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

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