Letter from the Chief Inspector of General Practice
This practice is rated as Requires Improvement overall. The practice was previously inspected on 30 August 2016 and rated requires improvement for safe, effective and well led.
The key questions are rated as:
Are services safe? – Requires Improvement
Are services effective? – Good
Are services caring? – Requires Improvement
Are services responsive? – Good
Are services well-led? – Inadequate
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Requires Improvement
People with long-term conditions – Requires Improvement
Families, children and young people – Requires Improvement
Working age people (including those recently retired and students – Requires Improvement
People whose circumstances may make them vulnerable – Requires Improvement
People experiencing poor mental health (including people with dementia) - Requires Improvement
We carried out an announced comprehensive inspection at Dr Durston & Partners on 23 January 2018 to follow up breaches of regulation identified at our previous inspection undertaken on 30 August 2016. At our last inspection the provider was rated as requires improvement for key questions: Are services safe? Are services effective? Are services well led? We issued requirement notices in respect of breaches of regulation 11, 12, 17 and 18 of the Health and Social Care Act Regulations 2014. The concerns related to lack of adequate knowledge around consent, lack of safe management of medicines, infection control concerns which had not been adequately mitigated. The systems around the management of significant events, safeguarding, recruitment and training and appraisal and the arrangements for responding to emergencies were either absent or ineffective.
In addition to the breaches of regulation we also made recommendations of other actions the practice should take.
At this inspection we found:
Although some concerns highlighted on our last inspection had been addressed there were some areas where sufficient improvement had not been made.
For example:
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The systems in place to manage risk were not effective and did not ensure patients remained safe. The arrangements in place to respond to emergencies were not sufficient as there was no fire policy and not all staff had received basic life support and fire training in accordance with current legislation and guidance. Recruitment processes did not ensure that appropriate background checks had been completed or that risk assessments had been undertaken to consider their necessity. There was not adequate indemnity insurance in place for two members of nursing staff. Risks associated with the control and spread of infections were not being adequately assessed in the case of legionella and not sufficiently mitigated in the respect of furnishings in the treatment room.
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Although we witnessed staff treating patients with compassion, kindness, dignity and respect and patient feedback on the day of the inspection was largely positive; the practice had scored below the local and national average in respect of consultations with nurses. The practice was unaware of these lower scores and had taken no action in response to this.
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We were told that staffing continued to be an issue and that the current operational model was unsustainable due to the demands on the service, the high turnover of patients and the comparatively high level of deprivation among their population.
However we also found that:
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Although the practice had not met targets related to immunisations; clinical outcomes for patients were mostly in line with local and national averages and the practice had achieved good outcomes against the targets set within the CCG. Clinical audit was used to improve the quality of care.
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Most patients found the appointment system easy to use and reported that they were able to access care when they needed it.
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Practice staff were active within other local healthcare organisations which worked to improve the care provided to patients in the local area.
The areas where the provider must make improvements are:
The areas where the provider should make improvements are:
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Continue with work aimed at identifying patients with caring responsibilities to be able to provide appropriate support and signposting.
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Consider ways to formally record discussions around significant events, complaints and clinical updates.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice