Dr Howells & Partners

Updated 9 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Howells & partners (at that time known as Dr West & partners) on 18 May 2016. At that time, the practice was rated overall as good. However, we identified a breach in regulation relating to the way in which medicines were managed which resulted in a rating of requires improvement for provision of safe services. Specifically we found that learning from dispensary errors was communicated inconsistently, medicines were dispensed to patients before GPs had signed and authorised prescriptions and some medicines held for use in an emergency were out of date.

The practice sent us an action plan setting out the changes they were making to address the breach in regulation.

We carried out a focused inspection on 21 December 2016 to ensure these changes had been implemented and that the service was meeting regulation they had previously breached. The ratings for the practice have been updated to reflect our findings. We found the practice had made improvements in safe provision of services since our last inspection on 18 May 2016 and they were now meeting the requirements of the regulation in breach.

Our key findings in the area we inspected were as follows:

• The practice had introduced an effective system for reporting and learning from dispensing errors and “near misses”. This followed an improvement process designed by the Royal Pharmaceutical Society.

• Repeat prescriptions were being signed by GPs before medicines were dispensed to patients from both the practice dispensaries.

• The practice had an effective system for monitoring the medicines held for use in an emergency.

We have updated the ratings for this practice to reflect these changes. The practice is now rated good for the provision of safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 28 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators n 2015/16 was 84%. This was just below the previous year clinical commissioning group (CCG) average of 86% and national average of 89%.

• 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.

• A support group had been established for patients with a specific long term condition, fibromyalgia. This provided patients with practical advice about living with their condition.

Updated 28 June 2016

The practice is rated as good for the care of families, children and young patients.

• 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• The practice recognised that younger patients relied on them to deliver a full range of services that young patients in towns and cities would access from clinics.

• The practice sent every young patient an information pack when they attained their 14th birthday. The pack contained details of the services young patients could access from the practice.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for the cervical screening programme was 83%, which was better than the CCG average of 79% and better than the national average of 77%.

• 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 and health visitors.

Updated 28 June 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice liaised with village agents to identify older patients who may benefit from befriending and support with practical tasks such as transport to and from appointments.

• The practice supported five local care homes by providing weekly visits to all five homes to co-ordinate patient care.

Updated 28 June 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. Extended hours clinics were held on 34 Saturday mornings each year.

• Telephone consultations were available for patients who found it difficult to attend the practice during the customary working day.

Updated 28 June 2016

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

• 68% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2014/15, which was below both local and national averages. We noted the practice had achieved an overall improvement from 79% in 2014/15 to 90% in 2015/16 in the indicators for this group of patients. This was close to the CCG average of 95% and national average of 95% from 2014/15. Detailed data on each indicator was not available at the time of our visit.

• 88% of patients diagnosed with a long term mental health problem had an agreed care plan. This had improved from 49% in the previous year. This was slightly better than the CCG average of 85% in 2014/15 and matched the national average.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients 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.

• Counselling was available at the practice.

• The practice was in the process of becoming a dementia friendly practice. There was a dementia champion at each site, Dementia friends training had been completed for most practice staff.

Updated 28 June 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 vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable 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 was active in identifying carers and co-ordinated support for this group of patients via a member of staff who had been appointed as carers co-ordinator.