Drs Adey and Dancy

Updated 5 July 2017

Drs Adey and Dancy is responsible for providing primary care services to approximately 5686 patients. The practice is situated in Park Road, Tarporley in West Cheshire. There are two branch practices based in the nearby villages of Kelsall and Ashton. The practice is based in an area with lower levels of economic deprivation when compared to other practices nationally. The practice has a predominantly rural community. The practice has a slightly higher than average number of patients with a long standing health condition and of older patients when compared to other practices locally and nationally.

The staff team includes two GP partners, one salaried GP and one locum GP covering maternity leave. An advanced nurse practitioner, two practice nurses, a travel health and vaccine specialist nurse, a health care assistant, a practice manager and administration and reception staff. Two GPs are female and two are male. The nursing staff and health care assistant are female. The practice provides training to GP registrars and had one GP registrar at the time of the inspection.

The main practice is open 8am to 6.30pm Monday to Friday. The branch practice at Kelsall is open on Monday from 8.30am to 11.30am and Friday 9am to 12pm. The branch practice at Ashton is open Tuesday from 9am to 11am and Wednesday 9am to 11.30am. An extended hour’s service for routine appointments and an out of hour’s service are commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. Patient facilities are on the ground floor. The practice has limited on-site parking.

Drs Adey and Dancy has a Personal Medical Services (PMS) contract. The practice offers a range of enhanced services including, minor surgery, timely diagnosis of dementia, learning disability health checks and influenza and shingles immunisations.

Updated 5 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Drs Adey and Dancy on 8 November 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Drs Adey and Dancy on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out 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 regulation that we identified at our previous inspection on 8 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good and now as good for providing safe services.

Our key findings were as follows:

• Action had been taken to improve the recording of significant events.

• Action had been taken to ensure that the premises and equipment were safely maintained.

• A risk assessment had been recorded regarding the provision of emergency equipment at the branch practices.

In addition, the practice had made the following improvements:

• A system had been put in place to record the action taken following the receipt of patient safety alerts.

• An assessment had taken place to determine which emergency medication would be available.

• Protocols and staff guidance had been updated around the monitoring of urgent referrals to hospital and the management of the security of prescriptions.

• A risk assessment of the storage of patient records had been recorded.

• The staff recruitment procedure had been revised and a template devised to ensure information about any physical or mental conditions which were relevant (after reasonable adjustments) to the role the person was being employed for was considered.

• The salaried GP had received an in-house appraisal.

• A system had been introduced to ensure meetings were minuted on a consistent basis.

• A central record was held of clinical training that needed to be periodically renewed.

• Action plans had been developed to address the issues identified in the infection control audits for the branch practices.

The areas where the provider should make improvements are:

• The practice should consider obtaining a defibrillator and oxygen for both branch practices in order to be able to respond to certain medical emergencies.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 December 2016

The practice is rated as good for the care of people with long term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided such as screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had an established Year of Care model for diabetic patients. This model empowers and works in partnership with patients to develop person centred care plans to manage long term conditions. The practice was currently developing management plans for other long term conditions such as chronic obstructive pulmonary disease (COPD). The practice had monthly multi-disciplinary meetings and weekly clinical meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice provided information to patients to encourage them to manage their long term conditions. Patients were also referred to educational courses to support them to manage their long term conditions.

Updated 30 December 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Immunisation rates were relatively high for all standard childhood immunisations. Appointments for young children were prioritised. Minor illness clinics with the nurse practitioner were also provided. Appointments were available outside of school hours. Family planning and sexual health services were provided. The GPs liaised with other health care professionals, such as health visitors to ensure the needs of vulnerable children were addressed. A monthly Starting Well meeting was held which was attended by midwives and health visitors and provided a forum to discuss the needs of younger patients, including safeguarding concerns.

Updated 30 December 2016

The practice is rated as good for the care of older people. T he practice kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. The practice worked with other agencies and health providers to provide support and access to specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients. The practice was working with neighbourhood practices and the Clinical Commissioning Group (CCG) to provide services to meet the needs of older people. The practice shared a daily ward round at Tarporley War Memorial Hospital with its neighbourhood practices. This provision meant that patients had access to care and treatment in a timely manner and avoided duplication of visits. Weekly visits were made to patients living at two local care homes. The practice prioritised patients who may be at risk of poor health due to frailty. Following a medical event such as an unplanned hospital attendance the medical needs of patients were reviewed to identify what could be put in place to prevent future ill-health or hospital admission. The practice was actively monitoring patients in the last 12 months of life to promote their care and place of death in their last stages of life. An Acute Visiting service was provided with the aim of improving patient access to GP services and reducing emergency admissions to hospital and the use of emergency services.

Updated 30 December 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. Patients were encouraged to sign up for Patient Access so they could order repeat prescriptions, book appointments and view their medical records on-line which provided flexibility to working patients and those in full time education. The practice was open from 8am to 6.30pm Monday to Friday allowing early morning and evening appointments to be offered to working patients. The branch practices were open two mornings a week allowing patients to access these services also. The practice was piloting eConsult which allowed patients to gain self-care advice or complete a form for an on-line consultation with a GP. An extended hour’s service for routine appointments and an out of hour’s service were commissioned by West Cheshire CCG and provided by Cheshire and Wirral Partnership NHS Foundation Trust. The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, smoking cessation advice and family planning services. Reception staff sign-posted patients who do not necessarily need to see a GP. For example to services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP) and the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral).

Updated 30 December 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. Longer appointments were also offered. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. There was a counsellor located at the practice that the clinicians could refer patients to. The practice had information in the waiting areas about services available for patients with poor mental health. For example, services for patients who may experience depression. The staff team had received training in dementia awareness to assist them in identifying patients who may need extra support.

Updated 30 December 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example, if a patient had a learning disability to enable appropriate support to be provided. The practice worked with health and social care services to support the needs of vulnerable patients. Se rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff was the carer’s link. The practice referred patients to local health and social care services for support, such as drug and alcohol services. Staff had received safeguarding training relevant to their role and they understood their responsibilities in this area. Monthly multi-disciplinary meetings were held which were an effective way of identifying vulnerable patients and any support they required.