Letter from the Chief Inspector of General Practice

We previously inspected Dudley Partnerships for Health LLP on 12 October 2016. As a result of our inspection visit, the practice was rated as requires improvement overall with a requires improvement rating for providing effective and well led services; the practice was rated good for providing safe, caring and responsive services. A requirement notice was issued to the provider. This was because we identified a regulatory breach in relation to regulation 17, Good governance. We identified an area where the provider must make improvements and some areas where the provider should make improvements.

At the time of our inspection we inspected Dudley Wood Surgery under its previous practice name of Dudley Partnerships for Health LLP. This is because the practice had notified CQC of their name change which was being processed at the time of our inspection; this name change had taken place approximately three weeks before our inspection date.

We carried out an announced comprehensive inspection at Dudley Wood Surgery (formally known as Dudley Partnerships for Health LLP) on 19 July 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. You can read the reports from our previous inspections, by selecting the 'all reports' link for Dudley Partnerships for Health LLP on our website at www.cqc.org.uk.

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

• Patients spoke highly of the care provided by the practice team. The practice had improved on some areas of the latest national GP patient survey in comparison to the July 2016 publication. This included improved telephone access, opening hours as well as improved aspects of care.

• Practice systems ensured compliance with the requirements of the duty of candour. The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.

• During our most recent inspection we saw that lines of accountability were clear. Staff roles were clearly structured and well defined at all levels within the practice. Staff felt supported at all levels and spoke positively about being part of the practice team.

• We saw that learning was shared locally and across the wider partnership. Items such as significant events, complaints, safeguarding and clinical audits were discussed during practice meetings and in partnership-wide clinical governance meetings.

• We found that although the most recent national GP patient survey results showed that some improvement had been made, performance remained below local and national averages across most areas in response to questions about care and involvement in decision making. We noted that the practice had worked on an action plan since the previous survey which was published in July 2016. However, there was limited evidence of improvement to patient outcomes when we compared the two surveys.

• We saw that audits were used to drive improvements in patient care and to improve systems and processes in the practice.

• The practice could demonstrate that they used the information collected for Dudley clinical commissioning group’s long term condition framework; Dudley Quality Outcomes for Health (DQOFH) to monitor outcomes for patients.

• We noted that specific processes had been strengthened and well embedded within the practice, such as the process for managing uncollected prescriptions, the management of practice correspondence and better embedded prescribing policies.

• During our inspection we found that records of the infection control audit and legionella risk management contained gaps. Additionally, there was no evidence of immunisation status in place for a member of staff where required.

• On the day of our inspection we found that the security of patient notes was compromised due to a broken lock, staff assured us that the lock would be repaired as a priority. Shortly after our inspection took place the practice assured us that the notes were moved to a secure area of the practice in a lockable location.

• There were hearing loop and translation services available. There were some facilities in place for disabled people and for people with mobility difficulties. However, there was no evidence of any formal equality assessments carried out to determine how disabled patients and patients with mobility difficulties would access the health promotion room on the first floor in the absence of a lift. Shortly after our inspection the provider provided advised that patients with mobility difficulties were seen on the ground floor to avoid having to use the stairs.

The areas where the provider should make improvements are:

• Improve record keeping to support good governance arrangements across areas associated with infection control best practice guidelines.

• Formally assess and manage risk to ensure that patients with a disability and patients with mobility difficulties can safely access all areas of the practice required to suit their care and treatment needs.

• Consider working on areas to improve as identified from patient feedback and the national GP patient survey and assess the effectiveness of improvement as part of a continuous improvement cycle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We first inspected Dudley Partnerships for Health LLP in February 2016 as part of our new comprehensive inspection programme. As a result of our inspection, the practice was placed in special measures. The practice was rated as Inadequate overall. This was because we identified regulatory breaches in relation to regulation 12 for providing safe care and treatment and regulation 17 due to inadequate governance arrangements. Furthermore, we identified areas where the provider must make improvements and additional areas where the provider should improve.

We carried out an announced comprehensive inspection at Dudley Partnerships for Health LLP on 12 October 2016. This inspection was also conducted to see if improvements had been made in line with the special measures period of six months. Overall the practice is rated as requires improvement.

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

• We saw that staff were friendly and helpful and treated patients with kindness and respect. Staff spoken with demonstrated a commitment to providing a high quality service to patients.

• During our previous inspection in February 2016 we found that the practice did not operate effective systems to support monitoring specific to high risk medication and also for the management of pathology results. During our most recent inspection we observed that a more effective process had been utilised in the practice to allow for adequate monitoring of high risk medication. Furthermore, we saw how following our previous inspection the practice had strengthened their process for managing pathology results.

• An effective programme of clinical audits was implemented and used to monitor quality and to make improvements. We saw that practice continually monitored areas such as prescribing, record keeping and infection control.

• Governance arrangements were strong in some areas such as security of prescription stationery, management of pathology results and for monitoring emergency medicines. However, in other areas governance arrangements were not as robust and we found that further to our previous inspection, there were some protocols which were not embedded effectively.

• We found that there was no clear scheme of delegation in the practice which outlined roles and responsibilities giving clear lines of accountability.

• Although staff were aware of lead roles across key areas such as safeguarding, we found that staff were not always aware of some of the responsibilities of their colleagues that were specific to key processes. For example, mixed feedback regarding the management of clinical post highlighted that the process was not well embedded or effectively monitored.

• Unverified data provided by the practice during our inspection demonstrated that improvement had been made in some performance areas, such as areas the Quality and Outcomes Framework (QOF).

• Recently published QOF results for 2015/16 highlighted that the practices QOF achievement had significantly decreased. However, these results were based on partial data because the practice opted in to a local quality framework from October 2015. Although we received data from the clinical commissioning group (CCG) which demonstrated how the practice was performing across areas of the local framework, during our inspection we did not receive assurance from the provider to demonstrate how the practice actively monitored their performance under most areas of the new local quality framework.

• The practice held a variety of meetings and some of the practice staff members attended joint quarterly clinical governance meetings with staff from practices within the wider partnership. We saw that topics such as significant events and complaints were discussed during these meetings however we could not see that opportunities to share learning on a wider scale were maximised across the partnership.

• We saw that the practice was working through an action plan which had been developed in response to the results of the national GP patient survey, with specific actions in place to improve aspects of care, communication and access. We found that some measures had been implemented to improve this which included increasing clinical sessions and offering extended hours.

The areas where the provider must make improvements are:

• Ensure that governance arrangements are robust across all areas and ensure that policies are well embedded to support practice systems and processes in all areas including repeat prescribing, management of clinical post and monitoring of uncollected prescriptions.

The areas where the provider should make improvements are:

• Ensure that effective leadership is sustained in the practice in order to enable and support the team to continue to work on improving areas identified for improvement from the national GP patient survey responses.

• Maximise opportunities to share learning and good practice across the wider partnerships and use these as opportunities to proactively drive improvement.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously inspected Dudley Partnerships for Health LLP on 12 October 2016. As a result of our inspection visit, the practice was rated as requires improvement overall with a requires improvement rating for providing effective and well led services; the practice was rated good for providing safe, caring and responsive services. A requirement notice was issued to the provider. This was because we identified a regulatory breach in relation to regulation 17, Good governance. We identified an area where the provider must make improvements and some areas where the provider should make improvements.

At the time of our inspection we inspected Dudley Wood Surgery under its previous practice name of Dudley Partnerships for Health LLP. This is because the practice had notified CQC of their name change which was being processed at the time of our inspection; this name change had taken place approximately three weeks before our inspection date.

We carried out an announced comprehensive inspection at Dudley Wood Surgery (formally known as Dudley Partnerships for Health LLP) on 19 July 2017. This inspection was conducted to see if improvements had been made following the previous inspection in 2016. You can read the reports from our previous inspections, by selecting the 'all reports' link for Dudley Partnerships for Health LLP on our website at www.cqc.org.uk.

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

• Patients spoke highly of the care provided by the practice team. The practice had improved on some areas of the latest national GP patient survey in comparison to the July 2016 publication. This included improved telephone access, opening hours as well as improved aspects of care.

• Practice systems ensured compliance with the requirements of the duty of candour. The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.

• During our most recent inspection we saw that lines of accountability were clear. Staff roles were clearly structured and well defined at all levels within the practice. Staff felt supported at all levels and spoke positively about being part of the practice team.

• We saw that learning was shared locally and across the wider partnership. Items such as significant events, complaints, safeguarding and clinical audits were discussed during practice meetings and in partnership-wide clinical governance meetings.

• We found that although the most recent national GP patient survey results showed that some improvement had been made, performance remained below local and national averages across most areas in response to questions about care and involvement in decision making. We noted that the practice had worked on an action plan since the previous survey which was published in July 2016. However, there was limited evidence of improvement to patient outcomes when we compared the two surveys.

• We saw that audits were used to drive improvements in patient care and to improve systems and processes in the practice.

• The practice could demonstrate that they used the information collected for Dudley clinical commissioning group’s long term condition framework; Dudley Quality Outcomes for Health (DQOFH) to monitor outcomes for patients.

• We noted that specific processes had been strengthened and well embedded within the practice, such as the process for managing uncollected prescriptions, the management of practice correspondence and better embedded prescribing policies.

• During our inspection we found that records of the infection control audit and legionella risk management contained gaps. Additionally, there was no evidence of immunisation status in place for a member of staff where required.

• On the day of our inspection we found that the security of patient notes was compromised due to a broken lock, staff assured us that the lock would be repaired as a priority. Shortly after our inspection took place the practice assured us that the notes were moved to a secure area of the practice in a lockable location.

• There were hearing loop and translation services available. There were some facilities in place for disabled people and for people with mobility difficulties. However, there was no evidence of any formal equality assessments carried out to determine how disabled patients and patients with mobility difficulties would access the health promotion room on the first floor in the absence of a lift. Shortly after our inspection the provider provided advised that patients with mobility difficulties were seen on the ground floor to avoid having to use the stairs.

The areas where the provider should make improvements are:

• Improve record keeping to support good governance arrangements across areas associated with infection control best practice guidelines.

• Formally assess and manage risk to ensure that patients with a disability and patients with mobility difficulties can safely access all areas of the practice required to suit their care and treatment needs.

• Consider working on areas to improve as identified from patient feedback and the national GP patient survey and assess the effectiveness of improvement as part of a continuous improvement cycle.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice