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Dr law & partners scheduled report (primarymedicalservices location oct 2014)
Dr Law & Partners
Tel: 01283 564848
Date of inspection visit: 1 October 2014
Date of publication: 08/01/2015
This report describes our judgement of the quality of care at this service. It is based on a combination of what we foundwhen we inspected, information from our ongoing monitoring of data about services and information given to us fromthe provider, patients, the public and other organisations.
Overall rating for this service
Are services safe?
Are services effective?
Are services caring?
Are services responsive to people's needs?
Are services well-led?
1 Dr Law & Partners Quality Report 08/01/2015
Summary of findings
ContentsSummary of this inspection
Overall summary 2The five questions we ask and what we found 4The six population groups and what we found 6What people who use the service say 8Areas for improvement 8Outstanding practice 8
Detailed findings from this inspectionOur inspection team 9Background to Dr Law & Partners 9Why we carried out this inspection 9How we carried out this inspection 9Detailed findings 11
Overallsummary
Letter from the Chief Inspector of General
changes to respond to this and on-going monitoring
demonstrated that changes still needed to be
We inspected this service on 1 October 2014 as part of our
considered. The practice had been working with the
new comprehensive inspection programme.
Local Area Team, Clinical Commissioning Group andPatient Participation Group (PPG) to address this issue.
The overall rating for this practice is good. We found the
PPGs are an effective way for patients and GP practices
practice to be good in the safe, caring, responsive and
to work together to improve the service and to
well-led domains and outstanding in the effective
promote and improve the quality of care patients
domain. We found the practice provided good care to
older people; people with long term conditions; people in
• There were systems in place to keep patients safe from
vulnerable circumstances; families, children and young
the risk and spread of infection. Systems were in place
people; working age people and people experiencing
to monitor and make required improvements.
poor mental health.
• Evidence we reviewed demonstrated that most
Our key findings were as follows:
patients were satisfied with how they were treated andthat this was with compassion, dignity and respect. It
• Patients were kept safe because there were
also demonstrated that the GPs were good at listening
arrangements in place for staff to report and learn
to patients and gave them enough time.
from key safety risks. The practice had a system inplace for reporting, recording and monitoring
We saw several areas of outstanding practice including:
significant events over time.
• The practice recognised that patient satisfaction with
access to appointments had fallen over the past year.
There was evidence that the practice had made
2 Dr Law & Partners Quality Report 08/01/2015
Summary of findings
• The provider had developed a referrals feedback slip
However, there were also areas of practice where the
to gather information from the hospital physiotherapy
provider needs to make improvements.
department to monitor the appropriateness of their
The provider should:
patient referrals.
• The lead nurse at the practice was supported by the
• Ensure that all electrical equipment at the practice is
GP partners within and outside of the service to take
safety tested.
on a leadership role. An example of this is where thelead practice nurse led and chaired the local practice
Professor Steve Field CBE FRCP FFPH FRCGP
nurse forums to promote best practice in the
Chief Inspector of General Practice
administration of influenza, pneumonia and shinglesvaccinations for older people.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
3 Dr Law & Partners Quality Report 08/01/2015
Summary of findings
ThefivequestionsweaskandwhatwefoundWe always ask the following five questions of services.
Are services safe?
The practice is rated as good for safe. Patients were kept safebecause there were arrangements in place for staff to report andlearn from key safety risks to patients. The practice had a system inplace for reporting, recording and monitoring significant events overtime. The GP senior partner and staff we spoke with told us therewas a blame free culture within the practice. They told us thepractice was open and transparent when things went wrong. Therewere robust systems in place to protect children and vulnerableadults from the risk of abuse. The practice worked with otherservices to prevent abuse and to put plans of care in place.
Medicines were stored safely. The system that ensured temperaturesensitive medicines were stored appropriately was effective. Therewere systems in place to keep patients safe from the risk and spreadof infection. Patients were also protected from unsafe or unsuitableclinical equipment however, some non-clinical electrical equipmenthad not been safety tested since 2010. Patients were cared for bysuitably qualified and trained staff and staffing establishments wereregularly reviewed to keep patients safe and meet their needs.
