Archived: Dr P O'Horan & Partners Also known as The Burns Practice

Updated 25 July 2016

Dr P J O'Horan and partners, or the Burns Medical Practice as it is known locally, in located in Cantley in a suburb of Doncaster. The partners have another practice at Albion Place, Doncaster, DN1 2EG.   Both practices have one patient list and provide services for 10,398 patients under the terms of the NHS General Medical Services contract. The practice catchment area is classed as within the group of the fifth more deprived areas in England. The age profile of the practice population is similar to other GP practices in the Doncaster Clinical Commissioning Group (CCG) area and has more patients registered at the practice between the ages of 55 to 69 years old.

The practice has six GP partners, three female and three male and four GP trainees. They are supported by a community matron, five practice nurses, a healthcare assistant a practice manager and a team of reception and administrative staff. The practice is open between 8am to 6pm Monday to Friday at both sites. Early morning appointments are available from 7am with GPs on weekdays by request. The practice opens alternate Saturday mornings for appointments with GPs. Appointments with GPs, practice nursing staff and the healthcare assistants are available during the opening hours. A phlebotomy service with the healthcare assistant is available daily.

In addition to pre-bookable appointments that could be booked up to six weeks in advance, urgent appointments were also available for people that needed them. When the practice is closed calls were answered by the out-of-hours service which is accessed via the surgery telephone number or by calling the NHS 111 service.

The practice is located in a purpose built premises that were being extended by adding a first floor during our visit. There are a number of parking spaces to the front of the practice and designated disabled parking spaces.

As part of the Care Quality Commission (Registration) Regulations 2009: Regulation 15 we noted GP partners registered with the Care Quality Commission as the partnership did not reflect the GP partners currently at the practice. We were told this would be addressed following the inspection and the appropriate applications and notifications submitted.

Updated 25 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr P O'Horan and Partners on 24 May 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.
• Although risks to patients who used services were assessed, the systems and processes to address these risks were not implemented well enough by all staff. For example, we found out of date glucose test strips and an out of date vial of medicine for injection which expired in 2013 in a GP visit bag. 

• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 areas of outstanding practice:

The practice were innovative in their approaches to providing integrated person-centred care that involved other health and social service providers, particularly for those with multiple and complex needs. The practice funded a community matron seconded from the local community trust to review those admitted to hospital, who attended accident and emergency regularly or used other services frequently. The community matron would meet with the patient either at home, in hospital or at the practice to review their health and social circumstances, with their carers present when relevant. Patients were given the opportunity to specify where and how they wanted to receive support and be cared for. For those in hospital this facilitated an early discharge home with appropriate support from local services. Patients were provided with information about services to help them maintain their independence such as a fee paying community laundry service, charities who provide transport to and from hospital appointments, the local fire officer's contact details to perform home fire safety checks, telephone befriending services along with referrals to other community health services such as chiropodists and dieticians.

The practice implemented the 'The Herbert Protocol' introduced by South Yorkshire Police, the Alzheimer’s Society, health trusts and Dementia Action Alliances to provide police officers with early access to information when dealing with missing people living with dementia. All patients living with dementia registered at the practice were encouraged to complete the form which was designed to make sure that, if someone was reported missing, the police could access important information about that person as soon as possible. The form contained information about their medical status, mobility, access to transport, places of interest and daily routines. Once completed, copies were made and then available for use if the person should ever be reported missing. The idea is that speedy access to information will help officers track missing people down quickly.

The areas where the provider should make improvement are:

• Review and implement the procedures for checking medicines in GP bags to all practice staff.
• Review vaccine fridge temperature calibration in to comply with Public Health England Protocol for ordering, storing and handling vaccines (March 2014).

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 25 July 2016

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

• Practice nursing staff had lead roles in long term condition management and patients at risk of hospital admission were identified as a priority.

• The practice funded a community matron seconded to the practice from the local community trust to provide care to those whose circumstances may make them vulnerable and were registered at the practice. Part of the role included the follow up of patients admitted to and discharged from hospital and those who attended accident and emergency. The matron would visit the patient either at home or hospital and review their health and social circumstances.

• 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.
• Performance for diabetes related indicators was 4% above the CCG average and 11% above the national average.

Updated 25 July 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 accident and emergency attendances. Immunisation rates were relatively high 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 percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months was 77% which was comparable to the CCG average of 76%.
• 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, health visitors and school nurses.
• The practice’s uptake for the cervical screening programme was 85%, which was above the CCG average of 82% and the national average of 81%.

Updated 25 July 2016

The practice is rated as good for the care of older people.

• All patients had a named GP.
• 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 people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice had patients residing at seven nursing homes within the area, and the community matron conducted ward rounds every two weeks to review those patients who were registered with the practice.​ This provided the opportunity for long term condition and medication reviews to be performed and improved communication with residents relatives as they were aware of the time of visits and could be present if they wished.
• The community matron also liaised directly with hospital consultants and we were shown evidence where the consultant in old age psychiatry was contacted to review a patient's medication. The community matron then prescribed the changes to the medication to ensure the patient was receiving a therapeutic dose.
• All patients over the age of 75 were offered an annual review if they had not attended the practice in the previous 12 months.

Updated 25 July 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.

Updated 25 July 2016

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

• 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is above the national average of 83%.
• 99% of patients with complex mental illness had an agreed care plan in their record in the previous 12 months which is above the national average of 89%.
• The practice regularly worked with multidisciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice carried out advance care planning for patients living 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 were trained as dementia friends.
• The practice implemented the 'The Herbert Protocol' introduced by South Yorkshire Police, the Alzheimer’s Society, health trusts and Dementia Action Alliances to provide police officers with early access to information when dealing with missing people living with dementia. All patients living with dementia registered at the practice were encouraged to complete the form which was designed to make sure that, if someone was reported missing, the police could access important information about that person as soon as possible. The form contained information about their medical status, mobility, access to transport, places of interest and daily routines. Once completed, copies were made and then available for use if the person should ever be reported missing. The idea is that speedy access to information will help officers track missing people down quickly..

Updated 25 July 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 those whose circumstances may make them vulnerable.
• The practice informed patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in 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.
• The practice were innovative in their approaches to providing integrated person-centred care that involved other health and social service providers, particularly for those with multiple and complex needs. The practice funded a community matron seconded from the local community trust to review those admitted to hospital, who attended accident and emergency regularly or used other services frequently. The community matron would meet with the patient either at home, in hospital or at the practice to review their health and social circumstances, with their carers present when relevant. Patients were given the opportunity to specify where and how they wanted to receive support and be cared for. For those in hospital this facilitated an early discharge home with appropriate support from local services. Patients were provided with information about services to help them maintain their independence such as a fee paying community laundry service, charities who provide transport to and from hospital appointments, the local fire officer's contact details to perform home fire safety checks, telephone befriending services along with referrals to other community health services such as chiropodists and dieticians.