of working hours.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 January 2017

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

  • Performance for the six mental health related indicators was higher than the England average in all areas.For example the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had had a comprehensive, agreed care plan documented in their record, in the preceding 12 months (01/04/2015 to 31/03/2016) was 90% compared to the national average of 89%.

  • 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 25 January 2017

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

  • The practice demonstrated a proactive and responsive approach to understanding the needs of vulnerable patients and to deliver care in a way that met their needs. For example, the practice had well established shared care arrangements for patients who had drug and alcohol dependence. The practice was able to demonstrate the significant benefit this service had had for these patients.

  • The practice was proactive in identifying and responding to patients who were carers or who experienced social isolation. They worked closely with volunteer groups. For example The Red Cross. The practice was able to demonstrate the positive impact this work had had for 2.4% of their population.

  • The practice held a register of patients living in vulnerable circumstances including housebound patients, carers and those with a learning disability.

  • The practice offered longer appointments for patients assessed as needing them.

  • The practice offered 11 ‘open surgery – sit and wait’ surgeries per week across both sites including two evening surgeries and one weekend surgery every week. Pre-booked face to face and telephone appointments was also used which meant patients within this group could see a GP at any time.

  • There were longer appointments available for patients with a learning disability.

  • Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice.

  • The practice offered a range of services aimed at providing care closer to the patient’s home.

  • 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.