Are services effective?
The practice is rated as outstanding for effective. Our findings atinspection showed systems were in place to ensure that allclinicians were not only up-to-date with both the National Institutefor Health and Care Excellence guidelines and other locally agreedguidelines but we also saw evidence that confirmed that theseguidelines were influencing and improving practice and outcomesfor their patients. We saw data that showed the practice wasperforming highly when compared to neighbouring practices in theClinical Commissioning Group (CCG).
The practice was using innovative and proactive methods toimprove patient outcomes. Examples of this included a referralsfeedback slip to gather information from the hospital physiotherapydepartment to monitor the appropriateness of their patient referrals;easy read care plans for patients with learning disabilities; 100% ofwomen were offered long acting reversible contraception whenprovided with emergency contraception and the lead practice nursewas supported by the practice to take on a leadership role for thedevelopment of other practice nurses in the region.
Are services caring?
The practice is rated as good for providing caring services. Datashowed that patients rated the practice higher than others for
4 Dr Law & Partners Quality Report 08/01/2015
Summary of findings
several aspects of care. Patients said they were treated withcompassion, dignity and respect and they were involved in decisionsabout their care and treatment. Information to help patientsunderstand the services available was easy to understand. We alsosaw that staff treated patients with kindness and respect, andmaintained confidentiality
Are services responsive to people's needs?
The practice is rated as good for responsive. We found the practicehad initiated many positive service improvements for their patientpopulation that were over and above their contractual obligations.
The practice was supported by a very active Patient ParticipationGroup (PPG) who helped with a number of initiatives to benefitpatients. The practice reviewed the needs of their local populationand engaged with the NHS Local Area Team (LAT) and CCG to secureservice improvements where these were identified. All patients over75 years were provided with a named doctor for continuity of careand urgent appointments were available the same day. The practicehad good facilities and was well equipped to treat patients andmeet their needs. There was an accessible complaints system withevidence demonstrating that the practice responded appropriatelyto issues raised. There was evidence of shared learning fromcomplaints with staff and other stakeholders.
Are services well-led?
The practice is rated as good for being well-led. It had a clear visionand strategy. Staff were clear about the vision and theirresponsibilities in relation to this. There was a clear leadershipstructure and staff felt supported by management. The practice hada number of policies and procedures to govern activity and heldregular governance meetings. There were systems in place tomonitor and improve quality and identify risk. The practiceproactively sought feedback from staff and patients, which it actedon. The patient participation group (PPG) was active. PPGs are aneffective way for patients and GP practices to work together toimprove the service and to promote and improve the quality of carepatients receive. Staff had received inductions, regular performancereviews and attended staff meetings and events.
5 Dr Law & Partners Quality Report 08/01/2015
Summary of findings
ThesixpopulationgroupsandwhatwefoundWe always inspect the quality of care for these six population groups.
Older people
The practice is rated as good for the care of older people. Nationallyreported data showed that outcomes for patients were good forconditions commonly found in older people. The practice offeredproactive, personalised care to meet the needs of the older peoplein its population and had a range of enhanced services, for example,in dementia and end of life care. It was responsive to the needs ofolder people, and offered home visits and rapid accessappointments for those with enhanced needs.
People with long term conditions
The practice is rated as good for the care of people with long-termconditions. There were emergency processes in place and referralswere made for patients whose health deteriorated suddenly. Longerappointments and home visits were available when needed. Allthese patients had a structured annual review to check that theirhealth and medication needs were being met. For those people withthe most complex needs, GPs worked with relevant health and careprofessionals to deliver a multidisciplinary package of care.
