Archived: Dudley Partnerships for Health LLP

Letter from the Chief Inspector of General Practice

We first inspected Dudley Partnerships for Health LLP in February 2016 as part of our new comprehensive inspection programme. As a result of our inspection, the practice was placed in special measures. The practice was rated as Inadequate overall. This was because we identified regulatory breaches in relation to regulation 12 for providing safe care and treatment and regulation 17 due to inadequate governance arrangements. Furthermore, we identified areas where the provider must make improvements and additional areas where the provider should improve.

We carried out an announced comprehensive inspection at Dudley Partnerships for Health LLP on 12 October 2016. This inspection was also conducted to see if improvements had been made in line with the special measures period of six months. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• We saw that staff were friendly and helpful and treated patients with kindness and respect. Staff spoken with demonstrated a commitment to providing a high quality service to patients.

• During our previous inspection in February 2016 we found that the practice did not operate effective systems to support monitoring specific to high risk medication and also for the management of pathology results. During our most recent inspection we observed that a more effective process had been utilised in the practice to allow for adequate monitoring of high risk medication. Furthermore, we saw how following our previous inspection the practice had strengthened their process for managing pathology results.

• An effective programme of clinical audits was implemented and used to monitor quality and to make improvements. We saw that practice continually monitored areas such as prescribing, record keeping and infection control.

• Governance arrangements were strong in some areas such as security of prescription stationery, management of pathology results and for monitoring emergency medicines. However, in other areas governance arrangements were not as robust and we found that further to our previous inspection, there were some protocols which were not embedded effectively.

• We found that there was no clear scheme of delegation in the practice which outlined roles and responsibilities giving clear lines of accountability.

• Although staff were aware of lead roles across key areas such as safeguarding, we found that staff were not always aware of some of the responsibilities of their colleagues that were specific to key processes. For example, mixed feedback regarding the management of clinical post highlighted that the process was not well embedded or effectively monitored.

• Unverified data provided by the practice during our inspection demonstrated that improvement had been made in some performance areas, such as areas the Quality and Outcomes Framework (QOF).

• Recently published QOF results for 2015/16 highlighted that the practices QOF achievement had significantly decreased. However, these results were based on partial data because the practice opted in to a local quality framework from October 2015. Although we received data from the clinical commissioning group (CCG) which demonstrated how the practice was performing across areas of the local framework, during our inspection we did not receive assurance from the provider to demonstrate how the practice actively monitored their performance under most areas of the new local quality framework.

• The practice held a variety of meetings and some of the practice staff members attended joint quarterly clinical governance meetings with staff from practices within the wider partnership. We saw that topics such as significant events and complaints were discussed during these meetings however we could not see that opportunities to share learning on a wider scale were maximised across the partnership.

• We saw that the practice was working through an action plan which had been developed in response to the results of the national GP patient survey, with specific actions in place to improve aspects of care, communication and access. We found that some measures had been implemented to improve this which included increasing clinical sessions and offering extended hours.

The areas where the provider must make improvements are:

• Ensure that governance arrangements are robust across all areas and ensure that policies are well embedded to support practice systems and processes in all areas including repeat prescribing, management of clinical post and monitoring of uncollected prescriptions.

The areas where the provider should make improvements are:

• Ensure that effective leadership is sustained in the practice in order to enable and support the team to continue to work on improving areas identified for improvement from the national GP patient survey responses.

• Maximise opportunities to share learning and good practice across the wider partnerships and use these as opportunities to proactively drive improvement.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dudley Partnerships for Health, Quarry Road Surgery on 10 February 2016. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

• There was a system in place for reporting and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns. However, we identified further incidents that were managed effectively but not formally recorded and that therefore the practice was missing opportunities for learning.

• Governance arrangements were not robust. The practice had a number of policies and procedures to govern activity. However not all of these were practice specific, such as the practices policy for infection control. We identified gaps in the arrangements for managing, recording and mitigating risks. 
• During our inspection we found that the practice was not operating an effective system with regards to monitoring high risk medicines. We also identified a back-log of blood test results for review on the clinical system which demonstrated that the practice had failed to follow appropriate protocols with regards to the management of pathology results.
• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement.

• Members of the management team had identified that the practice needed to be more opportunistic and proactive when identifying patients with long term conditions. Staff explained that clinical coding needed to be reviewed, to ensure patient population lists and chronic disease registers were a true reflection of the practices population.

• We noticed that members of staff were courteous and helpful to patients both attending at the reception desk and on the telephone.

The areas where the provider must make improvements are:

• The provider must ensure processes are robust for reporting and managing significant events, incidents and near misses, ensure all events are recorded.

• The provider must carry out clinical audits including re-audits to ensure improvements have been identified and achieved and improve governance arrangements including systems for recording, assessing and mitigating risks across the practice.

• Ensure robust protocols are implemented with regards to monitoring high risk medicines and review of pathology results.

• Improve governance of records across the practice to ensure that policies and protocols are practice specific and to ensure that records are maintained to reflect the management and mitigation of risks assessed.

The areas where the provider should make improvement are:

• Continue to support the practices patient participation group (PPG) through a programme of regular meetings governed by minutes and monitoring systems to implement improvements at the practice.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made so a rating of inadequate remains for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice