Drs Bryan, Hadley, Jones & Chan Also known as Dale Medical Practice

Updated 14 June 2017

Drs Bryan, Hadley, Jones and Chan are the GP partners at Dale Medical Practice. This is as semi-rural practice located in the village of Wombourne. The practice is situated in a building converted in 2001 from previously being a public house. The practice population has low deprivation and low unemployment when compared to national averages. Life expectancy is in line with the national average. The practice has a patient list size of 6,575 of which a higher percentage are elderly patients; 25% are 65 and over compared to the national average of 17%.

The practice has four GP partners whose combined number of clinics is equal to three point two five whole time equivalents. The partners are assisted by a clinical team consisting of a practice nurse and a second nurse working on a sessional basis of approximately three hours per week. The administration team consists of a practice manager, a senior administrator, and seven supporting staff.

The practice is open from 8am Monday to Friday. Extended hours appointments are offered on a Monday and Thursday when the practice is open until 7.15pm and on a Tuesday when the practice is open until 7.30pm. On Wednesdays and Fridays the practice closes at 6.30 pm. Appointment times are from 8.30am until 11am in the morning and from 3.30pm to 6pm in the afternoon. Extended hours appointments are available until 7pm on a Monday and a Thursday, and until 7.15pm on a Tuesday.

When the practice is closed the telephone lines are diverted to the NHS 111 service and there is an out of hours service provided by Malling Health. The nearest hospitals with A&E units are situated at Dudley and New Cross Hospital, Wolverhampton. There are minor injury units at Dudley and Wolverhampton.

Updated 14 June 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Drs Bryan, Hadley, Jones and Chan on 21 March 2016.

We found that there was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Fit and proper persons employed:

• The provider could not evidence that the appropriate recruitment checks had been completed on all staff employed.

A requirement notice was served on the practice in respect of the breach of regulations. The practice subsequently sent us an action plan to say what they would do to meet legal requirements.

The overall rating for the practice at the original inspection was good and the full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Drs Bryan, Hadley, Jones and Chan on our website at www.cqc.org.uk.

We undertook an announced focused inspection on 25 May 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 March 2016 inspection. We visited the practice to review the improvements made. This report only covers our findings in relation to those requirements and additional improvements made since our last inspection. The legal requirements had been met and the rating in the safe key question changed from requires improvement to good.

Our key findings were as follows:

• The practice had completed a disclosure and barring service (DBS) check or risk assessment for all staff employed.
• The practice had identified and planned training needs for practice staff. Training had been completed or planned.
• Staff had received an annual appraisal.
• There was a risk log and completed risk assessments for each risk identified.
• Monitoring checks mentioned in the legionella risk assessment had been completed (Legionella is a bacterium which can contaminate water systems in buildings).
• There was an effective recall system for patients with learning disabilities to have annual health checks completed.
• Learning from complaints was seen to have been shared with staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 May 2016

The practice is rated as good for the care of people with long-term conditions. Patients were reviewed in both GP and nurse led chronic disease management clinics.  We found that the nursing staff had the knowledge, skills and competency to respond to the needs of patients with long term conditions such as diabetes and asthma. Longer appointments and home visits were available when needed and reviews were coordinated to minimise the required number of patient visits. All patients with a long term condition were offered a review to check that their health and medication needs were met. Written management plans had been developed for patients with diabetes and asthma and those with long term conditions at risk of hospital admissions. For those people with the most complex needs, the GPs worked with relevant health and social care professionals to deliver a multidisciplinary package of care. 

Updated 20 May 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 who were at risk, for example, children and young people who had protection plans in place. Appointments were available outside of school hours and the premises were suitable for children and babies. Same day emergency appointments were available for children. There were screening and vaccination programmes in place and the child immunisation rates were in line with the local Clinical Commissioning Group averages. The practice worked closely with the health visiting team to encourage attendance. New mothers were offered post-natal checks and development checks for their babies.

Updated 20 May 2016

The practice is rated as good for the care of older people. Patients over the age of 75 years had a named GP and all hospital admissions were reviewed for those identified as at risk. This included patients that resided in nursing and care homes.  The practice offered proactive, personalised care to meet the needs of the older people in its population and had a long established proactive multidisciplinary approach to frail and elderly patients. A red, amber, green (RAG) rating system was used to prioritise the needs of patients. All those patients rated as red and amber were reviewed at each of the monthly multidisciplinary team meetings. The practice was responsive to the needs of older people and offered home visits and longer appointments as required. The practice identified if patients were also carers. Male patients over 65 years of age were invited to attend an abdominal aortic aneurysm screening (AAA) done at the practice (AAA screening is a way of detecting a dangerous swelling of the aorta, the main blood vessel that runs from the heart to the rest of the body).

Updated 20 May 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. A range of on-line services were available, including medication requests, booking of appointments and access to health medical records. The practice offered a full range of health promotion and screening that reflected the needs for this age group. Although all patients aged 40 to 75 years old were offered a health check with the nursing team, this was not actively promoted by the practice.

Updated 20 May 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Patients who presented with an acute mental health crisis were offered same day appointments. People experiencing poor mental health were offered an annual physical health check. Dementia screening was offered to patients identified in the at risk groups. It carried out advance care planning for patients with dementia.

The practice regularly worked with multi-disciplinary teams in the case management of patients with mental health needs. This included support and services for patients with substance misuse and screening for alcohol misuse with onward referral to the local substance misuse or alcohol service if required. The practice also worked closely with the health visiting team to support mothers experiencing post-natal depression. It had told patients about how to access various support groups and voluntary organisations and signposted patients to the advocacy service where appropriate.

Updated 20 May 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. We found that the practice enabled all patients to access their GP services and assisted those with hearing, sight and language difficulties.

The practice held a register of 32 patients with a learning disability. These patients were included on the case management register and those with more complex needs were identified. The practice had carried out 17 annual health checks (53%) on these patients in the preceding 12 months. No evidence was seen that the remainder of health checks were planned to be completed by the end of March (the data is collated between April and March each year).

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This included patients with learning disabilities who required complex care. It had told 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.