Families, children and young people
This practice is rated as good for families, children and youngpeople. We saw that the practice provided services to meet theneeds of this population group. Staff were knowledgeable abouthow to safeguard children from the risk of abuse. Quarterly face toface meetings between the GPs, health visitors and midwives wereheld at the practice to discuss how to manage and support childrenand families in vulnerable situations. There were effective screeningand vaccination programmes in place to support patients andhealth promotion advice was provided. Information was available toyoung people regarding sexual health and family planning advicewas provided by staff at the practice. The GPs and nurses that wespoke with demonstrated a clear understanding of the importanceof determining if a child was Gillick competent when gainingconsent to care and treatment. A Gillick competent child is a childunder 16 who has the legal capacity to consent to care andtreatment. They are capable of understanding implications of theproposed treatment, including the risks and alternative options.
Working age people (including those recently retired and
This practice is rated as good for working age patients. We saw thatthe practice offered a range of appointments which included
6 Dr Law & Partners Quality Report 08/01/2015
Summary of findings
pre-bookable appointments, same day appointments andtelephone consultations. Staff told us that they tried to ensure thatpatients who were working were able to have an early appointmentat 8am whenever possible. The practice offered all patients aged 40to 75 years old a health check with the practice nurse. Well womenand well men checks were available for patients to request. Familyplanning services were provided by the practice for women ofworking age. There was evidence that the practice monitored theeffectiveness of their family planning service through audit.
Following changes in practice identified in these audits, 100% ofwomen were offered long acting reversible contraception whenemergency hormonal contraception had been given. This helped toprevent unwanted pregnancies.
People whose circumstances may make them vulnerable
The practice is rated as good for the care of people whosecircumstances may make them vulnerable. The practice held aregister of patients living in vulnerable circumstances includinghomeless people and those with a learning disability. It had carriedout annual health checks for people with a learning disability.
People experiencing poor mental health (including people
This practice is rated as good for patients experiencing poor mentalhealth. The practice maintained a register of patients whoexperienced mental health problems. We saw that staff had theknowledge, skills and competencies to assess and respond to theirneeds. Patients experiencing poor mental health received an annualhealth review to ensure appropriate treatment and support was inplace. The practice worked with the local primary care mentalhealth team to provide appointments at the practice for patientsexperiencing poor mental health. This enabled patients to receivecounselling and treatment in surroundings that were familiar tothem and maintained their discretion.
7 Dr Law & Partners Quality Report 08/01/2015
Summary of findings
WhatpeoplewhousetheservicesaySeventeen of the 18 patients we spoke with on the day of
spoke with on the day of our inspection told us they
our inspection were complimentary about the care and
experienced problems getting through to the practice on
treatment they received. We reviewed the four patient
the phone to make an appointment. Most patients
comments cards from our Care Quality Commission
however told us the appointment system was easy to use
(CQC) comments box that had been placed in the
and met their needs. The results of the GP Patient survey
practice prior to our inspection. We saw that comments
supported these findings.
were overwhelmingly positive. Patients told us the staff
The results from the National Patient Survey showed that
were always caring and treated them with dignity and
98% of patients said that their overall experience of the
respect. They said the nurses and doctors listened and
practice was good and that 90% of patients would
responded to their needs and they were involved in
recommend the practice to someone new to the
decisions about their care. Patients told us that the
practice was always clean and tidy. Some patients we
Areasforimprovement
Action the service SHOULD take to improve
The provider should ensure that all electrical equipmentat the practice is safety tested.
OutstandingpracticeThere were examples of outstanding practice at Dr Law
The lead nurse at the practice was supported by the GP
and partners as follows:
partners within and outside of the service to take on aleadership role. An example of this is where the lead
The practice had developed a referrals feedback slip to
practice nurse led and chaired the local practice nurse
gather information from the local hospital's
forums to promote best practice in the administration of
physiotherapy department to monitor the
influenza, pneumonia and shingles vaccinations for older
appropriateness of their patient referrals.
8 Dr Law & Partners Quality Report 08/01/2015
Dr Law & Partners
Our inspection team
and family medicine since 1992. They do not provide anout-of-hours service to their own patients but they havealternative arrangements for patients to be seen when the
Our inspection team was led by:
practice is closed
Our inspection team was led by a CQC lead inspector.
