Drs King, Hill and Entwistle Also known as Haslington Surgery

Updated 15 June 2017

Drs King, Hill and Entwistle is based in the semi-rural village of Haslington in Cheshire; it is a less deprived area when compared with the rest of Cheshire. There were 6724 patients on the practice register at the time of our inspection. The practice has a higher than average number of older patients (60 to 85+ years) and lower than average number of younger patients (birth to 40 years).

The practice is managed by three partners (all male). Employed are a salaried GP (female), a practice manager, three nurses, reception and administration staff.

The practice is open 8am to 6.30pm on weekdays, no extended hours are offered.

Patients requiring GP services outside of normal working hours are referred on to the local out of hour’s provider N.E.W. operated by the East Cheshire Trust.

The practice has a General Medical Services (GMS) contract and has enhanced services contracts which include childhood vaccinations.

Updated 15 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs King, Hill and Entwistle on 7 June 2016. Overall the practice was rated as requires improvement. We rated the practice as requires improvement in the four domains of safety, effective, responsive and well led. We rated the practice good for the caring domain. The practice was issued with Requirement Notices and a Warning Notice. The full comprehensive report on the 7 June 2016 inspection can be found by selecting the ‘all reports’ link for Drs King, Hill and Entwistle on our website at www.cqc.org.uk.

We undertook an announced comprehensive inspection on 25 April 2017 to check that the practice had responded to the concerns which were identified during the inspection of 7 June 2016. The practice is now rated as good overall.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with their registered GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure and staff said they felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

There were areas where the provider should make improvement. The provider should:

• Develop a formal programme or plan of continuous clinical and internal audit.

• Good practice and National Institute for Health and Care Excellence (NICE) were used by staff but the provider should implement a system to ensure these guidelines were followed up and appropriate actions taken to stop this happening again.

• Review the staff training matrix to ensure accurate records are kept for the full training undertaken by staff.

• Ensure measures are in place to maintain the security of prescription forms used in printers when the printer is left unattended, such as overnight or when the consulting room is not in use.

• Undertake a risk assessment for the handling and use of liquid nitrogen.

• Ensure full records are completed for the system in place for cascading safety alerts.

• Complete full records for each significant event analysis including the analysis formto show the investigation that has been undertaken and what actions have been taken.

• Undertake an audit of all staff files to ensure f

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 15 June 2017

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

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• All these patients had a named GP and there was a system to recall patients for 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.

• The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required regular checks received these. There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• Practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health.

• The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

• Longer appointments and home visits were available for patients with long term conditions when these were required.

• Patients with multiple long term conditions could be offered a single appointment to avoid multiple visits to the surgery.

Updated 15 June 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency department (A&E) attendances. A GP was the designated lead for child protection. A regular safeguarding meeting was held with health visitors to discuss child protection concerns. Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

• Patients told us on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

• The practice monitored non-attendance of babies and children at vaccination clinics and a practice nurse told us they reported any concerns to relevant professionals.

• 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.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

• The premises were suitable for children and babies and baby changing facilities were available.

Updated 15 June 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population.

• Up to date registers of patients with a range of health conditions (including conditions common in older people) were maintained and these were used to plan reviews of health care and to offer services such as vaccinations for flu.

• The practice provided an enhanced service to prevent high risk patients from unplanned hospital admissions. This included these patients having a care plan detailing the care and treatment they required.

• GPs carried out regular visits to a local care home to assess and review patients’ needs and to prevent unplanned hospital admissions.

• Home visits and urgent appointments were provided for patients with enhanced needs.

• The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

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

Updated 15 June 2017

The practice is rated as good for the care of working-age people (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.

• Telephone consultations were provided and patients therefore did not always have to attend the practice in person.

• Extended hours appointments were not available.

• The practice provided a full range of health promotion and screening that reflected the needs of this age group. The practice was proactive in offering online services including the booking of appointments and requests for repeat prescriptions. Electronic prescribing was also provided.

Updated 15 June 2017

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

• The practice held a register of patients experiencing poor mental health and these patients were offered at least an annual review of their physical and mental health.

• The practice referred patients to appropriate services such as psychiatry and counselling services.

• The practice regularly worked with multi-disciplinary teams including in the case management of patients experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

• A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

• Processes were in place to prompt patients for medicines reviews at intervals suitable to the medication they were prescribed.

• Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

Updated 15 June 2017

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

• The practice held a register of patients living in vulnerable circumstances in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice worked with relevant health and social care professionals in the case management of vulnerable people.

• 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.

• Information and advice was available about how patients could access a range of support groups and voluntary organisations.