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Inspection Summary


Overall summary & rating

Good

Updated 9 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Howells & partners (at that time known as Dr West & partners) on 18 May 2016. At that time, the practice was rated overall as good. However, we identified a breach in regulation relating to the way in which medicines were managed which resulted in a rating of requires improvement for provision of safe services. Specifically we found that learning from dispensary errors was communicated inconsistently, medicines were dispensed to patients before GPs had signed and authorised prescriptions and some medicines held for use in an emergency were out of date.

The practice sent us an action plan setting out the changes they were making to address the breach in regulation.

We carried out a focused inspection on 21 December 2016 to ensure these changes had been implemented and that the service was meeting regulation they had previously breached. The ratings for the practice have been updated to reflect our findings. We found the practice had made improvements in safe provision of services since our last inspection on 18 May 2016 and they were now meeting the requirements of the regulation in breach.

Our key findings in the area we inspected were as follows:

  • The practice had introduced an effective system for reporting and learning from dispensing errors and “near misses”. This followed an improvement process designed by the Royal Pharmaceutical Society.

  • Repeat prescriptions were being signed by GPs before medicines were dispensed to patients from both the practice dispensaries.

  • The practice had an effective system for monitoring the medicines held for use in an emergency.

We have updated the ratings for this practice to reflect these changes. The practice is now rated good for the provision of safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 January 2017

The practice is rated as good for providing safe services. The practice had made significant progress in addressing concerns identified at their previous inspection and at this inspection we found:

  • Learning from dispensing errors was communicated to staff effectively. Staff were aware of errors and the actions they should take to avoid similar occurrences in the future.

  • Processes for dispensing medicines from the practice dispensaries complied with legislation and guidance from professional bodies. Repeat prescriptions were signed before the medicines were collected by patients.

  • Both medicines held in case of an emergency and those in GP bags were regularly checked to ensure they were in date and fit for use. An effective monitoring and checking system was in place.

At our earlier inspection we found:

  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients, that were not associated with medicines, were assessed and well managed.

Effective

Good

Updated 28 June 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 in a number of conditions. The practice demonstrated a 3% improvement from 2014/15 to 2015/16 across all indicators included in QOF. They had risen from 88% to 91%.

  • 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 28 June 2016

The practice is rated as good 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.

  • 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.

  • The practice was active in identifying patients who were carers and co-ordinated support for this group by working with ‘village agents’. These members of the community were able to assist carers with practical support and befriending.

Responsive

Good

Updated 28 June 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. For example, a directory of services had been developed for young patients.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

  • 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.

Well-led

Good

Updated 28 June 2016

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 management structure which staff understood and staff were encouraged to utilise their skills in supervisory roles.

  • 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.

  • 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 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. Patient participation groups (PPG’s) were active at both practice sites. The practice had worked with their PPG’s to establish a support group for patients with a specific long term condition.

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

Checks on specific services

People with long term conditions

Good

Updated 28 June 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.

  • Performance for diabetes related indicators n 2015/16 was 84%. This was just below the previous year clinical commissioning group (CCG) average of 86% and national average of 89%.

  • 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.

  • A support group had been established for patients with a specific long term condition, fibromyalgia. This provided patients with practical advice about living with their condition.

Families, children and young people

Good

Updated 28 June 2016

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

  • 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

  • The practice recognised that younger patients relied on them to deliver a full range of services that young patients in towns and cities would access from clinics.

  • The practice sent every young patient an information pack when they attained their 14th birthday. The pack contained details of the services young patients could access from the practice.

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 83%, which was better than the CCG average of 79% and better than the national average of 77%.

  • 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 and health visitors.

Older people

Good

Updated 28 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 patients in its population.

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

  • The practice liaised with village agents to identify older patients who may benefit from befriending and support with practical tasks such as transport to and from appointments.

  • The practice supported five local care homes by providing weekly visits to all five homes to co-ordinate patient care.

Working age people (including those recently retired and students)

Good

Updated 28 June 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, flexible and offered continuity of care.

  • 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. Extended hours clinics were held on 34 Saturday mornings each year.

  • Telephone consultations were available for patients who found it difficult to attend the practice during the customary working day.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 June 2016

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

  • 68% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/15, which was below both local and national averages. We noted the practice had achieved an overall improvement from 79% in 2014/15 to 90% in 2015/16 in the indicators for this group of patients. This was close to the CCG average of 95% and national average of 95% from 2014/15. Detailed data on each indicator was not available at the time of our visit.

  • 88% of patients diagnosed with a long term mental health problem had an agreed care plan. This had improved from 49% in the previous year. This was slightly better than the CCG average of 85% in 2014/15 and matched the national average.

  • 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.

  • Counselling was available at the practice.

  • The practice was in the process of becoming a dementia friendly practice. There was a dementia champion at each site, Dementia friends training had been completed for most practice staff.

People whose circumstances may make them vulnerable

Good

Updated 28 June 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 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.

  • The practice was active in identifying carers and co-ordinated support for this group of patients via a member of staff who had been appointed as carers co-ordinator.