Why we carried out this
The lead inspector was accompanied by two GPspecialist advisors and an expert by experience who had
personal experience of using primary medical services.
We inspected this service as part of our new
Background to Dr Law &
comprehensive inspection programme. This provider hadnot been inspected before and that was why we included
Dr Law and Partners' practice provides primary medical
How we carried out this
services to patients living in Burton-on-Trent, Staffordshire.
The practice is a two storey purpose built town surgery.
There are nine consulting rooms and two treatment rooms.
The surgery has its own patient car park with easy access
To get to the heart of patients' experiences of care and
for patients with disabilities. The surgery building is owned
treatment, we always ask the following five questions:
jointly by some of the partners. The practice houses
attached staff including district nurses, health visitors,
• Is it effective?
midwife and counsellors all of whom provide clinics within
• Is it caring?
the surgery.
• Is it responsive to people's needs?
A team of six GP partners, one salaried GP, three GP
• Is it well-led?
Registrars, six nurses including an advanced nurse
We also looked at how well services are provided for
prescriber, a practice manager, 10 receptionists and seven
specific groups of people and what good care looks like for
administrative staff provide care and treatment for
them. The population groups are:
approximately 10,200 patients. There are five female andtwo male doctors at the practice to provide patients with a
choice of who to see. The practice provides an
• People with long-term conditions
anticoagulation clinic for patients who are on warfarin and
• Families, children and young people
need to have their blood monitored on a regular basis. The
• Working age people (including those recently retired
practice has been a training practice for doctors to gain
experience and higher qualifications in General Practice
• People living in vulnerable circumstances• People experiencing poor mental health (including
people with dementia)
9 Dr Law & Partners Quality Report 08/01/2015
Detailed findings
Before carrying out our inspection, we reviewed a range of
1 October, 2014. During our inspection we spoke with three
information we held about the practice and asked other
GPs, one GP Registrar, two nurses, three receptionists, the
organisations to share what they knew. We spoke with the
practice manager, three receptionists, a Health Visitor and
chair of the Patient Participation Group and managers of
18 patients. We observed how patients were cared for. We
three care homes where Dr Law & Partners provide care
reviewed four patient comment cards sharing their views
and treatment. We carried out an announced inspection on and experiences of the practice.
Dr Law & Partners Quality Report 08/01/2015
Are services safe?
Barring Service (DBS) check had been completed for allclinical and administrative staff. DBS checks help
Safe Track Record
employers make safer recruitment decisions and preventunsuitable people from working with vulnerable adults and
Patients were kept safe because there were arrangements
children. It replaced the Criminal Records Bureau (CRB)
in place for staff to report and learn from key safety risks to
patients. Staff we spoke with knew it was important toreport incidents and significant events to keep patients
The practice worked with other services to prevent abuse
safe from harm. They were aware of the most appropriate
and to implement plans of care. We spoke with a Health
person to report their concerns to. We saw that a log of
Visitor on the day of our inspection. They told us that they
incidents, complaints and significant events had been kept
had quarterly face to face meetings with the GPs to discuss
at the practice. We saw they had all been appropriately
how to manage and support children and families in
investigated. We saw that reviews of incidents and
vulnerable situations. They told us the GPs were
significant events over time had been completed to identify approachable and were able to contact them to discussif there were any reoccurring concerns across the service.
any concerns they may have.
Learning and improvement from safety incidents
Patients were kept safe from the risk of abuse during an
The practice had a system in place for reporting, recording
intimate examination. There was an up to date chaperone
and monitoring significant events. They kept records of
policy in place to ensure patients were protected from
significant events that had occurred over the last 12
potential abuse during an intimate examination. Nursing
months and these were made available to us. The practice
staff were aware of their chaperone responsibilities and
was open and transparent when things went wrong. The GP some patients confirmed that a chaperone had beensenior partner and staff we spoke with told us there was a
offered during an intimate examination. There was one
blame free culture within the practice. Clinical staff
poster on display within the reception area informing
described to us how learning from significant events was
patients of their right to request a chaperone. It was not
shared with them at a weekly practice based learning
clearly visible and could only be seen when a patient stood
session or on an individual basis. We found there was no
at the reception desk.
formal system in place that documented when learning
had been shared with clinical and non-clinical staff.
