Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dinnington Group Practice on 25 May 2016, where we found the overall rating for the practice was good. At the inspection on 25 May 2016 we did not identify any breaches of regulations but found there were areas for improvement in the safe domain. We completed a further announced focused inspection on 10 May 2017 to confirm that the practice had carried out their plan to make improvements. Whilst we found some improvements had been made since the May 2016 inspection and the overall rating for the practice remained good we found the practice continued to need to make further improvements in the safe domain. 

The full comprehensive report for the 25 May 2016 and the responsive report for 10 May 2017 inspection can be found by selecting the ‘all reports’ link for Dinnington Group Practice on our website at www.cqc.org.uk.

We completed an announced focused inspection on 22 November 2017 to confirm that the practice had carried out their plan to make improvements that we identified in our previous inspection on 10 May 2017. We found improvements had been made since our inspection 10 May 2017 and the practice was rated as good for safe and good overall. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice had made the following improvements :

• Repeat prescriptions were signed by an appropriate prescriber within a reasonable time frame.

• Medicines requiring refrigeration were managed safely.

• Balance checks of controlled drugs had been regularly carried out and recorded.

• The procedure for following up uncollected prescriptions had been reviewed and implemented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dinnington Group Practice on 25 May 2016. The overall rating for the practice was good but with requires improvement for safety. The full comprehensive report for the 25 May 2016 inspection can be found by selecting the ‘all reports’ link for Dinnington Group Practice on our website at www.cqc.org.uk.

At the inspection on 25 May 2016 we did not identify any breaches of regulations although there were areas for improvement. This inspection was an announced focused inspection carried out on 10 May 2017 to confirm that the practice had carried out their plan to make improvements that we had identified in our previous inspection on 25 May 2016. This report covers our findings in relation to the improvements made since our last inspection.

Overall the practice is rated as Good.

The practice had made the following improvements:

• The practice had implemented Public Health England guidance in relation to the calibration of thermometers used in vaccine fridges.

• The standard of cleaning and handwashing facilities at Woodsetts surgery had been improved.

• Procedures relating to the security of blank prescription forms held in printers had been reviewed and improved in line with NHS Protect guidance.

• All staff undertaking the role of dispenser were qualified to NVQ2 level. A competency assessment of dispensing staff had been carried out.

• The practice procedures for Controlled Drugs awaiting destruction at the Woodsetts surgery had been implemented.

• Staff access to the dispensary at Woodsetts had been risk assessed and security arrangements had been improved and implemented.

• The procedures relating to access to the Controlled Drug cupboard at Woodsetts surgery had been reviewed and improved.

• Equipment had been provided to enable the medicine storage room temperatures to be monitored and records of the temperatures had been recorded.

• Portable appliance testing (PAT) and calibration had been completed.

• The practice had continued to try to improve access to the practice and had implemented a daily drop in clinic at one site.

However, we found areas which required improvement during the inspection on 10 May 2017.

Action the practice must take to improve:

• Ensure prescriptions are signed by an appropriate prescriber within a reasonable time frame.

• Ensure medicines requiring refrigeration are managed and stored safely.

Action the practice should take to improve:

• Regularly carry out balance checks of controlled drugs.

• Review the procedure for following up uncollected prescriptions

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dinnington Group Practice on 25 May 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were maximised.
• Risks to patients were assessed and well managed with the exception of infection prevention and control and some aspects of medicines management in the dispensary. These issues were mainly confined to one of the branch surgeries.
• The practice used innovative and proactive methods to improve patient outcomes. For example, to provide continuity of care for patients in care homes and initiation of yoga group for patients.
• Data showed patients were not always satisfied with some aspects of the service such as access to appointments and involvement in their care. However, feedback from patients on the day of the inspection was more positive.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, changes to the telephone system to try to improve access.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• 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 two areas of outstanding practice:

The practice was innovative in providing services to improve outcomes for patients. For example:

The practice had implemented a care home service in a way that gave continuity of care for patients. They had done this by providing a set visit day and time with the same GP. Staff at care homes attended by the GPs told us this arrangement worked to the benefit patients and their families. They said this service had reduced the need for patients to attend the accident and emergency department and use of the out of hour’s service. The data relating to acute admissions to hospital showed a significant reduction in admissions from each of the care homes attended, year on year, since implementation. The practice had provided this initiative since 2013 without any extra remuneration although since April 2016 Rotherham CCG had provided extra payments for care home patients as an enhanced service.

One of the GPs had an interest in yoga as a tool for self-care in conditions relating to depression and anxiety. The practice had implemented a yoga group at the practice in June 2015. Classes were held weekly by an external trainer with use of a room at the practice and up to 20 patients attended and such was the interest a second class was being considered. A survey of the patients showed the patients had found these sessions to be mentally and physically beneficial. The GP who had implemented the sessions had shared the information with a local university and they were considering a research project of the benefits for patients.

The areas where the provider should make improvement are

• Implement Public Health England guidance in relation to the calibration of thermometers used in vaccine fridges.
• Improve the standard of cleaning and handwashing facilities at Woodsetts surgery.
• Review procedures relating to the security of blank prescription forms held in printers and store these in line with NHS Protect, Security of prescription forms guidance, updated August 2013.

• All staff undertaking the role of dispenser should be qualified to NVQ2 level.A competency assessment of dispensing staff should be carried out annually.

• Risk assess staff access to the dispensary at Woodsetts when dispensing staff are not present

• Implement the practice procedures for Controlled Drugs awaiting destruction at the Woodsetts surgery.
• Improve the procedures and storage arrangements to limit access to the key to the Controlled Drug cupboard at Woodsetts surgery to dispensary staff and GPs.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice