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Drs Czerniewski, Reynolds, Chesser & Harris Good Also known as Dunchurch Surgery

Inspection Summary


Overall summary & rating

Good

Updated 28 October 2016

We carried out an announced comprehensive inspection at Drs Czerniewski, Roberts, Reynolds & Chesser (Dunchurch Surgery) on 19 May 2016. Overall the practice is rated as good.

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

  • The practice used an effective system for reporting and recording significant events. The practice had robust procedures and measures in place to keep patients safe and help protect them from abuse.
  • Staff effectively assessed and managed risks to patients.
  • The practice used current evidence based guidance to assess patients’ needs and deliver care. Training was provided to staff to ensure they had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they found staff friendly and compassionate and they were happy with the continuity of care they received. They said their care felt personal and they were involved in decisions about their treatment.
  • Information about how to complain was clearly displayed and easy to understand. Complaints and concerns were analysed and used to improve the quality of care provided.
  • Patients told us they were able to get appointments when they needed them and urgent appointments were available on the same day, but they could experience a wait of between two weeks and one month if they wanted to see their preferred GP.
  • The practice had facilities which met patients’ needs.
  • The practice had a clear leadership structure and management supported staff to carry out their roles. The practice asked patients for feedback and was proactive in adopting changes.
  • The practice was familiar with the conditions of the duty of candour and exercised an open and honest culture.

The areas where the provider should make improvement are:

  • Maintain up to date records for locum GPs. This should include evidence of their hepatitis B immunisation status.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 October 2016

The practice is rated as good for providing safe services.

  • Staff knew how to raise concerns and report incidents and near misses. Significant events were thoroughly investigated and we saw that these were discussed by the practice GPs and learning disseminated to staff. Significant events were reviewed at an annual staff meeting to ensure lessons learned had been implemented to improve safety in the practice.

  • The practice had a clear approach to dealing with errors and offered patients an apology providing an explanation when things went wrong.

  • Staff we spoke with had a good understanding of their safeguarding responsibilities and knew how to report incidents. The practice had robust procedures and measures in place to keep patients safe and help protect them from abuse.

  • Most risks to patients were assessed and well managed but the arrangements for checking locums’ immunity to Hepatitis needed strengthening.

  • There were adequate arrangements in place to respond to emergencies and major incidents.

  • The practice had a system for dealing with safety alerts from external agencies. These were reviewed by the duty doctor and any requiring action were followed up and hard copies retained.

Effective

Good

Updated 28 October 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) 2014/15 showed patient outcomes were in line with or above average for the locality and compared to the national average.
  • Staff assessed needs and delivered care in line with current evidence based guidance. The practice had a system to update clinical staff with new guidance as it arose.
  • Clinical audits demonstrated quality improvement and monitoring. The practice also participated in local benchmarking.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. GPs in the practice had lead roles across a range of areas and training was monitored and updated consistently. Staff communicated well as a team to deliver personalised care to patients.
  • We saw evidence of appraisals for all staff and those we spoke with expressed confidence in using appraisals as an opportunity to progress.
  • Staff worked together and with other health and social care professionals to understand and meet the range and complexity of patients’ needs and to assess and plan ongoing care and treatment. The practice team was aware of its obligations regarding consent and confidentiality.

Caring

Good

Updated 28 October 2016

The practice is rated as good for providing caring services.

  • Patients said they found staff friendly and compassionate and they were happy with the continuity of care they received. They said their care felt personal and they were involved in decisions about their treatment.
  • 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 broadly in line with Clinical Commissioning Group (CCG) and national averages.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw that staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • Staff at three local care homes said the practice provided a responsive, helpful and very professional service to patients.
  • Staff told us that when a patient or the near relative of a patient died their GP contacted the family and sent them a sympathy card. GPs continued to support patients through consultations and by offering information about support services.
  • There was a carer’s notice board in the patient waiting area. The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 81 patients as carers (1% of the practice list). The practice contacted carers by phone annually to discuss their needs and direct them to avenues of support. Written information was also displayed in the waiting room to inform carers of the resources available.

Responsive

Good

Updated 28 October 2016

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 CCG to secure improvements to services where these were identified.
  • The practice offered lunchtime appointments to assist patients who worked during the day. Same day appointments were provided for children and urgent cases.
  • Patients said they found it difficult to make an appointment with a named GP if they wanted to be seen the same week, but spoke positively about their continuity of care.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded appropriately to issues raised.

Well-led

Good

Updated 28 October 2016

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

  • The practice had a clear vision to provide high quality compassionate care. Staff described a common goal of taking pride in the service they delivered and they worked in a way that supported the ethos of the practice.

  • There was a clear leadership structure and staff felt supported by management.
  • The practice effectively implemented the requirements of the duty of candour. The practice manager and GP partners encouraged an open culture.
  • There were systems in place to manage notifiable safety incidents.
  • The practice was proactive in acting on feedback from patients and its Patient Participation Group (PPG). A PPG is a group of patients registered with the practice who worked with the practice to improve services and the quality of care.
  • Staff were encouraged to undertake training and professional development. Specific areas for improvement were assessed at annual appraisals.
Checks on specific services

People with long term conditions

Good

Updated 28 October 2016

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

  • The nursing team offered chronic disease management clinics at flexible times. A retinal screening van visited the practice on approximately 10 days over a period of several months. Appointments for patients with a diagnosis of diabetes were scheduled for the same dates for patient convenience.
  • Longer appointments and home visits were available for patients with long term conditions.
  • Performance for diabetes related indicators was similar to the national average range. 85% of patients with diabetes’ last blood pressure reading within an acceptable range which was significantly higher than CCG and national averages of 79% and 78%. 94% of patients on the register had had a foot examination and risk classification in the previous 12 months, higher than the national average of 88%.
  • Patients with a long term condition had a care plan in place where appropriate.
  • House-bound patients were offered a flu vaccination which was administered in their own home.