Medicines were stored safely. We checked medicines stored
Reliable safety systems and processes including
in the locked medicine cupboard, fridges and the GP's
emergency blue box. We found that they were stored
Children and vulnerable adults were kept safe from the risk
appropriately and were in date. There was a policy that
of abuse because there were safeguarding systems in
clearly outlined how temperature sensitive medicines, such
place. Safeguarding policies were in place and staff knew
as vaccines, should be stored to ensure they were fit for
where to find them. There were two safeguarding leads at
purpose. It provided guidance on the action to take in the
the practice and staff knew to go to them for advice and
event of a problem. We saw that this system was effective
support. All staff had received training on safeguarding
because it had detected a problem with the temperature of
children and vulnerable adults at a level appropriate to
one of the medicine fridges and appropriate action had
their role. GPs had received the higher level three
been taken. Emergency medicines for medical emergencies
safeguarding training to support them in their role. A log
were available and all staff knew where they were stored.
containing records of this was made available to us. We
Controlled drugs were not kept at the practice.
asked medical, nursing and administrative staff about their
Medicines were administered safely. We saw there were
most recent training. Staff knew their responsibilities
signed Patient Group Directions (PGD) in place to support
regarding information sharing, documentation of
the nursing staff in the administration of vaccines. A PGD is
safeguarding concerns and how to contact the relevant
a written instruction from a qualified and registered
agencies in and out of hours. We saw that safeguarding
prescriber, such as a doctor, enabling a nurse to administer
contact details were easily accessible for staff and
a medicine to groups of patients without individual
displayed in most rooms. We saw that a Disclosure and
Dr Law & Partners Quality Report 08/01/2015
Are services safe?
prescriptions. A member of the nursing staff was qualified
the equipment was checked weekly to ensure it was in
as an independent prescriber. They had also completed the working order and fit for purpose. We saw there wasClinical Health Assessment module to provide them with
equipment at the practice that contained mercury. Mercury
the knowledge they required when prescribing.
is a hazardous substance and is subject to the Control of
The practice had a protocol for repeat prescribing which
Substances Hazardous to Health Regulations 2002. We saw
was in line with General Medical Council (GMC) guidance.
a risk assessment had been carried out and two mercury
This covered how staff that generated prescriptions were
spillage kits were available to keep patients and staff safe in
trained, how changes to patients' repeat medicines were
the event of a mercury spillage. We saw records that
managed and the system for reviewing patients' repeat
demonstrated that clinical equipment had been calibrated
and safety checked in July 2014. The practice could not
Cleanliness & Infection Control
provide evidence that non-clinical electrical equipmenthad recently been safety checked. Some electrical
There were systems in place to keep patients safe from the
equipment had not been safety tested since 2010.
risk and spread of infection. There was an appropriate
infection control policy available for staff to refer to. We saw Staffing & Recruitment
that the infection control lead had received appropriate
Patients were cared for by suitably qualified and trained
infection control training. An infection control audit had
staff. We saw evidence that health professionals, such as
been carried out in May 2014. Several issues had been
doctors and nurses, were registered with their appropriate
identified and an action plan put in place. We saw that
professional body and so considered fit to practice. There
action had been taken to address the issues and a date of
was a system in place that ensured health professionals'
completion recorded. Minor surgery was carried out at the
registrations were in date. There was a recruitment policy
practice. We saw that single use instruments were used
in place and we saw that it met the requirements of our
and they were in date. There were arrangements in place
regulations. We looked at the records of three members of
for the safe disposal of clinical waste and sharps, such as
staff and saw that appropriate recruitment processes and
needles and blades. We saw evidence that their disposal
checks had been carried out before staff started to work at
was arranged through a suitable company.
the practice. There were clearly defined staffing rotas andsystems in place to cover annual leave.
