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Inspection Summary


Overall summary & rating

Good

Updated 7 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Didcot Health Centre Practice on 6 July 2016. The practice was rated as requires improvement for providing safe services and the overall rating for the practice was good. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Didcot Health Centre Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 10 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 6 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • The practice had improved their communication of learning and actions taken following significant events. All staff had access to an update on the computer system and “practice education points” were discussed at team meetings.

  • The practice had reviewed the cold chain policy, fridge temperature recording and ensured vaccine safety was maximised.

  • The practice had reviewed their prescription security protocols to ensure blank prescriptions were securely stored.

  • The practice had reviewed the storage of an emergency medicine used to treat low blood sugar. They had ensured it was stored correctly and all staff knew of its location.

The practice had reviewed their carers support and updated their carers’ notice board to highlight areas where support was available. One of the non-clinical staff had undertaken training to support carers and the practice were facilitating the Alzheimer’s support group once per month.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 April 2017

The practice are rated as good for providing safe services:

  • The practice had improved their communication of learning and actions taken following significant events. All staff had access to an update on the computer system and “practice education points” were discussed at team meetings.

  • The practice had reviewed the cold chain policy, fridge temperature recording and ensured vaccine safety was maximised.

  • The practice had reviewed their prescription security protocols to ensure blank prescriptions were securely stored.

  • The practice had reviewed the storage of an emergency medicine used to treat low blood sugar. They had ensured it was stored correctly and all staff knew of its location.

Effective

Good

Updated 12 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • 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

Caring

Good

Updated 12 September 2016

The practice is rated as good for providing caring services.

  • The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.

  • Data from the national GP patient survey showed patients rated the practice similar to others for several aspects of care.

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

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

  • However, there was limited support for carers by the practice and not all patients identified as carers had a flag on their medical record to alert GPs and nurses to their carer status. We did note written information was available and the practice had an emergency telephone number for some carers to contact the practice urgently.

Responsive

Good

Updated 12 September 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 Clinical Commissioning Group to secure improvements to services where these were identified.

  • 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 quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

  • Feedback from patients reported that access to a named GP and continuity of care was not always available, although if needed, urgent appointments were usually available the same day.  

Well-led

Good

Updated 12 September 2016

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

  • The practice had a vision and strategy to deliver good quality care and promote positive outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a governance framework in place which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. Although prescription security was inconsistently managed and a cold chain breach went unidentified by management for 11 days.

  • 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. However, communications regarding learning from incidents and complaints often took time to be shared with all staff.

  • 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 active.

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

Checks on specific services

People with long term conditions

Good

Updated 12 September 2016

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

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

  • 81% of patients with diabetes had achieved a target blood level of 64mmol or below compared to the CCG average of 79% and national average of 78%.

  • 86% of patients with chronic obstructive pulmonary disease (COPD) had received a review including an assessment of breathlessness compared to the CCG average of 91% and national average of 90%.

  • 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 12 September 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. Immunisation rates were relatively high for all standard childhood immunisations.

  • 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.

  • 81% of women aged between 25 and 64 had a record of a cervical screening test performed within the previous five years compared to the CCG average of 83% and national average of 82%.

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

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

Older people

Good

Updated 12 September 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 patient in its population.

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

  • There was a dedicated emergency contact number for older patients with complex or end of life care needs. This ensured a GP was contactable quickly without the patient needing triage. The number was also given to other healthcare professionals and carers who were looking after patients in the community.

Working age people (including those recently retired and students)

Good

Updated 12 September 2016

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 and flexible. However, the addition of a third duty doctor has reduced continuity of care as patients will see or speak to whichever GP is available on the day.

  • 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.

  • 78% of female patients aged between 50 and 70 had been screened for breast cancer in the preceding 36 months compared to the CCG average of 75% and national average of 72%.

  • 56% of patients aged between 60 and 69 had been screened for bowel cancer in the preceding six months compared to the CCG average of 57% and national average of 55%.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 September 2016

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

  • 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 85% and national average of 84%.

  • 86% of patients with a diagnosed severe mental health condition had a care plan compared to the CCG average of 89% and national average of 88%.

  • 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 12 September 2016

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

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice held a register of carers, but did not offer any proactive support for them. Some did not have a flag on the computer system alerting GPs to their carer status.

  • 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.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • 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.