Archived: Droylsden Road Family Practice

Updated 19 January 2017

Droylsden Road Family Practice is located on the outskirts of Manchester and is part of North Manchester Clinical Commissioning Group (CCG).

The practice is in a highly deprived area which sees higher than average health problems in chronic obstructive pulmonary disease (COPD- name for a collection of lung diseases), drug and alcohol addiction and a range of mental health issues.

The male life expectancy for the area is 73 years compared with the CCG averages of 73 years and the national average of 79 years. The female life expectancy for the area is 79 years compared with the CCG averages of 78 years and the national average of 83 years. The practice is in the most deprived decile.

The practice is based in a large two storey house. On the ground floor there was an entrance and reception area with a large waiting area. All the consulting rooms are located on the ground floor with two further smaller waiting areas.

The practice has two GP partners (one male and one female), with one practice nurse. Members of clinical staff are supported by one practice manager and administrative staff.

The practice is open from 8am until 6:30pm Monday, Tuesday, Thursday and Friday and Wednesday 8am until1pm. Appointments times are between 9am and 6pm.

The practice has a General Medical Service (GMS) contract with NHS England. At the time of our inspection 4715 patients were registered.

Patients requiring a GP outside of normal working hours are advised to call “ Go-to- Doc” using the usual surgery number and the call is re-directed to the out-of-hours service. The surgery were part of the GP Access scheme offering extended hours and weekend appointments to patients.

Updated 19 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Droylsden Road Family Practice on 21 October 2016. Overall the practice is now rated as inadequate.

The practice had previously been inspected on 8 March 2016. Following this inspection the practice was rated inadequate with the following domain ratings:

Safe – Inadequate

Effective – Inadequate

Caring – Inadequate

Responsive – Inadequate

Well-led – Inadequate

The practice provided us with an action plan detailing how they were going to make the required improvements. In addition, they wrote to us with updates on progression and actions that had been addressed.

A focused inspection took place on the 5th & 7th July 2016, to check that the practice had followed their submitted plan and to confirm that they now met legal requirements with the premises.

Following this re-inspection on 21 October 2016, our key findings across all the areas we inspected were as follows:

• Systems were still at a very early stage of development and had not been fully embedded throughout the practice. A large number of policies had been introduced or were at final review stage awaiting sign off; therefore the impact of their effectiveness could not be fully assessed.
• Patients were at risk of harm because clinical systems and processes were not fully embedded to keep them safe. For example no care plans were in place, this had been previously identified in the March 2016 inspection.
• Patients test results and hospital admissions follow ups were not actioned by clinicians in a consistent way with no clear process to ensure patient safety. We identified patients who had not received information regarding the outcome of their test results from several weeks previously.
• Patients were at risk of harm because of serious inconsistencies in the quality of recordings of consultations between clinicians. For example, a significant long term condition had not been documented in the record of one patient.
• Patient’s referrals were not being processed in a timely manner after consultation.
• Repeat prescriptions, medication reviews and re authorisation checks were not always actioned appropriately by the clinical staff. Administrative staff were given permission to issue prescriptions even if the review dates were overdue.
• The practice did not have a system in place to ensure that all clinical staff, including locum GP’S were kept up to date. The practice did not disseminate NICE guidelines or monitor that they were being followed. Medical alerts were not disseminated and there was no record that they had been actioned appropriately.
• Improvements to cleanliness and hygiene of the premises had been made in that, patient areas were visibly clean and tidy.
• Information for patients was more readily available on the new website. This now provided patients with the opportunity to access services online.
• The practice had a newly formed patient participation group (PPG) and a notice board in the reception area which provided feedback to patients about how the practice had responded to patient concerns and the improvements made.
• The provider was aware of and complied with the requirements of the duty of candour.

The practice did not provide safe or effective care to patients, we found clinical areas where the provider must make improvements, these areas are:

• The provider must ensure that all clinicians undertake care planning for all at risk patients.
• The provider must develop a process to ensure that all clinicians respond in a timely manner to patients changing needs, including clinical reviews on hospital admissions, hospital discharges and patients with a long term condition.
• The provider must ensure all patients’ referrals are actioned within a timely manner.
• The provider must introduce a procedure to ensure all patients test results are followed up and actioned in a timely manner and in a consistent and timely way to ensure patient safety.
• The provider must ensure patient’s consultations notes are up to date, with consultation notes containing adequate patient information to be clear and precise relevant medical information to protect the patient from future risk of harm.
• The provider must follow the prescribing policy and procedure for reviewing and re-authorising repeat medication in a safe and timely manner.
• The provider must have a process to disseminate NICE guidelines and medical alerts to all clinical staff, including locums and keep an auditable trail of any actions taken.

The areas where the provider should make improvement are:

• Follow practice policy when recruitment checks are carried for all new staff.
• Add the full address of the Parliamentary and Health Service Ombudsman( PHSO) in the complaints policy and the patients information leaflet.
• Maintain the new governance systems to ensure integrated fully into the practice.
• Provide all staff with an annual review and appraisal.
• Review and increase the numbers of carers on the practices carers register.
• Continually monitor and maintain the appointment system.

Enforcement action was taken against the provider on the 8th November 2016, when we issued an urgent notice of decision to immediately suspend their registration as a service provider (in respect of all regulated activities for which they are registered) for a period of three months. We took this action because we believed that a person would or might be exposed to the risk of harm if we did not take this action.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 January 2017

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

This is because the concerns identified in relation to how effective, caring and well led the practice was impacted on all population groups.

• Longer appointments and home visits were available when needed.
• The practice nurse was responsible for the management of patients with long term conditions.
• The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less(01/04/2014 to 31/03/2015) was 63% which was lower than the national average of 78%.

Updated 19 January 2017

The practice is rated as inadequate for the care of families, children and young people. This is because the concerns identified in relation to how effective, caring and well led the practice was impacted on all population groups.

• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The premises were suitable for pushchairs to access.
• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the three routine clinical practice (RCP) questions. (01/04/2014 to 31/03/2015) was 74% compared to the national average of 75%.

Updated 19 January 2017

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

This is because the concerns identified in relation to how effective, caring and well led the practice was impacted on all population groups.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Longer appointments and home visits were available for older people when needed.
• The percentage of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months (01/04/2014 to 31/03/2015) was 64% which was lower than the national average of 89.9%.

Updated 19 January 2017

The practice is rated as inadequate for the care of working age people (including those recently retired and students). This is because the concerns identified in relation to how effective, caring and well led the practice was impacted on all population groups.

• The surgery was part of the GP Access scheme offering extended hours and weekend appointments to patients.
• Telephone consultations were available for patients that required them.
• NHS Health checks were available to this population group.

Updated 19 January 2017

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). This is because the concerns identified in relation to how effective, caring and well led the practice was impacted on all population groups.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 59% which was lower than national average of 88.4%.
• There was no system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.
• The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to31/03/2015) was 77% which was lower than national average of 84%.

Updated 19 January 2017

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. This is because the concerns identified in relation to how effective, caring and well led the practice was impacted on all population groups.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• Staff knew how to recognise signs of abuse in vulnerable adults and children.