On the day of our inspection the practice was clean andtidy. Patients we spoke with told us that the reception area
Monitoring Safety & Responding to Risk
and consulting rooms were always clean. They told us that
Staffing establishments were reviewed to keep patients
when appropriate, staff wore personal protective
safe and meet their needs. Where staffing issues had been
equipment such as gloves. Staff confirmed personal
identified, we saw that action plans were in place outlining
protective equipment was readily available and we saw
how risks would be managed and work re-allocated. We
that it was.
saw that the practice population size of the practice hadbeen continually increasing. An appointments audit had
The practice had taken reasonable steps to protect staff
been carried out in February, March and May 2014 which
and patients from the risks of health care associated
highlighted the increased demand for appointments with
infections. We saw that staff had received the relevant
GPs. To help to meet this demand, a GP had been
immunisations and support to manage the risks of health
employed to provide an additional five sessions per week.
care associated infections. A legionella risk assessment had There were systems in place to deal with busy periods and
been completed in May 2014 and an action plan put in
staff shortages. The practice had a business continuity plan
place. We saw that work was being carried out to address
in place that contained a risk assessment and an action
the identified issues.
plan detailing how the practice would respond to busy
periods such as the increase demand for appointments in
Patients were protected from unsafe or unsuitable
equipment. Emergency equipment such as a defibrillator
Maintenance of the premises was designed to keep
was available for use in a medical emergency. We saw that
patients safe. We saw there was subsidence and cracks inthe plaster at the practice. We were shown risk
Dr Law & Partners Quality Report 08/01/2015
Are services safe?
assessments, action plans, quotes and timeframes for the
confirmed they had received CPR training and
repair work to be completed. A fire risk assessment and
appropriately described the care they would provide to
asbestos management plan had been completed which
patients in the event of a medical emergency. There were
confirmed that the building was safe.
emergency drugs, a defibrillator, oxygen, pulse oximeters
Arrangements to deal with emergencies and major and airway maintenance equipment for adults and
children available at the practice. There were systems inplace to ensure that the emergency drugs and oxygen were
There were systems in place to deal with medical
in date and that the emergency equipment was fit for
emergencies. We saw records demonstrating that staff
were trained in cardiopulmonary resuscitation (CPR) andwhen they would be due for an update. Staff we spoke with
Dr Law & Partners Quality Report 08/01/2015
Are services effective?(for example, treatment is effective)
method of communicating with patients with learningdifficulties was effective and met their needs. There were
Effective needs assessment
systems in place that ensured babies received a new bornand eight week development assessment. A GP told us that
Patients' needs were assessed and care and treatment
patients with mental health difficulties received an annual
delivered in line with current evidence based guidance. We
health review. We saw there was a care plan template to
saw electronic records demonstrating that clinical staff had
enable GPs to plan the care for patients with mental health
access to the National Institute for Health and Care
difficulties. GPs we spoke with were able to describe how
Excellence (NICE) guidelines. Clinical staff described to us
this template was applied during a patient's assessment.
how they used these to assess the needs of their patients.
Every patient over 75 years had a named GP and each of
For example, we saw that changes to the guidance for the
the 14 care homes had a named GP. We spoke with
prescription of statins (medicines that can help to lower
representatives from three of the 14 care homes the
cholesterol levels in blood) had been followed. We saw
practice provided care and support to. They confirmed that
minutes of practice meetings where new guidelines were
needs assessments were completed when required. The
disseminated and the implications for the practice's
senior GP partner told us that they were exploring the
performance and patients were discussed. All the GPs
introduction of weekly ward rounds within the care homes
interviewed were aware of their professional
to ensure that older patients' needs were assessed and
responsibilities to maintain their knowledge.
