Archived: The Surgery, Ashby

Updated 17 April 2018

The Surgery Ashby is situated in a village to the north west of the city of Leicester .

It has approximately 3,559 patients and the practice’s services are commissioned by West Leicestershire Clinical Commissioning Group (CCG). They are also a part of the North West Leicestershire Medical Alliance Federation. Thirteen GP practices work together to deliver healthcare for local communities.

The practice has a General Medical Services Contract (GMS). The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

At the Surgery Ashby the service is provided by one GP (male) and one long term locum GP (female), one practice manager, one nurse, one health care assistant, five administration and reception staff and one housekeeper.

Dr David Laurence Dawes has one location registered with the Care Quality Commission (CQC) which is:-

The Surgery Ashby, 30 North Street,, Ashby-de-la-Zouch, Leicestershire LE65 1HS

www.thesurgerynorthstreetashby.nhs.uk

The practice is a single storey building and has suitable access for patients who have reduced mobility.

The level of deprivation is significantly lower than local and national averages. The level of income deprivation affecting children and older people is below CCG average and well below national average.The level of deprivation is 11% compared to a CCG average of 14% and national average of 24%.

The practice has 33% of patients registered at the practice aged 0yrs to 18, 25.5% aged 18yrs to 64, 25% aged 65 and over, 12% aged 75 and over and 4% aged over 85 years of age. Of these 97% are white British.

The practice is open between 8.15am and 6pm Monday to Friday. When the practice is closed and between the times of 12.30 to 2pm and 6pm to 6.30pm the answerphone gives patients details to contact the practice mobile, 111 or 999. Appointments are available from 8.15am until 10.50am and 3.30pm to 5.30pm Monday to Friday. The practice does not offer extended hours. Pre-bookable appointments can be booked two months in advance and on the day emergency appointments were also available.

The practice has opted out of the requirement to provide GP consultations when the surgery is closed. The out-of-hours service is provided by Derbyshire Health United from 6.30pm to 8am. There are arrangements in place for services to be provided when the practice is closed and these are displayed on their practice website.

Updated 17 April 2018

Dr David Laurence Dawes (the provider) had been inspected previously at The Surgery Ashby on the following dates:

• 29 June 2017 under the comprehensive inspection programme. The practice was rated Inadequate overall and placed in special measures for a period of six months. Breaches of legal requirements were found in relation to safeguarding service users from abuse and improper treatment and governance arrangements within the practice. Warning notices were issued which required them to achieve compliance with the regulations set out in the warning notices by 20 October 2017.

• 6 December 2017 - A focused inspection was undertaken to check that they now met the legal requirements. Regulation 13, safeguarding service users from abuse and improper treatment had been met in full. However not all the requirements of the warning notice had been met in relation to Regulation 17 Good Governance. A requirement notice were issued and an action plan was sent, in which the practice identified what improvements would be put in place to ensure compliance of the regulation.

Reports from our previous inspections can be found by selecting the ‘all reports’ link for The Surgery Ashby on our website at www.cqc.org.uk.

This inspection was undertaken following a six month period of special measures and was an announced comprehensive inspection on 6 February 2018.

This practice is rated as Inadequate overall. (Previous inspection in June 2017 was inadequate).

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups.

The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

At this inspection we found:

• We found an improved system in place for reporting and recording significant events, lessons were shared to make sure action was taken to improve safety in the practice.

• The practice had an effective system in place to safeguard children and vulnerable adults from abuse.

• Patients’ health was not always monitored in a timely manner to ensure medicines were being used safely and followed up on appropriately.

• The practice did not routinely review the effectiveness and appropriateness of the care it provided. Care and treatment was not always delivered according to evidence- based guidelines. We found very limited evidence of care plans in place to ensure vulnerable older people, high risk patients and patients needing end-of-life care received care and treatment that is appropriate to their needs.

• There was limited quality improvement.

• Staff had not received an appraisal in the last 12 months.

• The most recent results from the national GP patient survey published in July 2017 was consistently high and showed extremely positive patient satisfaction in all of the 23 outcomes. The practice had been ranked top in Leicestershire.

• Feedback from people who use the service was consistently and strongly positive. 29 patients expressed high levels of satisfaction about all aspects of the care and treatment they received. The feedback from comments cards we reviewed told us that staff worked hard, had a caring attitude and were concerned about their patient’s wellbeing. The service provided was friendly, efficient, staff listened and gave you complete confidence.

