Archived: Drayton Road Surgery

Updated 11 February 2016

Drayton Road Surgery is located in Bletchley in Milton Keynes. It is part of the NHS Milton Keynes Clinical Commissioning Group (CCG). The total practice population is 2856. Available information shows the practice to have a higher than average population of males aged between 30 to 54 years and females aged between 30 to 49 years. There are significantly lower than average populations of both males and females aged from 70 years to over 85 years. Whilst the percentage of its patient population that are in employment is similar to national averages, the percentage unemployed is significantly higher. The national average across England is 6.2% in comparison to the practice figure of 12.9%. National data indicates that the area is one of moderate deprivation, with a higher than national average value for children affected by deprivation.

This is a singled handed GP practice with one male GP and two female nurses working alongside a practice manager, three receptionists and three administration staff. There is a female locum GP who attends the surgery once a week. The practice holds a General Medical Services (GMS) contract with NHS England for providing services.

The practice is open from 8am to 8pm on Mondays and from 8am to 6.30pm Tuesday to Friday. Appointments with a GP are available from 9am to 12pm and from 4pm to 6pm Monday to Friday. Extended hours appointments are available on Mondays between 6.30pm and 8pm. Appointments with a nurse are available from 8am to 1pm Monday to Thursday and from 8am to 11am on Fridays.

Updated 11 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drayton Road Surgery on 1 December 2015. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews and investigations were not thorough enough. Learning and outcomes were not always shared to reduce the risk of reoccurrence.
• Risks to patients were assessed but were not always actioned, such as those relating to safety alerts, legionella and infection control.
• Data showed patient outcomes were good for the locality. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and were cared for.

• Information about services was available but information on how to complain was not clearly signposted.

• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity which were regularly reviewed, with the exception of some Patient Group Directions.
• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Investigate significant events and complaints thoroughly and ensure that required action is taken and outcomes and learning are shared to reduce the risk of reoccurrence.

• Ensure medicines are managed appropriately and that a cold chain policy is developed and followed with regard to the storage of vaccines.

• Ensure that patients’ medication is kept under review to minimise risks associated with taking medicines that require monitoring.

• Review all emergency equipment and medicines to ensure they remain ready for use in a medical emergency.

• Improve staff knowledge and understanding of responsibilities regarding appropriate safeguarding of vulnerable adults.

• Take action to mitigate the risks identified in legionella and infection control audits.

• Develop an effective system for allocating roles and responsibilities to ensure identified risks are monitored.
• Take account of the risks associated with the future sustainability of the practice, giving adequate provision to succession planning in light of proposed staff changes and the increased demand on the service.

In addition the provider should:

• Improve procedures for updating Patient Group Directions.

• Provide patients with clear information on how to complain.

• Implement a system for responding to uncollected prescriptions on patients’ records.
• Encourage a more systematic approach to registering carers.
• Develop more formalised processes for multi-disciplinary meetings and discussions to improve outcomes for vulnerable and high risk patients.
• Complete full cycle audits to evaluate and improve the quality of services provided.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups the practice will be re-inspected within six months after the report is published. If, after re-inspection, the practice has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place the practice into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 11 February 2016

The provider was rated as inadequate for providing safe services and requires improvement for being effective, responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were however, some examples of good practice.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. These patients received a structured annual review and had tailored care plans that were updated. Interim reviews were available for patients that required them. There was a register of palliative care patients but they did not have care plans. Although district nurses attended the surgery regularly, we were not shown any evidence of palliative care patients being discussed or actions taken to improve their care.

Updated 11 February 2016

The provider was rated as inadequate for providing safe services and requires improvement for being effective, responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were however, some examples of good practice.

There were systems in place 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw limited evidence of working with health visitors who we were told visited the practice on an ad hoc basis and as needed. The practice’s uptake for the cervical screening programme was 82.12% which was comparable to the national average of 81.88%.

Updated 11 February 2016

The provider was rated as inadequate for providing safe services and requires improvement for being effective, responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were however, some examples of good practice.

Nationally reported data showed that outcomes for patients were good in conditions commonly found in older people. Patients aged over 75 were invited for health checks and the practice kept registers of patients’ health conditions to enable them to offer appropriate services, such as flu vaccines. It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. We saw that staff were considerate of the needs of these patients and would offer additional assistance if required, for example arranging transport home from the practice and phoning patients to ensure they had arrived home safely.

Updated 11 February 2016

The provider was rated as inadequate for providing safe services and requires improvement for being effective, responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were however, some examples of good practice.

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. For example, the practice had extended surgery hours to encompass evening appointments on Mondays at the request of patients. We were told that these appointments were specifically for patients who were unable to attend the practice during normal working hours. Patients were able to order repeat prescriptions online; however, the practice had not extended its online services to include appointment booking. The practice had struggled to provide NHS health checks for patients aged 40-74 and had only completed 197 health checks since starting the initiative in 2012 (there were 1080 eligible patients at the practice).

Updated 11 February 2016

The provider was rated as inadequate for providing safe services and requires improvement for being effective, responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were however, some examples of good practice.

83.3% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. The practice held a register of patients suffering from mental health conditions and although they did not attend multi-disciplinary meetings these patients received regular reviews. These patients were offered flexibility of appointments and the small practice population meant that these patients were easily recognised by the practice staff. The practice had told patients experiencing poor mental health how to access various support groups and organisations. The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. We saw evidence that required staff had received training in dementia.

Updated 11 February 2016

The provider was rated as inadequate for providing safe services and requires improvement for being effective, responsive and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group. There were however, some examples of good practice.

The practice held a register of patients with learning disabilities and staff were aware of the number of patients. There were nine patients on the register and four had received an annual review in the 12 months prior to our inspection. The GP was unaware of a translator services available and advised us he had never struggled to communicate with a patient. The practice had information on various support agencies available to patients. Carers were supported particularly well by the practice. These patients received a telephone call from one of the receptionists to check on their status and wellbeing and offer support as needed. There was evidence to show that staff had received training on safeguarding adults and children. However, when questioned they could only demonstrate an understanding of the requirements for protecting children. There was a policy for safeguarding adults and the staff when questioned discussed any action they would take if they suspected a patient was the victim of domestic violence. They were unable to identify any other safeguarding concerns for adults that they would need to identify and action.