monitored effectively. The representatives from the homes
The practice referred patients appropriately to secondary
we spoke with confirmed this had been discussed with
and other community care services. National data showed
the practice had a high referral rate to ophthalmology,
Staff told us there was a high turnover of temporary
general surgery and trauma. The practice told us they were
residents registered with them at one time. This was due to
investigating why this was and what they could do to
a nearby housing association that accommodated
reduce it. We saw that the practice was proactive and had
temporary residents and a nearby residential drug and
developed a referrals feedback slip to gather information
alcohol addiction centre. The practice informed us that
from the physiotherapy department regarding the
they had a policy to accept homeless patients and any
appropriateness of their referrals. An analysis of the
patient who lived within their practice boundary
feedback slips was ongoing.
irrespective of race, culture, religion or sexual preference.
Patients with long term conditions received an annual
They told us all patients received the same quality of
needs assessment. We saw that an audit had been carried
service from all staff to ensure their needs were met.
out on blood test requests for routine long term conditions
Management, monitoring and improving outcomes
such as high blood pressure or diabetes. The audit
for people
identified that the blood tests requested varied amongst
The practice participated in the Quality and Outcomes
GPs. As a result of the audit a proforma had been
Framework (QOF). The QOF rewards practices for providing
developed that standardised which blood tests were
quality care and helps to fund further improvements. We
appropriate and effective for patients with a stable long
saw that there was a robust system in place to frequently
term condition.
review QOF data and recall patients when needed. The
Patients with a learning disability received an annual
practice participated in a benchmarking process with other
health assessment using the Cardiff Health Check
practices within East Staffordshire Commissioning Group
template. We saw that the assessment was carried out by a
(CCG). This allowed practices to compare their performance
practice nurse who had completed a health assessment
against other practices in the CCG in areas such as referrals
module. A GP buddying system was in place if the nurse
to A&E. We saw minutes demonstrating that the GP who
required additional support or advice. At the end of the
attended these meetings shared the information with the
review we saw that the patient was provided with a health
other staff at the practice.
action plan which was agreed with them. Information
The practice had a system in place for completing clinical
inviting them to the assessment and the health action plan
audit cycles. The practice showed us 10 clinical audits that
were provided in an easy read format ensuring that the
Dr Law & Partners Quality Report 08/01/2015
Are services effective?(for example, treatment is effective)
had been completed recently. Following each clinical audit, to support new doctors into the practice. A GP registrar wechanges to treatment or care were made where needed
spoke with told us they felt very supported at the practice.
and the audit repeated to ensure outcomes for patients
They told us they valued the GP buddying system which
had improved. For example, following an alert from the
provided them with a daily named GP they could go to for
Medicines and Healthcare Products Regulatory Agency
advice and support. The senior GP partner told us that they
(MHRA) regarding the use of simvastatin (a medicine used
had been asked by the Deanery of the local university to
to reduce blood cholesterol levels) a clinical audit was
support two GP registrars who required additional support.
carried out by the practice. The aim of the audit was to
The GP registrars went on to successfully complete their
ensure that all patients prescribed simvastatin were not
training. GPs we spoke with told us they were supported in
put at risk of serious drug interactions. The first audit
their revalidation through an appraisal system.
demonstrated that 187 patients were not receiving the
Revalidation is the process by which licensed doctors are
revised dose of simvastatin. The information was shared
required to demonstrate that they are up to date with
with GPs and patients were called for a medication review.
current best practice and fit to practise.
A second clinical audit was completed one year later which
A management task planner was in place for 2014-2015
demonstrated that only one patient was not receiving the
which identified when staff appraisals and training were
new recommended dose.
due. We looked in the records of three recently recruited
The practice had taken on the enhanced service for the
members of staff and saw that they had all received an
avoidance of unplanned hospital admissions. Enhanced
induction to the practice, completed an appraisal within
services are additional services provided by GPs to meet
the last year and identified their training needs. Staff we
the needs of their patients. To meet this objective they have spoke with all confirmed they received an annual appraisal.
