Background to this inspection
Updated
31 March 2016
Dr Dijoux and Partner occupy a purpose built GP premises in Cleethorpes, North Lincolnshire.
They have a Primary Medical Services (PMS) contract and also offer enhanced services, for example, childhood vaccination and immunisation scheme, extended opening hours, facilitating timely diagnosis and support for people with dementia, annual health checks for people with learning disabilities, rota virus and shingles vaccination, remote care monitoring and minor surgery.
There are approximately 3650 patients on the practice list and the majority of patients are of white British background. The proportion of the practice population in the 65 years and over age group is higher than the England average. The practice population in the under 18 age group is lower than the England average. The practice scored six on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. The overall practice deprivation score is similar to the England average, the practice is 22.5 and the England average is 23.6. People living in more deprived areas tend to have a greater need for health services.
The practice has two male GPs. There is one partner and one salaried GP. There are two health care assistants, a practice nurse, and a complex case manager. There is a business partner, a deputy practice manager, a patient liaison manager and five reception and administration staff.
The practice is open between 8am and 6.30pm Monday to Friday and has extended hours from 6.30pm to 7pm on Monday to Friday. Appointments are available from 8am to 12pm every morning and 3pm to 6pm daily.
When the practice is closed patients use the 111 service to contact the Out Of Hours (OOH) provider. Information for patients requiring urgent medical attention out of hours is available in the waiting area, in the practice information leaflet and on the practice website.
Updated
31 March 2016
Letter from the Chief Inspector of General Practice
GOOD
We carried out an announced comprehensive inspection at Dr Dijoux and Partner on 10 February 2016. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
- There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
- Risks to patients were assessed and well managed.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Information about services and how to complain was available and easy to understand.
- Patients said they found it easy to make an appointment with a named GP and that 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 clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
- The practice should ensure audit second cycles are completed.
- The provider was aware of and complied with the requirements of the Duty of Candour.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
31 March 2016
GOOD
The practice is rated as good for the care of people with long-term conditions.
- Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
- The practice had recognised where their service for this group of patients was below average and had implemented a plan to improve this performance.
- Longer appointments and home visits were available when needed.
- All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the complex case manager worked with relevant health and care professionals to deliver a multidisciplinary package of care.
Families, children and young people
Updated
31 March 2016
GOOD
The practice is rated as good for the care of families, children and young people.
- 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.
- Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
- The practice’s uptake for the cervical screening programme was 87% which was comparable to the national average of 82%.
- 63% of patients diagnosed with asthma, on the register, had an asthma review in the last 12 months. This was worse than the national average of 90% however the practice had recognised this and had a plan to improve this performance.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
Updated
31 March 2016
GOOD
The practice is rated as good for the care of older people.
- The practice offered proactive, personalised care to meet the needs of the older people in its population.
- The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
Working age people (including those recently retired and students)
Updated
31 March 2016
GOOD
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.
- The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
People experiencing poor mental health (including people with dementia)
Updated
31 March 2016
GOOD
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- 97% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average (94%)
- The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
- The practice carried out advance care planning for patients with dementia.
- The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations and had a system in place to text patients if missed appointments or collecting their prescriptions.
- The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
- Staff had a good understanding of how to support patients with mental health needs and dementia.
People whose circumstances may make them vulnerable
Updated
31 March 2016
GOOD
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 including homeless people, travellers and those with a learning disability.
- The practice offered longer appointments for patients with a learning disability.
- The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
- The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
- 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.