Drs Parnell, Albardiaz, James and Dale Also known as Northiam / Broad Oak Surgery

Updated 2 March 2017

Dr James & Partners provides general medical services to the residents of Northiam, Brede, Broad Oak and the surrounding area. The practice population is approximately 6100 patients There are three GP partners (two male and one female) and one salaried GP (female) who are supported in their clinical work by two practice nurses and two health care assistants (HCAs). There is a practice manager, five part time receptionists and nine part time dispensers. There are four part time members of the administrative staff. There is some cross over of skills between some of the receptionists and dispensers and some staff are therefore trained to cover more than one role if required.

The practice is a training practice and trains qualified doctors who wish to be GPs.

The practice is open between 8.00am and 6.30pm Monday to Friday. Appointments are from 8.30am to 11.30am every morning and 3.30pm to 6.00pm Monday to Thursday afternoon and 2.00pm to 4.00pm on a Friday afternoon. Extended surgery hours are offered every Saturday from 8.30am to 10am. Booked appointments are from 8.30am to 9.00am and urgent appointments are available from 9.00am to 10.00am.

The Broad Oak branch has appointments available from 08.30am to 11.30am on Monday to Thursday mornings and from 3.30pm to 6.00pm on a Wednesday afternoon.

When the practice is closed they are covered by an out of hours service that is accessed by dialling 111.

Drs James & Partners main surgery is:

The Surgery, Main Street, Northiam,Rye,TN31 6ND.

They also have a branch at:

Broad Oak 6 Reedswood Road, Broad Oak, Brede, East Sussex TN31 6DH.

Both surgeries have a dispensary for dispensing medicines to patients. We inspected aspects of the dispensary at the Broad Oak site as well as the Northiam site. The remainder of the inspection took place just at the Northiam site.

The practice provides a range of clinics and services including clinics for patients with diabetes, respiratory and heart conditions, childhood immunisations, a travel clinic. and clinics to monitor treatment with blood thinning medicines. The surgery also offers a counselling service, smoking cessation and well person clinics. Minor injuries can be treated at the surgery.

The practice also offers a range of minor surgery procedures including cryotherapy (a treatment to freeze lesions such as warts), excision of moles and small skin lesions as well as removing in growing toe nails.

The percentage of patients under 18 is lower than the national average and the percentage older than 65 is almost twice the national average. Deprivation scores for the area are low compared with the national average.

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr James & Partners on 5 January 2016. The overall rating for the practice was good, but breaches of legal requirements were found in the safe domain. The practice sent to us an action plan detailing what they would do in relation to the shortfalls identified and the action taken in order to meet the legal requirements in relation to the following:-

• Not all staff were trained in the safeguarding of vulnerable adults and not all clinical staff were trained in the Mental Capacity Act of 2005.
• Not all staff had been risk assessed as to whether a Disclosure and Barring Service (DBS) check was required to carry out their roles and not all clinical staff had been subject to enhanced DBS checks. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Infection control audits were not being carried out on a regular basis. Additionally there was no comprehensive action plan to identify any infection prevention and control issues and to address any identified concerns.
• Maximum and minimum temperatures were not always recorded on all fridges containing medicines.
• There was not a reliable system for recording and tracking the prescription sheets that were transferred between the main surgery and the branch surgery.
• There had not been regular rehearsals of fire safety and evacuation procedures.
• There were no failsafe procedures for ensuring patients were aware of histology and other test results.

This inspection was an announced focused inspection carried out on 24 January 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 05 January 2016.

Our key findings across the areas we inspected were as follows:-

• All staff had received training in the safeguarding of vulnerable adults and all clinical staff had received training in the Mental Capacity Act 2005.

• All staff had been risk assessed as to whether they needed a DBS check. All clinical staff had been DBS checked to an Enhanced level

• There had been two infection control audits since the previous inspection.Actions had been identified and resolved.

• Maximum and minimum temperatures had been recorded daily for all fridges.

• There was a reliable system in place for tracking blank printer prescriptions between the main and branch surgeries.

• A rehearsal of fire safety and evacuation procedures had been carried out since the last inspection and recorded.

• A new system had been introduced to ensure that patients were made aware of test results that required further discussion.

This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Dr James and Partners on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 March 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.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• Each GP managed their own diabetic and cardiac patients

• All diabetic patients were reviewed annually and if required would be seen every six months.
• There were cardiac care clinics for patients with heart conditions.
• Patients with COPD were recalled annually and offered spirometry checks.
• In-house INR testing (a blood test for monitoring patients on an anti-coagulant medication) was available.

The practice achieved high QOF (Quality Outcomes Framework, a system for assessing quality of care) points for management of patients with long-term conditions.

Updated 17 March 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 the computer system was also flagged up other members of the household who may be at risk or were considered to be a potential risk to the child.

• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control (01/04/2014 to 31/03/2015) was 75.3% (national average 75.3%).

• 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. For example if their GP assessed it as appropriate, at the age of 15 patients were written to and notified that their on-line access codes would be changed so as to preserve confidentiality in the event that the contact details that were held belonged to their parents.

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

• There were personal family lists for each GP.

• The health visitor held clinics at the surgery twice a month.

• Contraceptive services were provided by a GP & practice nurse including the fitting of IUCDs (coils) and contraceptive implants.

• Child immunisation and vaccination services were offered.

• Chlamydia screening was offered.

• Counselling services were also offered in-house by a local charity.

• Schools were encouraged to send children to the GP rather than to A&E for minor injuries.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 94% (national average 81.83%)

Updated 17 March 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.
• It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Care plans were in place for patients on the at-risk register.
• Patients in care homes were regularly visited to monitor their health.
• Contact was made with patients after any hospital admission.
• There were monthly multi-disciplinary meetings to review specific patients and work towards reducing unplanned admissions.
• Regular six-monthly medication reviews were carried out.
• An automatic repeat prescription system was available so there was no need to request repeat prescriptions.
• Medication was prescribed in blister packs if required.
• Wound care was offered and leg ulcers were treated in the surgery.
• Telephone consultations were available if required.

Updated 17 March 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 offered new patient health checks with their GP and practice nurse.

• Saturday morning appointments were available.

• An automatic repeat prescription system was in place so that there was no need to request repeat prescriptions.

• Patients 40 – 74 were invited for NHS health checks.

• Telephone appointments were available.

• There was an on-line booking facility for appointments and repeat medication.

• The GPs discussed the choice of hospital with patients if a referral was required.

• The practice offered travel clinics and was a yellow fever vaccination centre.

• The practice was proactive in offering to treat minor injuries at the surgery to avoid patients having to attend to A&E.

• Minor Surgery procedures were carried out in the surgery.

• In-house D-dimer testing was available (D-dimer testing is a blood test to help diagnose thrombosis).

Updated 17 March 2016

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

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 89.7% (national average 88.5%)

• There were annual reviews of patients with learning disabilities.

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

• The practice hosted memory clinics two to three times a month for patients with suspected 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.

• Urgent appointments were available with their own GP for patients experiencing poor mental health.

• Patients’ needs were discussed at MDT meetings and at partners’ meetings.

• Regular reviews of medication were carried out for patients experiencing poor mental health.

• Daily or weekly prescriptions were available from dispensary to monitor the use of medications which could be dispensed as weekly blister packs.

• In-house counselling was available which was provided by a local mental health counselling service.

Updated 17 March 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.

• 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. However we did not see evidence that all staff had completed formal training in the safeguarding of vulnerable adults or that all clinical staff had received training in the Mental Capacity Act. 2005.

• Cases were reviewed with the safeguarding lead and staff were able to discuss concerns about patients with them.

• The practice would signpost carers to a local group involved with caring for carers and also to access breaks for carers.

• Vulnerable patients were discussed at multidisciplinary team (MDT) meetings.

• GPs would discuss vulnerable children and any safeguarding issues with the health visitor.