  • The practice had appointed an end of life care lead who held quarterly palliative care meetings with district and Macmillan nurses. This helped the practice to provide a coordinated package of care to people with terminal illnesses. The practice followed the Gold Standards Framework (GSF) in end of life care. The GSF encourages clinicians to focus on providing high quality, coordinated care to people nearing the end of their lives.

Families, children and young people

Good

Updated 28 October 2016

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

  • The practice had a safeguarding lead who held quarterly child safeguarding meetings.
  • Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages.
  • Staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals. Clinical staff showed a clear understanding of Gillick competence and Fraser guidelines. Gillick competence is concerned with determining a child’s capacity to consent. Fraser guidelines are used specifically to decide if a child can consent to contraceptive or sexual health advice and treatment.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice told us they targeted pregnant women with health promotion such as smoking cessation and pertussis (whooping cough) immunisation.
  • Postnatal and baby checks were offered to mothers during an extended appointment for convenience.

Older people

Good

Updated 28 October 2016

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

  • The practice recognised that it had a higher than average population of older people, with 29% of the patient list aged 65 or over. The practice offered personalised care to meet their needs. For example the practice offered a phlebotomy service to older patients who were unable to travel independently to local hospitals.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Clinical staff maintained care plans for older patients at higher risk of admission to hospital.
  • The practice had patients who lived in three local care homes. We spoke with staff at the care homes who described the service the practice provided to people as responsive, helpful and very professional. GPs carried out medication reviews and dealt appropriately with patients’ relatives.

Working age people (including those recently retired and students)

Good

Updated 28 October 2016

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

  • The practice remained open at lunchtime to assist patients who worked during the day.
  • Appointments could be booked up to six weeks in advance. Patients could register with the online booking service to book routine GP appointments at a time that was convenient for them. The practice was trialling a system of offering later afternoon appointments online to help address the needs of working patients. 
  • The practice offered a range of screening and health promotions to meet the needs of working age people. For example, heart health checks were available to those aged 40 to 74. QOF indicators showed that the practice’s patient uptake of cervical screening was in line with national averages. 
  • The practice offered flu vaccination clinics on Saturday mornings at the appropriate times of year to try to improve uptake by working age patients with long term conditions.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 October 2016

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

  • Clinical staff at the practice liaised with local multi-disciplinary teams to provide continuity of care to patients experiencing poor mental health, including those with dementia.
  • The practice used mental health care plans and offered annual health checks for patients with ongoing mental health issues.
  • Longer appointments were available to patients experiencing poor mental health if requested or known to be needed.
  • Performance for mental health related indicators was similar to CCG and national averages. For example, 90% of patients experiencing poor mental health had a comprehensive agreed care plan documented within the last 12 months. This was 2% above the national average and 6% above the CCG average.
  • The practice maintained personalised care plans for patients on their dementia register.
  • 82% of patients diagnosed with dementia had a face to face care review in the past 12 months, compared with 84% nationally and 82% in the CCG area overall.
  • The practice held an in-house presentation chaired by a member of the Alzheimers Society on how to become a Dementia Friend. The Dementia Friends programme is aimed at improving people’s understanding of dementia and the ways they can help people living with the condition. The presentation was attended by the Patient Participation Group (PPG), and resulted in a number of practice staff and PPG members becoming Dementia Friends. A PPG is a group of patients registered with the practice who worked with the practice to improve services and the quality of care.
  • Weekly counselling sessions were offered at the surgery through Improving Access to Psychological Therapies (IAPT). IAPT are NHS services for people with mild, moderate and moderate to severe symptoms of anxiety or depression.

People whose circumstances may make them vulnerable

Good

Updated 28 October 2016

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

  • The practice held registers of patients living in vulnerable circumstances including those with a learning disability. Potentially vulnerable patients were identified via new patient health checks, consultations, and interactions with staff.
  • The practice used a case management register to help manage potentially vulnerable patients and reduce avoidable or unplanned admissions or re-admissions to hospital. For example, the practice had a number of older patients on its case management register who were considered to be at risk and lived alone. The practice informed us that all of these patients had either had an annual health check or had been given an appointment to attend one within the year.
  • The practice offered longer appointments for patients who required them.
  • Patients considered to be at risk, for example those with a severe learning disability, had personalised care plans.
  • The practice had a lead for its patients in a local care home for people with a learning disability. The lead visited six monthly to carry out reviews.
  • The practice asked patients with mobility difficulties if they had someone who could collect their prescriptions for them, and offered to help if needed.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities and how to contact relevant agencies. There were lead members of staff for children’s and adults’ safeguarding, and GPs were trained to an appropriate level in safeguarding adults and children.
  • The practice offered patients who did not speak the English language with confidence access to translation services where appropriate.
  • Disabled facilities were available at the practice including parking, step free access to consultation rooms and a hearing loop.
  • The practice had no travellers or homeless people on their patient list at the time of our visit but explained they would accept and register people from these groups as temporary patients.