• The practice had made improvements to their governance arrangements and had taken some of the appropriate steps required to ensure patients remained safe. Further work was still required in regard to quality improvement to improve patient outcomes, management of risk and meeting minutes.

• At this inspection we still had concerns in regard to the clinical oversight and governance arrangements in place.

The areas where the provider must make improvements as they are in breach of regulations are:

Ensure care and treatment is provided in a safe way to patients.

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

This service was placed in special measures on 17 August 2017. Insufficient improvements have been made such that there remains a rating of inadequate for this inspection.

At present we are not taking further action in line with our enforcement procedures as the practice have begun the process to merge with another local GP practice. They will remain in special measures.

The practice have been sent a letter in which we have set out all the concerns found at the inspection and the Commission require them to send us fortnightly action plans in respect of the areas of concern found at the inspection on 6 February 2018.

The service will also be kept under review and if needed further action could be taken in line with our enforcement procedures to begin the process of preventing the provider from operating the service which would lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 August 2017

The provider was rated as inadequate for safe and well led services. Effective was rated as requires improvement. Caring and responsive were rated as good. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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

• The nurse had the lead role in long-term disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less was 90.1% which was 1% below the CCG average and 1.2% below the national average. Exception reporting was 4.2% which was 1.2% below CCG average and 1.3% below national average.

• The percentage of patients with asthma, on the register, who had had an asthma review in the preceding 12 months that includes an assessment of asthma was 92.4% which was 13.1% above the CCG average and 16.8% the national average. Exception reporting was 6% which was 3.7% below the CCG average and 1.9% below national average.

• The percentage of patients with COPD who had had a review, undertaken by a healthcare professional was 93.6% which was 2.6% above the CCG average and 4% above the national average. Exception reporting was 2.1% which was 10.1% below the CCG average and 9.4% below national average.
• 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.

Updated 17 August 2017

The provider was rated as inadequate for safe and well led services. Effective was rated as requires improvement. Caring and responsive were rated as good. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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

• On the day of the inspection from the sample of documented examples we reviewed we found the systems to identify and follow up children living in disadvantaged circumstances and who were at risk were not effective.

• The practice’s uptake for the cervical screening programme was 85%, which was above the CCG average of 83% and the national average of 81%.

• Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given for vaccines for the under two year old and five year old was 90% which were comparable to CCG/national averages.

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

• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Updated 17 August 2017

The provider was rated as inadequate for safe and well led services. Effective was rated as requires improvement. Caring and responsive were rated as good. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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

• Not all staff had completed safeguarding training so we were not assured that staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered personalised care to meet the needs of the older patients in its population.

• 10.6% of the practice population are aged 75 and over.

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

• The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less was 84.6% which was 1.1% above the CCG average and 1.7% above the national average. Exception reporting was 5.5% which was 1.9% above the CCG average and 1.6% above national average.

• Where older patients had complex needs, the practice shared summary care records with local care services.

Updated 17 August 2017

The provider was rated as inadequate for safe and well led services. Effective was rated as requires improvement. Caring and responsive were rated as good. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The practice is therefore rated as inadequate for the care of working age people (including those recently retired and students).

• The practice understood its population profile and had used this understanding to meet the needs of its population. It offered accessible, flexible and offered continuity of care but did not have extended opening hours.

• 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.

Updated 17 August 2017

The provider was rated as inadequate for safe and well led services. Effective was rated as requires improvement. Caring and responsive were rated as good. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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

• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months 9.3% above the CCG average and 12.4% above the national average

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% which was above the CCG average of 95% and national average of 89%.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months was 100% which was above the CCG average of 95% and national average of 90%.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

Updated 17 August 2017

requires improvement. Caring and responsive were rated as good. The concerns which led to these ratings apply to everyone using the practice, including this population group.

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

• The practice offered longer appointments for patients with a learning disability.

• From information given to us on the day of the inspection we found that they could not evidence that any patients with a learning disability had received a review of their care in the last 12 months.

• The practice told us they regularly worked with other health care professionals in the case management of vulnerable patients but they did not formally document the discussions.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Not all staff had completed safeguarding training so we were not assured that staff were able to recognise the signs of abuse in vulnerable adults and children or if they were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies out of normal working hours.