Archived: Durdells Avenue Surgery

Updated 12 June 2017

Durdells Avenue Surgery is based in a residential area of Kinson, Bournemouth, and is part of NHS Dorset Clinical Commissioning Group (CCG). The practice is in a purpose-built two storey building. Durdells Avenue Surgery provides services under a NHS Personal Medical Services

contract to approximately 2850 patients living within the practice boundary. The practice is located in an area of greater deprivation compared to the average for England and has a higher proportion of older patients compared to the average for England.

The practice has two male GP partners. One GP works part-time and does not offer regular clinical sessions, which had been the case over the last 18 months. At the time of our inspection, this GP was on leave. The practice employs regular locum GPs, some of whom were male and some were female, to cover clinical sessions. Since April 2017, a neighbouring practice had supported the practice by releasing two of their GPs to work up to six sessions per week at Durdells Avenue Surgery. The practice also employs a female practice nurse. The clinical team are supported by a practice manager and a team of six secretarial and reception staff.

Durdells Avenue Surgery is open between 8.30am and 6.30pm Monday to Friday. Phone lines open at 8am. Extended hours surgeries are available every Tuesday evening until 7pm. Appointments are available every day from 9am until 11am and from 2pm until 4pm on

Mondays, Wednesdays and Fridays and from 2pm until 5pm on Tuesdays. GPs also perform daily home visits to patients who are unable to attend the practice.

Durdells Avenue Surgery has opted out of providing out-of-hours services to their own patients and refers them to the Boscombe and Springbourne Health Centre (based in Bournemouth) walk in service at weekends, and the Dorset Urgent Care service via the NHS 111 service. The

practice offers online facilities for booking of appointments and for requesting prescriptions.

We carried out our inspection at the practice’s only location which is situated at:

1 Durdells Avenue

Kinson

Bournemouth

Dorset

BH11 9EH

Updated 12 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced focussed inspection of Durdells Avenue Surgery on 9 May 2017. This was to check compliance relating to the serious concerns found during a comprehensive inspection on 7 February 2017 which resulted in the Care Quality Commission issuing a Warning Notice with regard to Regulation 12, Safe care and treatment; Regulation 17, Good Governance and Regulation 18, Staffing.

Other areas of non-compliance found during the inspection undertaken on 7 February 2017 will be checked by us for compliance at a later date.

Following our inspection undertaken on 7 February 2017 we rated the practice as inadequate overall and the practice was placed in special measures. Specifically, the domains of safe, effective, responsive and well-led were assessed as providing inadequate services. The domain of caring was rated as good.

This report covers our findings in relation to the warning notice requirements only and should be read in conjunction with the latest comprehensive inspection report for the February 2017 inspection. This can be found by selecting the ‘all reports’ link for Durdells Avenue Surgery on our website at www.cqc.org.uk.

At this inspection in May 2017, we checked the progress the provider had made to meet the significant areas of concern as outlined in the Warning Notices dated 3 March 2017, for breaches of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We gave the provider until 30 April 2017 to rectify these concerns. The Warning Notices were issued because we found there were inadequate systems or processes to effectively reduce risks to patients and staff and ensure high quality care as follows:

• Patients were at risk of harm because systems and processes were not being followed to keep them safe. For example, not all staff had received training in safeguarding and emergency procedures were not adequate.
• The practice had no clear leadership structure and limited formal governance arrangements to ensure high quality care.
• Staff were able to report incidents, near misses and concerns; however the practice had not ensured that learning from such events was consistently shared with all staff to ensure improvements to care were made.
• A limited amount of clinical audits had been carried out, and there was no effective system to manage performance and improve patient outcomes.
• Staff were not adequately supported. There were gaps in training that staff required to perform their roles effectively, a lack of staff meetings and staff appraisals.

