Dr Nederlof and Partners Also known as Riverside Surgery

Updated 15 May 2017

Dr Swindlehurst and Partners provides care for approximately 14,400 patients. The service is located in Evesham and covers Evesham town and surrounding areas. The practice holds a General Medical Services (GMS) contract with NHS England. The GMS contract is the contract between general practices and NHS England for delivering primary care services to local communities.

The practice is managed by seven GP partners (five male, two female) who between them provide 56 clinical sessions per week and seven administration sessions. Clinical sessions are also covered by locum GPs. Since our previous inspection in May 2016 a full time pharmacist has been employed. GPs are supported by an advanced nurse practitioner, five practice nurses and four health care assistants (HCA). Nurses and HCAs provide cervical screening, vaccinations, review of long term conditions, health checks and phlebotomy (taking blood samples) services. The practice employs a practice manager, a deputy practice manager, two senior receptionists, 13 receptionists, two administrators and one medical secretary.

The practice offers a range of clinics for chronic disease management, diabetes, heart disease, cervical screening, contraception advice, minor surgery, injections and vaccinations.

The practice is open from 8am until 6.30pm every weekday with the exception of Wednesdays when the practice opens until 8pm. Appointments are available from 8.30am until 12.30pm and from 3pm until 5.30pm daily. Extended hours appointments are available on Wednesdays from 6pm until 8pm for family planning appointments and for patients to receive health checks by a HCA.

The practice accepts medical students for experience and teaching purposes.

Patients who live in excess of one mile from a pharmacy are eligible to have their prescribed medicines dispensed from the practice. This equates to 33% of registered patients. Medicines can be collected from the practice or any of the designated outlets. The opening hours are from 8.30am until 6pm every weekday. The dispensary is under the overall responsibility of the pharmacist, has a dispensary manager, three dispensers and one trainee dispenser. There is a delivery service every morning for patients who are unable to access the practice.

The practice has opted out of providing GP services to patients out of hours such as nights and weekends. During these times GP services are provided currently by a service commissioned by NHS South Worcestershire Clinical Commissioning Group (CCG). When the practice is closed, there is a recorded message giving out of hours’ details. The practice leaflet also includes this information and there are leaflets in the waiting area for patients to take away with them.

We carried out an announced comprehensive inspection at Dr Swindlehurst and Partners on 11 May 2016. The overall rating for the practice was requires improvement. The provider was rated inadequate for safe and requires improvement for well led. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Swindlehurst and Partners on our website at www.cqc.org.uk.

This inspection was undertaken to ensure the required improvements had been made and was an announced comprehensive inspection on 31 January 2017.

Updated 15 May 2017

Letter from the Chief Inspector of General Practice

We had previously carried out an announced comprehensive inspection of Dr Swindlehurst and Partners on 11 May 2016. As a result of our inspection the practice was rated as requires improvement overall and inadequate for providing safe services. The full comprehensive report for the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Swindlehurst and Partners on our website at www.cqc.org.uk.

During the last inspection we identified a breach of:

• Regulation 12; Safe care and treatment:

• The registered person did not do all that was necessary to manage and mitigate risks to the health and safety of service users.

• The provider did not have a robust process to ensure appropriate action is taken following receipt of patient safety alerts.

• Processes and systems had not been implemented in relation to medicines management to ensure safe and appropriate storage of vaccines and prescription forms for use in printers.

As a result we identified areas the provider must improve:

• Implement a process to ensure appropriate action is taken following receipt of patient safety alerts.

• Processes and systems to be implemented and monitored in relation to medicines management to ensure safe and secure storage of vaccines and prescription stationery including the use and storage of prescription pads and blank prescription paper.

We also identified further areas the provider should improve:

• Ensure lessons are learnt from incidents and near misses.

• Develop ways to monitor and improve patient satisfaction.

• Ensure training and support for staff to enable them to carry out their roles for example, in infection control.

Following the inspection the practice sent us an action plan detailing the actions they were going to take to ensure improvement.

We carried out a further comprehensive inspection on 31 January 2017 to check that the provider had made improvements in line with our recommendations and to ensure regulations were now being met. Overall the practice is now rated as good.

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

• There were clearly defined processes and procedures to ensure patients were safe and an effective system in place for reporting and recording significant events. They were fully reviewed at every staff meeting.
• Patients’ needs were assessed and care delivered in line with current guidelines. Staff had the appropriate skills, knowledge and experience to deliver effective care and treatment.
• Patients told us they were treated with dignity, respect and compassion. Patients were involved in decisions about their care and treatment.
• Urgent same day patient appointments were available when needed. All patients we spoke with and those who completed comment cards before our inspection said they were always able to obtain same day appointments.
• Information about how to complain was available and easy to understand. The practice received very few complaints from patients and reviewed complaints to ensure lessons learned were not repeated.
• Patients said GPs gave them enough time.

• Staffing levels were monitored and reviewed when a member of staff left or when service level dictated. Safe arrangements were in place for staff recruitment that protected patients from risks of harm.

• The practice was visibly clean and measures were taken to prevent unnecessary infections.

• There was a clear leadership structure and staff told us they felt well supported by senior staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 15 May 2017

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

• Patients had a named GP and a review every six to 12 months to monitor their condition and ensure they received correct medicines. The frequency of the review depended on the severity of the patient’s condition.

• Nursing staff had lead roles in chronic disease management.

• Longer appointments and home visits were available when needed. Two practice nurses carried out home visits for health reviews of those patients who were unable to access the practice.

• Clinical staff worked with health and care professionals to deliver a multidisciplinary package of care.

• Where necessary patients in this population group had a personalised care plan and risk assessment in place and they were regularly reviewed.

Updated 15 May 2017

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

• Systems were in place to identify children and young people who might be at risk, for example, those who had a high number of A&E attendances.

• There were appointments outside of school hours and the practice building was suitable for children and babies.

• Outcomes for areas such as child vaccinations were in line with or above average for the Clinical Commissioning Group (CCG).

• Alerts were put onto the electronic record when safeguarding concerns were raised.

• There was regular liaison and monthly meetings with the health visitors to review those children who were considered to be at risk of harm.

• Extended hours were in place for patients to attend for the family planning service every Wednesday from 6pm until 8pm.

• Appointments were available for patients to attend for health checks with a health care assistant every Wednesday from 6pm until 8pm.

Updated 15 May 2017

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

• Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

• Staff kept up to date registers of patients’ health conditions and information was held to alert staff if a patient had complex needs.

• Care plans were in place with the most vulnerable older patients and used with multi-disciplinary teams to reduce unplanned hospital admissions. These patients had an alert placed on their patient records to ensure clinical staff were aware.

• Practice staff worked with other agencies and health providers to provide patient support.

• The Proactive Care Team (PACT) assessed frail patients in their own home and those in care homes to ensure their health needs were met.

• Home visits were offered to those who were unable to access the practice and patients with enhanced needs had prompt access to appointments.

• A GP was responsible for visiting a care home that had been delegated to the practice for provision of medical care.

Updated 15 May 2017

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

• The practice ensured it provided services to meet the needs of the working age population. For example, extended hours appointments were available on Wednesday evenings for health checks and family planning services.

• Telephone consultations were available for patients who were unable to reach the practice during the day.

• All patients who requested a same day appointment received a phone call from a GP to enquire about their symptoms and to determine if advice only or a face to face appointment was needed.

• Online services were available for booking appointments and ordering repeat prescriptions.

• Practice staff encouraged patients to attend for health screening procedures to promote their health.

• The practice website gave advice to patients about how to treat minor ailments without the need to be seen by a GP.

Updated 15 May 2017

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

• The practice worked with multi-disciplinary teams to provide appropriate care for patients with poor mental health. This included patients with dementia.

• Patients who experience poor mental health had received an annual physical health check.

• Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experienced poor mental health, including those with dementia.

• An enhanced service included GPs carrying out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. This enabled staff to put a care package in place that provided health and social care support systems in place to promote patients well-being.

• Referrals to other health professionals were made when necessary.

• Staff had a good understanding of how to support patients who had dementia and who experienced mental health illness.

Updated 15 May 2017

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

• Practice staff regularly worked with multi-disciplinary teams in the case management of vulnerable patients and these patients had been signposted to additional support services.

• There was a register of vulnerable patients including those with a learning disability.

• Longer appointments were available for patients with a learning disability.

• Staff knew how to recognise signs of abuse, the actions they should take and their responsibilities regarding information sharing.

• There was a clinical lead for dealing with vulnerable adults and children.

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

• The practice worked with multi-disciplinary teams to provide appropriate care for patients with poor mental health. This included patients with dementia.

• Patients who experience poor mental health had received an annual physical health check.

• Practice staff regularly worked with multi-disciplinary teams in the case management of patients who experienced poor mental health, including those with dementia.

• An enhanced service included GPs carrying out assessments of patients who experienced memory loss in order to capture early diagnosis of dementia. This enabled staff to put a care package in place that provided health and social care support systems in place to promote patients well-being.

• Referrals to other health professionals were made when necessary.

• Staff had a good understanding of how to support patients who had dementia and who experienced mental health illness. The practice had identified 3% of patients as carers.