Archived: Open Door (Health) Limited Also known as Open Door (Health) Limited 1-1174453782

Updated 20 October 2016

Open Door (Health) Limited  operates from premises purpose-built in 2013. The practice area covers North East Lincolnshire. It provides GP and practice nurse access along with social care for a small number of patients who have been removed from other GP lists in the area for exhibiting violent and aggressive behaviour.  There is a disabled parking space at the rear of the building. All patient services are on the ground floor.

The practice has one male GP, two practice nurses and a healthcare assistant. They are supported by an operational manager, clinical services manager, two receptionists and a medical administrator.

The majority of patients are of white British background. The practice population profile is higher than the England average for the 20-44 years age group and lower than the England average for the other age groups apart from 0-4yrs which is similar to the England average. The practice scored one on the deprivation measurement scale, the deprivation scale goes from one to ten, with one being the most deprived. People living in more deprived areas tend to have a greater need for health services.

The practice was open between 8am and 6.30pm Monday to Friday. GP appointments were from 9am to 4.30pm to Monday, Wednesday and Friday. Nurse appointments were available 8am to 5pm Monday to Friday with extended hours until 7pm on Thursday. In addition to pre-bookable appointments that could be booked up to three weeks in advance, urgent appointments were also available for people that needed them.

Out of Hours care (from 6.30pm to 8am) is provided through the local out of hours service.

Updated 20 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Open Door (Health) Limited on 7 July 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 managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The majority of patients said they were treated with compassion, dignity and respect. However, some patients said they did not feel supported, listened to and involved in decisions about their care.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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 provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

• The Herbert protocol is a national scheme for patients with dementia. It records vital information about the person in advance. Information such as medication, description, photograph, significant places in the person’s life and their daily routine. This can then be used in event of a vulnerable person going missing. The information will help the police and other agencies locate the missing person as quickly as possible and return them to safety. The practice apply the Herbert protocol to all their patients with dementia.
• Nursing staff used a memory box to occupy patients with dementia whilst their carer receives treatment. (The memory box contained items from the patients’ earlier life and times and helped reassure and calm them).

The areas where the provider must make improvement are:

• Ensure there is an appropriately qualified and clinically skilled individual present when the practice is open to see patients on days when the GP is absent.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Risk assesses the lack of provision of emergency oxygen.

The areas where the provider should make improvement are:

• Obtain appropriate emergency medicines and ensure safe systems are put in place for their safe storage and management.
• Put in place a system for the checking and maintenance of the defibrillator.
• Record actions following the receipt of national safety alerts.​

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 October 2016

The practice is rated as requires improvement 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.
• 77% of patients on the diabetes register had a record of a foot examination and risk classification within the preceding 12 months (01/04/2014 to 31/03/2015). This was below the clinical commissioning group (CCG) average of 91% and the national average of 88%.
• 86% of patients with diabetes, on the register, had an influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015). This was below the clinical commissioning group (CCG) average of 97% and the national average of 94%.
• 54% of patients with COPD 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). This was below the CCG average of 91% and the national average of 90%.
• 60% of patients with asthma, on the register, had an asthma review in the preceding 12 months that includes an assessment of asthma control using the 3 RCP questions. (01/04/2014 -31/3/2015). This was below the CCG average of 79%and the national average of 75%
• Longer appointments were available when needed.
• 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 20 October 2016

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 comparable to CCG and national averages 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 78%, which was below the CCG average of 85% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 20 October 2016

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 urgent appointments for those with enhanced needs.

Updated 20 October 2016

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 offered a full range of health promotion and screening that reflects the needs for this age group. Online services were not offered.

Updated 20 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This is better than the CCG average of 90% and the national average of 84%.
• 100% of patients with schizophrenia and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months. This is better than the CCG average of 93% and the national average of 88%.
• 57% of patients with schizophrenia, and other psychoses had their alcohol consumption recorded in the preceding 12 months. This is below the CCG average of 94% and the national average of 90%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.
• 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.
• The Herbert protocol is a national scheme for patients with dementia. It records vital information about the person in advance. Information such as medication, description, photograph, significant places in the person’s life and their daily routine. This can then be used in event of a vulnerable person going missing. The information will help the police and other agencies locate the missing person as quickly as possible and return them to safety. The practice apply the Herbert protocol to all their patients with dementia.
• Nursing staff used a memory box to occupy patients with dementia whilst their carer receives treatment. (The memory box contained items from the patients’ earlier life and times and helped reassure and calm them).

Updated 20 October 2016

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 other health care professionals in the case management of vulnerable patients.
• 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.