Drs Davies Henney Edney & Snowden Also known as Malpas Surgery Laurel Bank Malpas

Updated 5 August 2016

Drs Davies Henney and Edney (also known as Laurel Bank Surgery) is situated in Old Hall Street, Malpas, Cheshire. The practice is responsible for providing primary care services to approximately 6,600 patients. The practice serves a rural community which has lower than average levels of economic deprivation when compared to other practices nationally. The number of patients with a long standing health condition is about average when compared to other practices nationally. The practice offers a dispensary service to patients.

The staff team includes three partner GPs, three salaried GPs, four practice nurses, two health care assistants/phlebotomists, practice manager, dispensary staff and administration and reception staff.

The practice is open 8:00am to 6.30pm Monday to Friday. An extended hour’s service for routine appointments operates from the practice three times a week, on two evenings from 6.30pm to 8pm and on Saturday mornings. In addition an extended hour’s service and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patients closer to the Shropshire border were also able to access the out of hour’s service provided by Shropshire Doctors Cooperative Ltd (Shropdoc).

The practice has a General Medical Service (GMS) contract. the practice offers a range of enhanced services such as flu and shingles vaccinations, minor surgery and timely diagnosis of dementia.

Updated 5 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Davies Henney and Edney (Also known as Laurel Bank Surgery) on 10th May 2016.

Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
• There were systems in place to reduce risks to patient safety, for example, infection control procedures and the management of staffing levels. Improvements should be made to the storage of printable prescriptions and the recruitment procedure.
• The medication dispensary was overall managed safely. We identified some improvements that could be made to improve the operation of the dispensary.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff felt well supported. They had access to training and development opportunities and had received training appropriate to their roles.

• Patients generally said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw staff treated patients with kindness and respect.

• Services were planned and delivered to take into account the needs of different patient groups.

• Access to the service was monitored to ensure it met the needs of patients.

• Information about how to complain was available. There was a system in place to manage complaints.

• There were systems in place to monitor and improve quality and identify risk.

We saw areas of outstanding practice in how the practice cared for and responded to the needs of patients:

• Due to the rural location of the practice a number of community services could be difficult for patients to access. The practice had addressed this by providing a range of services to patients in-house. This included phlebotomy, pre-diabetic testing and lifestyle advice. Pre-diabetic and type 2 diabetes information packs had been devised by the practice nurse. The practice was also a host-site for the rural community ultrasound service and to a range of community services such as drug and alcohol support services, podiatry and counselling.

• The GPs operated personal lists encouraging patients to see their named GP for their on-going routine needs, providing continuity of care to patients. Results from the National GP Patient Survey from January 2016 (data collected from January-March 2015 and July-September 2015) showed that 90% of respondents with a preferred GP usually got to see or speak to that GP compared to the CCG average of 59% and national average of 59%.

• The practice worked closely with social workers from learning disability services to support patients. We were given examples of how nursing staff had supported patients with a learning disability to ensure they received the services required. For example, a practice nurse had accompanied an anxious patient to the local hospital. A carer told us that they found the practice to be extremely supportive of patients with a learning disability.

• The practice visited a local nursing home four times a week reviewing the needs of patients and managing acute conditions presented to them on the day.

• The practice had recently initiated a weekly teleconference call with the local hospital to improve speed and quality of patient discharge.

• One of the GPs was a Dementia Champion and had provided training to Patient Participation Group members and employees of local shops in support of the village becoming prepared to support people with dementia.

• The nursing team were recently involved in a healthy living promotion which focused on making the local community more aware of the causes of diabetes. This had involved the nurses visiting a local school and working with the children to produce posters supporting healthy eating.

• The practice worked closely with the Patient Participation Group (PPG) who had set up events and services to support the local community. For example the PPG organised local walks which helped to support socially isolated patients and improve health. A local fair had also been organised in 2014 with the aim of raising the profile of a number of community health and social care services. The practice had a sixth form student in their Patient Participation Group (PPG) who had worked with one of the GPs to set up a Facebook page to engage younger patients.

• The practice worked alongside patients and empowered them to be partners in their care. The practice had devised over 80 patient information leaflets so that patients had access to information about a number of conditions to help keep them informed and assist in identifying health issues and how to respond to them.

• A Patient and Equipment Fund which patients regularly donated to and raised money for was in operation and provided funds for equipment used by all patients such as a 24 hour blood pressure monitor, digital scales and home BP Monitors. The Patient and Equipment Fund provided funds for night sitters for patients in the last weeks of life where they or their families wished to keep the patient at home.

The areas where the provider should make improvements are:

• Document reviews of actions taken following the receipt of patient safety alert information to demonstrate that actions identified have been implemented.

• Review the procedure for the recruitment of locums to ensure references are taken for locums regardless of the length of their employment.

• Review the arrangements for the storage of loose-leaf prescriptions for use in printers to increase their security.

• In order to improve the effectiveness of the dispensary the standard operating procedures should be reviewed to ensure they reflect current guidance and legislation in relation to the management of controlled medications. The frequency for removing uncollected prescriptions should be more frequent to identify any issues with patients not collecting their medication. Dispensing errors should be more fully recorded so that lessons can be learned and outcomes monitored. There should be a more regular destruction of controlled medications to ensure that there is a limited amount on site.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 August 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. Diabetic dietetic and chronic disease lifestyle advice was provided to patients alongside individual care plans. The clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives.

Updated 5 August 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Families were registered with the same GP as far as possible to ensure GPs fully understood family dynamics and were any extra support may be needed. The staff we spoke with had appropriate knowledge about child protection and all staff had safeguarding training relevant to their role. The safeguarding lead staff liaised with midwives and health visiting colleagues to discuss any concerns about children and how they could be best supported. The practice had a sixth form student in their Patient Participation Group (PPG) who had worked with one of the GPs to set up a Facebook page to engage younger patients. The nursing team were recently involved in a healthy living promotion at a local school.

Updated 5 August 2016

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice visited a local nursing home four times a week reviewing the needs of patients and managing acute conditions presented to them on the day. The practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients. The Community Integrated Care Team was based in the same building as the practice which facilitated good communication. The practice had recently initiated a weekly teleconference call with the local hospital to improve speed and quality of patient discharge.  The practice was working with neighbourhood practices and the Clinical Commissioning Group (CCG) to provide services to meet the needs of older people. For example, they had piloted a community practice nurse for the frail elderly since October 2015 who visited frail housebound patients who had difficulty accessing the service. Each of these patients had a care plan which could be given to any visiting clinician.

Updated 5 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments up to four weeks in advance, book on the day appointments and telephone consultations. Patients could book appointments on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice was open from 8:00am to 6:30pm Monday to Friday allowing early morning and late evening appointments to be offered to this group of patients. An extended hour’s service for routine appointments was provided at the practice three times a week. In addition patients were able to access the extended hour’s service commissioned by West Cheshire CCG. The practice website provided information around self-care and local services available for patients. The practice offered health checks to patients aged 40 – 74 which helped identify potential health risks. Sexual health, family planning and minor injuries services were provided.

Updated 5 August 2016

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). GPs worked with specialist services to review care and to ensure patients received the support they needed. The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients experiencing poor mental health, including dementia, an annual health check and a medication review. The practice referred patients to appropriate services such as psychiatry and counselling services. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression. Clinical and non-clinical staff had undertaken training in dementia to ensure all were able to appropriately support patients. One of the GPs was a Dementia Champion and had provided training to Patient Participation Group members and employees of local shops in support of the village becoming prepared to support people with dementia.

Updated 5 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, p atient’s records were flagged for families in need, patients at risk of violence or abuse or requiring attention without delay. Longer appointments were offered to patients who required them, for example, patients with a learning disability. There was a recall system to ensure patients with a learning disability received an annual health check. The practice worked closely with social workers from learning disability services to support patients. We were given examples of how nursing staff had supported patients with a learning disability to ensure they received the services required. For example, a practice nurse had accompanied an anxious patient to the local hospital. The staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and all staff had safeguarding training relevant to their role. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff was the carer’s link and Information was provided to patients regarding services available for carers. The practice referred patients to local health and social care services for support, such as drug and alcohol services and to the wellbeing coordinator.