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Dr. Andrew, Edwards, Hayes & Cleary Good

Inspection Summary


Overall summary & rating

Good

Updated 19 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr. Andrew, Edwards, Hayes & Cleary on 18 October 2016. We found that the practice had breached a regulation relating to the safe delivery of services. The practice was rated as requires improvement for safe and good for effective, caring, responsive and well led. The overall rating for the practice was good. The full comprehensive report on the 18 October 2016 inspection can be found by selecting the ‘all reports’ link for Dr. Andrew, Edwards, Hayes & Cleary on our website at www.cqc.org.uk.

The practice required improvement for the provision of safe services to ensure that the risks associated with checking, maintaining and safely storing medicines had been appropriately assessed. Following the inspection the provider sent us an action plan detailing how they would improve their medicines processes to ensure that they reflected national guidelines.

This inspection was a desk-based review carried out on 10 January 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 18 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection on 18 October 2016 and they were meeting the regulation that had previously been breached.

Our key findings were as follows:

  • The practice had updated their procedures and standard operating procedures (SOP) for checking and maintaining medicines and ensuring that they were stored in line with manufacturers’ specifications.

  • The practice had reviewed and improved their systems for checking and storing controlled drugs and had implemented new processes.

  • The practice had reviewed and improved the process for making changes to patients’ prescribed medicines to make sure that it followed best practice guidance.

  • The practice had reviewed and improved how dispensary staff should record and analyse near misses in the dispensary (to include dispensing and prescribing near misses).

  • The practice ensured that there were procedures in place to cover all activities in the dispensary and now monitor adherence to procedures and quality in the dispensing service.

We have changed the rating for this practice in safe, to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 January 2017

The practice was rated as requires improvement for providing safe services in October 2016 and was re-rated as part of this inspection.

When we inspected the practice in October 2016 we identified a breach of regulation leading to a rating of requires improvement. The practice had undertaken improvements since the last inspection and at this inspection we found they were complying with regulations. They are now rated good for the provision of safe services. Specifically we found:

  • The practice had updated their procedures and standard operating procedures (SOP) for checking and maintaining medicines and ensuring that they were stored in line with manufacturers’ specifications. The practice sourced a larger medicines fridge, updated the fridge temperature monitoring form and implemented a fridge monitoring SOP to ensure that medicines were stored in line with manufacturers’ specifications.

  • The practice had reviewed their systems for checking and storing controlled drugs and had implemented new processes. The practice amended their controlled drugs SOP to ensure that the controlled drug record book was completed in line with legislation and best practice.

  • The practice had reviewed the process for making changes to patients’ prescribed medicines to ensure it followed best practice guidance. The prescribing policy had been updated to ensure dispensers referred changes back to the GP for checking before medication was issued.

  • The practice had reviewed how dispensary staff should record and analyse near misses in the dispensary (to include dispensing and prescribing near misses). The adverse incidents SOP had been updated to include the recording of picking errors and near misses and a form for recording this had been implemented.

  • The practice ensured that there were procedures in place to cover all activities in the dispensary and monitor adherence to procedures and quality in the dispensing service. Standard operating procedures had been implemented for uncollected medicines and a system to monitor dispensary processes to support this had been introduced.

Effective

Good

Updated 19 January 2017

Caring

Good

Updated 19 January 2017

Responsive

Good

Updated 19 January 2017

Well-led

Good

Updated 19 January 2017

Checks on specific services

People with long term conditions

Good

Updated 28 November 2016

The practice is rated as good for the care of patients 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 overall diabetes related indicators was 96% which was above both the clinical commissioning group average of 95% and the 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.

Families, children and young people

Good

Updated 28 November 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.

  • 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 women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years was 87% which was above both the clinical commissioning group average of 84% and the 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 rapid response nurses through minutes of weekly multi-disciplinary meetings.

Older people

Good

Updated 28 November 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example in dementia, influenza and pneumococcal and shingles immunisations.

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

  • Older patients had access to a named GP to enable continuity of care.

  • Weekly meetings took place that included discussions of hospital admissions, hospital discharges and palliative care patients.

Working age people (including those recently retired and students)

Good

Updated 28 November 2016

The practice is rated as good for the care of working-age patients (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 evening appointments were available on Thursdays at Bream Surgery from 6.45am to 8am and at Yorkley Health Centre from 6.30pm to 9.30pm for working age patients to attend outside of working hours.

  • Services available included in house lung function testing, phlebotomy, minor surgery, heart tracings, blood test monitoring for patients taking blood thinning medicines and NHS health checks.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 November 2016

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

  • 71% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%.
  • Performance for mental health related indicators was 94% compared to the CCG average of 97% and national average of 82%.

  • 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.

  • Annual dementia reviews were carried out on patients who had been diagnosed or are at risk of dementia and the practice maintains a register to monitor these patients.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and a primary mental health nurse visited each practice once a week.

People whose circumstances may make them vulnerable

Good

Updated 28 November 2016

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

  • The practice held a register of patients living in vulnerable circumstances including 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 and held weekly multi-disciplinary meetings to highlight any patients of concern or any safeguarding issues.

  • 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 participated in a local social prescribing initiative whereby patients with non-medical issues, such as debt or loneliness could be referred by a GP to a single hub for assessment as to which alternative service might be of most benefit and could be seen at the practice. A social prescriber held weekly clinics at the practice for patients that did not wish to be seen at home.