At our inspection on 9 May 2017 we found the provider had achieved compliance in regulation 12 as set out in the Warning Notice. We found the provider had achieved compliance in some areas of regulation 17 and regulation 18 as set out in the Warning Notices. However, there were still areas relating to these Warning Notices that required improvement. Our key findings were:

• There were systems in place to ensure significant events were reported and investigated.
• Clinical audits had been commenced and the practice could demonstrate patient outcomes were monitored.
• The practice had taken steps to reduce any potential health and safety risks for patients and staff.
• Risks were assessed and generally well managed with the exception of security of clinical areas.
• Staff had received the training necessary for them to carry out their roles effectively, however not all staff had received appraisals.
• The partners in the practice did not have the capacity to ensure high quality care.
• Complaints from patients were not responded to within appropriate time frames.

The other key lines of enquiry will be reassessed by us at another inspection when the provider has had sufficient time to meet the outstanding issues. At that time a new rating will be assessed for the provider. The outstanding issues that the practice must address are:

• Ensure that the process for handling and responding to patient complaints is in line with contractual agreements.
• Ensure that staff receive regular appraisals.
• Ensure a programme of audit and other activity is in place to monitor improvements to patients care and outcomes have been achieved.

In addition, the issues that the practice should address are:

• Review the security arrangements for clinical areas, so that blank prescription stationery is consistently kept secure.
• Review the arrangements to monitor staff training.
• Continue to review the process for recording and investigating significant events so learning and improvements to the quality of care can be demonstrated.

The ratings for the provider will remain in place until a comprehensive inspection is undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 April 2017

The provider was rated as good for caring and inadequate for safe, effective, responsive and well-led. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good caring practice.

• The practice nurse had a lead role in chronic disease management.
• Performance for diabetes related indicators was similar to the Clinical Commissioning Group (CCG) and national average. For example, 94% of patients with diabetes had an acceptable blood pressure reading recorded in the preceding 12 months compared to a CCG average of 93% and a national average of 91%. However, exception reporting for some diabetes indicators was higher than the CCG and national average.
• All these patients had a named GP.

Updated 6 April 2017

The provider was rated as good for caring and inadequate for safe, effective, responsive and well-led. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good caring practice.

• 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 mixed for all standard childhood immunisations.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the Clinical Commissioning Group average of 83% and the national average of 81%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• There was a designated information board aimed at families, children and young people.
• The practice worked with other professionals to ensure the needs of this group were met. For example, we saw evidence of meetings with health visitors.

Updated 6 April 2017

The provider was rated as good for caring and inadequate for safe, effective, responsive and well-led. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good caring practice.

• The practice offered home visits and on the day appointments.
• Nationally reported data showed that outcomes for patients for conditions commonly found in older patients were similar to national averages. For example, 93% of patients with chronic obstructive pulmonary disease, a lung condition, had a review within the previous 12 months compared to the clinical commissioning group (CCG) average of 92% and national average of 89%. However, exception reporting for this figure was 22% which was higher than CCG and national averages.
• The practice regularly reviewed patients who had unplanned admissions to hospital, to ensure their needs were met.

Updated 6 April 2017

The provider was rated as good for caring and inadequate for safe, effective, responsive and well-led. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good caring practice.

• The practice offered online services and health promotion and screening that reflects the needs for this age group.
• The practice offered catch up immunisations for students aged 17 and above.
• Extended hours appointments via the walk-in service were offered every Tuesday until 7pm.
• The practice offered on-line booking of appointments.

Updated 6 April 2017

The provider was rated as good for caring and inadequate for safe, effective, responsive and well-led. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good caring practice.

• A total of 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is higher than the CCG average of 86% and the national average of 84%. Exception reporting for this indicator was lower than CCG and national averages.
• A total of 95% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the last 12 months. This was higher than the CCG average of 89% and the national average of 88%. Exception reporting for this indicator was lower than CCG and national averages.

• The practice worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those 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 not undergone training in The Mental Capacity Act 2005.

Updated 6 April 2017

The provider was rated as good for caring and inadequate for safe, effective, responsive and well-led. The issues identified as inadequate overall affected all patients including this population group. There were, however, examples of good caring practice.

• The practice worked with multi-disciplinary teams in the case management of vulnerable patients.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• The practice did not keep a register of patients with a learning disability; we were told there were no patients with a learning disability registered at the practice.
• Staff could describe how to recognise signs of abuse in vulnerable adults and children. However, there was a lack of safeguarding training and appropriate safeguarding processes in the practice were not embedded. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns.