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 For example, we found out of date glucose test strips and an out of date vial of medicine for injection which expired in 2013 in a GP visit bag. The defibrillator pads had expired in April 2016.

• 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 two 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.

• Keep accurate records of actions taken in relation to the legionella risk assessment.

• 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