Archived: Dr Vivian Ding & Partners Also known as Bursledon Surgery

Updated 3 November 2016

Dr Vivian Ding is a solo registered provider at Bursledon Surgery, The Lowford Centre, Portsmouth Road, Lowford, Southampton, Hampshire, SO31 8ES.

There is one female GP who is also the provider; also an advanced nurse practitioner and a practice nurse as well as a healthcare assistant and phlebotomist. The practice is supported by a reception and administration team and an office manager. There is no practice manager at the practice. The practice currently provides services for approximately 3764 patients. The practice had slightly higher than average numbers of patients aged four years and under; and 30-34 years old.

The practice is a teaching practice (teaching practices take medical students and training practices have GP trainees and F2 doctors). The practice is part of the NHS West Hampshire Clinical Commissioning Group (CCG). Bursledon Surgery serves the whole of Bursledon as well as the surrounding areas of Lowford, Old Netley, Butlocks Heath, Netley and Hamble-Le-Rice, Swanwick,Sarisbury Green andparts of Hedge End andSholing. The population for this practice is recorded as being in the fourth less deprived decile and are predominantly white British.

The practice is open between 7.30am and 1.00pm and 2.00pm and 6.30 pm Monday to Friday. Appointments available between 8.30am to 6.30pm daily. Extended hours appointments are offered at the following times from 7.30am to 8.00 am on Mondays and Wednesdays and 6.30pm to 7.30 pm on Thursdays.

When the practice is closed patients are advised to dial 111 for the local out of hours service which is provided by West Hampshire CCG.

Regulated activities are provided from Bursledon Surgery, The Lowford Centre, Portsmouth Road, Lowford, Southampton, Hampshire, SO31 8ES which was visited during the inspection.

The registered location for this provider is no longer operational and all care and treatment takes place at this address. The provider has been informed to apply for amendment to the registration.

Updated 3 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the provider address of Dr Vivian Ding, Bursledon Surgery, The Lowford Centre, Portsmouth Road, Lowford, Southampton, Hampshire, SO31 8ES on 28 June 2016.

The registered location for this provider is no longer operational and all care and treatment takes place at this address. The provider has been informed to apply for amendment to the registration.

Overall the practice is rated as Inadequate.

Our key findings were as follows:

• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff. When incidents and complaints had been identified reviews and investigations were not thorough enough.

• Staff had not been trained in how to safeguard children and vulnerable adults from abuse.

• There were no processes in place for receiving and responding to medicine and safety alerts.

• Robust recruitment processes were not in place and appropriate checks were not carried out for all staff.

• Staffing levels were not always adequate to ensure that all care and treatment was delivered in a timely way.

• Staff had not received training which was relevant to their roles.

• There was no process in place for staff meetings, appraisals and clinical supervision.

• Measures to monitor and improve patient outcomes were inconsistent. Limited audits were undertaken to support quality improvement. The practice did not compare its performance to others or shared learning internally.

• There was no governance structure in place supported by policies and procedures. Staff were unclear about what policies were in place and were not always able to locate them.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

Importantly, the provider must:

• Ensure there are processes for sharing of learning as a result of significant events, incidents and near misses.

• Ensure recruitment records include all necessary employment checks for all staff.

• Ensure staffing is adequate in order to ensure there are no delays to patients receiving appropriate care.

• Ensure all staff have received the relevant training for their role.

• Ensure patient complaints are reviewed and responded to.

• Ensure there are formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

In addition the provider should:

Ensure patient information is in formats suitable for the patient group.

• Review systems for identifying patients who are also carers and provide them with sufficient support and information.

• Review the complaints received by the practice and develop systems to analysis themes and trends and share learning with relevant staff.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give patients who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 3 November 2016

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

The provider was rated as inadequate for safe, effective, responsive  and well-led care. The issues identified as inadequate overall affected all patients including this population group. However, there were some areas of good practice.

• GPs carried out chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the national average. For example, t he percentage of patients with diabetes, on the register, in whom the last average blood glucose levels were within acceptable limits the preceding 12 months was 77% compared to the clinical commissioning group average of 80% and the national average of 78%.

Updated 3 November 2016

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

The provider was rated as inadequate for safe, effective, responsive and well-led care. The issues identified as inadequate overall affected all patients including this population group. However, there were some areas of good practice.

• Children were given same day appointments.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw examples of joint working with midwives, health visitors and school nurses.

Updated 3 November 2016

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

The provider was rated as inadequate for safe, effective, responsive and well-led care. The issues identified as inadequate overall affected all patients including this population group. However, there were some areas of good practice.

• The safety of care for older people was not a priority and there were limited attempts at measuring safe practice.

• There was a care navigator employed who provided support for older people managing their multi-disciplinary care needs.

Updated 3 November 2016

The practice is rated as inadequate for the care of working age people.

The provider was rated as inadequate for safe, effective, responsive and well-led care. The issues identified as inadequate overall affected all patients including this population group. However, there were some areas of good practice.

• The practice offered early morning appointments on Mondays and Wednesdays and evening appointments on Thursdays for people who were unable to attend appointments during working hours.

Updated 3 November 2016

The practice is rated as inadequate for the care of people experiencing poor mental health.

The provider was rated as inadequate for safe, effective, responsive and well-led care. The issues identified as inadequate overall affected all patients including this population group. However, there were some areas of good practice.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• A total of 18 patients were on the register for mental health conditions. Three of these patients did not have an agreed care plan documented in the record, in the preceding 12 months.

Updated 3 November 2016

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

The provider was rated as inadequate for safe, effective, responsive and well-led care. The issues identified as inadequate overall affected all patients including this population group. However, there were some areas of good practice.

• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• Staff had not had recent training in how to protect vulnerable adults from abuse and were not fully aware of the processes to follow if they suspected people were at risk.