Archived: Debenham Group Practice

Updated 6 June 2017

The Debenham Group Practice is situated in Debenham, Suffolk. The practice area extends into the 43 outlying villages, has three surgery sites, and dispenses medicines to patients who live in these villages. The practice offers health care services to 8736 patients and has consultation space for GPs and nurses as well as for professionals including midwives, physiotherapists, and phlebotomists. We visited the dispensary but not the branch sites as part of this inspection.

The practice holds a Personal Medical Service (PMS) contract with the local Clinical Commissioning Group (CCG), and is a training practice with two GP trainers. A training practice has trainee GPs working in the practice; a trainee GP is a qualified doctor who is undertaking further training to become a GP. A trainer is a GP who is qualified to teach, support, and assess trainee GPs. There are currently two trainee GPs working in the practice.

• There are five GP Partners and one salaried GP at the practice (four female and two male GPs). There are two healthcare assistants, phlebotomist, two nurse practitioners, and three practice nurses. A team of six dispensary trained staff support the team leader.

• There is a team of 15 administration and reception staff support the business manager.

• The practice is open between 8am and 6.30pm Monday to Friday; extended hours are available on Thursday mornings and Monday evenings.

• Care UK provides out of hours care via the NHS 111 service.

• The practice told us that, since our last inspection, they had joined the Suffolk Primary Care Partnership which is a partnership of 11 practices.

Updated 6 June 2017

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Debenham Group Practice on 18 August 2016. The practice was rated as good overall with a rating of requires improvement for providing safe services. As a result of the findings on the day of the inspection the practice was issued with a requirement notice for Regulation 12 (Safe care and treatment). You can read our findings from our last inspections by selecting the ‘all reports’ link for Debenham Group Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 May 2017 to confirm that the practice had carried out the improvements needed to meet the legal requirements in relation to the breaches in regulations identified in our previous inspection on 18 August 2016. This report covers our findings in relation to those requirements.

The key findings from our inspection on 22 May 2017 were as follows:

• The systems and processes to ensure patients taking high risk medicines had been monitored appropriately had been improved.

• Two GP partners had taken a lead role in quality improvement and regular audits to monitor quality had been performed. We noted that this had led to more discussions amongst the clinical staff to further improve the electronic summaries of medical records.

• We found the practice had significantly improved the process to ensure that patients affected by national patient safety alerts were identified and their treatment reviewed in response to the alert. We reviewed the practice log which detailed the alert received and actions taken.

• Security arrangements had been implemented for blank prescription forms; pads were securely stored and there were systems to monitor their use.

• The practice had implemented a standard operating procedure for carrying out and recording stock checks of controlled drugs in line with national guidance and we saw that regularly stock checks of controlled drugs were recorded and where necessary actions taken.

• We also noted that, since our last inspection, the practice had made additional improvements. For example, a bar code scanner had been introduced in the dispensary to improve the dispensing process and dispensary staff described a process for ensuring second checks by another staff member or doctor when dispensing certain medicines, for example controlled drugs.

• A weekly news briefing was sent to all staff alerting them to updates, reminders, training, and news.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 September 2016

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 worked closely with the diabetic specialist nurse, ensuring that patients were treated and supported without the need to travel to the hospital.

• Longer appointments and home visits were available when needed this included for patients with a learning disability.

• 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Appointments were offered at the branch sites to ensure that patients who had difficulty in travelling could access routine follow up.

Updated 30 September 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 were in line with the national average for the 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.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice offered six week postnatal and baby checks.

• A full range of contraceptive care was offered at all sites including long acting contraceptives.

• We saw positive examples of joint working with midwives, health visitors, and school nurses.

Updated 30 September 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.

• They offered daily surgeries at both branch sites.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those that needed them.

• The practice looked after patients who lived in care homes and they offered proactive care for these patients and undertook regularly visits to the homes. The nurse practitioner also attended regularly to ensure that patients received holistic care for all their health needs.

• The practice hosted Age UK each month; this ensured that older patients could, if they wished, have face to face appointments with voluntary staff to gain support and advice.

Updated 30 September 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, 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 provided early morning appointments on two days and evening appointments on another day.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Smoking cessation and NHS health checks were encouraged.

• The practice was flexible with appointments; patients were able to make appointments at times that were convenient to them for routine and annual follow ups.

Updated 30 September 2016

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

• The practice had 63 patients diagnosed with dementia on the register. All of these patients had received an invite for an annual review, and 90% of these patients had received an annual review. The reviews included advance care planning. The remaining 10% were either not willing or it was not appropriate at this time to undertake the review.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice encouraged patients to access the Debenham Project (a local support group for dementia suffers and their carers).

• 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.

• Appointments were available with GPs on the day to ensure that any potential crisis or deterioration of situations were managed timely.

Updated 30 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There was a lead GP and nurse practitioner who actively managed the register of patients living in vulnerable circumstances including homeless people, travellers, and those with a learning disability. All of these patients received a review at six monthly intervals or sooner if needed.

• 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 were aware of their responsibilities regarding information sharing, and the documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• One GP worked at the local prison to ensure that those patients’ health care needs were met.