Archived: Dr Lionel Dean

Updated 12 October 2016

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection in January 2016, found issues relating to the safe, effective and well led domains and we asked the practice to make further improvements. We found Dr Lionel Dean’s practice required improvement for the safe, effective and well led domains. The practice was rated good for providing caring and responsive services.

The follow up focussed inspection on 27 September 2016 was undertaken to check whether the practice had made necessary changes following our inspection in January 2016. For this reason we have only rated the location for the key questions to which these relate. This report should be read in conjunction with the full inspection report of 12 January 2016.

At our inspection on the 27 September 2016, we found the practice had made improvements since our last inspection. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective and well led services.

Specifically we found:

• The practice had taken number of steps to improve the governance arrangements in the practice. This included policies and procedures being updated and reviewed. The practice had improved processes to identify, manage and mitigate safety risks.

• The patient participation group (PPG) was still in a formative stage, however new patients had joined the group and there had been two PPG meetings.

• The cleanliness of the practice had improved and there were effective systems to monitor the cleaning standards.

• Infection control had been improved. The infection control lead had ensured all staff had received training and they had sought support for their lead role. Infection control audits had been completed and actions taken. A legionella risk assessment had taken place and actions implemented.

• Staff had received appropriate recruitment checks and the recruitment policy had been amended to state which documentation was required for newly recruited staff. Disclosure and barring service checks had been completed for staff undertaking chaperone duties.

• Clinical performance and patient outcomes had improved for those patients with Asthma and Diabetes.

• Medical records from another practice which merged with Dr Lionel Dean had been summarised by July 2016.

• Medication reviews for all the practice patients were conducted in a timely manner.

• All staff had complete training records. The practice had implemented a system to highlight training which was due for update.

• The number of carer’s identified had increased since the last inspection.

The areas where the provider should make improvements are:

• Continue to develop the patient participation group, ensuring the group is effective and can influence and recommend improvements to the services provided to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 October 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff and GPs had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 91% of patients with diabetes, on the register, had achieved the target blood pressure reading in the last 12 months compared with a CCG average of 90% and national average of 91%.

• Diabetes indicators from the practice showed an improvement in recording blood sugar levels (below 75) from 62% in January 2015 to 81% in September 2016.

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

Updated 12 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 were similar to Clinical Commissioning Group (CCG) targets for all standard childhood immunisations.

• The practice were aware of national data for 2014/15 that reflected below average indicators in asthma management and had already matched or exceeded their Quality and Outcomes Framework target for the current year (2015/16).

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

• 81% of females aged 25-64 had attended cervical screening within a 5 year period compared with the CCG average of 77% and national average of 82%.

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

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

Updated 12 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 patients in its population.

• There was a named lead GP for care of patients over 75 years old.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

The practice had patients listed from three local care homes and carried out regular reviews of their care. The practice responded appropriately to these patients when an urgent review was required. The practice had achieved 100% of the Quality and Outcomes framework points for dementia care. This was better than the CCG average of 90% and national average of 95%.

Updated 12 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 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.

The practice provided a total of seven hours of extended clinical hours to accommodate appointments for this population group.

Updated 12 October 2016

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

• 95% of patients diagnosed with a severe mental health problem had a comprehensive, agreed care plan documented in their record, in the preceding 12 months, compared to the CCG average of 90% and national average of 88%.

• 88% of patients with a new diagnosis of dementia had received the appropriate blood level checks within a specified timescale, compared with the CCG average of 86% and national average of 82%.

• 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.

• 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.

Updated 12 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 with a learning disability and there was a lead GP for this patient group.

• 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 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.