recently completed 170 care plans for elderly patients. We
Where staff had identified the need for additional training
spoke with representatives from three of the 14 care homes specific to their role or for their professional development,the practice provided care and support to. They confirmed
staff told us they had been supported to access this. The
that care plans had been put in place and the care that the
practice manager showed us a training log that identified
practice provided was of a high standard. They told us they
what training staff had completed, when they had
had a good working relationship with the practice and that
completed it and when it needed to be repeated. Continual
the practice responded quickly to any concerns they had
clinical development and supervision was supported
about patients. Every patient over 75 years of age had a
through a weekly one hour practice based learning session
named GP and each of the 14 care homes had a named GP
within the practice. We saw evidence that these sessions
to ensure continuity of care and to develop relationships
included such areas as reviewing significant events and
between the GP and care home staff. The practice had 23
audit or guest speakers. All staff were provided with one
patients on their end of life register. We saw minutes from
hour of protected learning time each week to enable them
multi-disciplinary meetings between GPs, palliative care
to access online training.
nurses and district nurses that demonstrated care plans for
Working with colleagues and other services
patients near the end of their life were reviewed on a
The practice worked with other service providers to meet
regular basis. The practice used special notes to ensure
patients' needs and manage complex cases. We saw, and a
that the out of hours service were also aware of the needs
Health Visitor confirmed, that quarterly meetings between
of these patients when the practice was closed.
GPs, Health Visitors and midwives were held to discuss,
assess and plan care around safeguarding concerns. The
Staff had the skills, knowledge and experience to deliver
practice held multidisciplinary team meetings to discuss
effective care and treatment. The practice manager, a lead
the needs of patients with end of life care needs. Minutes
GP and lead practice nurse were responsible for staff
from multi-disciplinary meetings between the practice,
training. The practice was a training practice for GP
palliative care nurses and district nurses demonstrated that
registrars. GP registrars are qualified doctors who
patients who were receiving end of life care were provided
undertake additional training to gain experience and higher with appropriately co-ordinated care. We saw that thequalifications in general practice and family medicine.
practice used special notes to ensure that the out of hours
There was a comprehensive induction programme in place
service were also aware of the needs of these patients
Dr Law & Partners Quality Report 08/01/2015
Are services effective?(for example, treatment is effective)
when the practice was closed. We saw that the practice
legal capacity to consent to care and treatment. They are
worked with the district nursing teams and community
capable of understanding implications of the proposed
matrons to assist in the provision of long term condition
treatment, including the risks and alternative options. The
monitoring and management of care for housebound
practice had access to interpreting services to ensure
patients. The practice worked with the local primary care
patients understood procedures if their first language was
mental health team to provide appointments at the
not English.
practice for patients experiencing poor mental health.
Some staff we spoke with had not received training in the
Mental Capacity Act 2005 but demonstrated knowledge
There was a system in place for receiving, managing,
regarding best interest decisions for patients who lacked
reviewing and following up the results of tests requested
capacity. Mental capacity is the ability to make an informed
for patients. Reception staff we spoke with clearly
decision based on understanding a given situation, the
understood their role and responsibilities in handling these options available and the consequences of the decision.
results and who the results were to be shared with. Blood
People may lose the capacity to make some decisions
and X-ray results were received electronically and reviewed
through illness or disability. We saw examples of how
by a GP on a daily basis. The GP who reviewed the results
young people, patients with a learning disability, mental
was responsible for taking the appropriate action. The
health difficulty or dementia were supported to make
practice used special notes to ensure that the out of hours
decisions. For example, there were easy read leaflets and
service were also aware of the needs of patients receiving
health action plans to enable patients with learning
end of life care when the practice was closed. The practice
difficulties to understand their planned treatment and care.
was in the process on putting patient care plans on to the
When patients did not have capacity the staff we spoke
special notes system so that the out of hours service were
with gave us examples of how the patient's best interest
aware of patients' needs.
was taken into account.
Hospital discharge, A&E, outpatients and discharge letters
When a person does not wish to be resuscitated in the
were received in paper format. Once the practice received
event of severe illness a 'Do not attempt resuscitation'
the letters they were allocated to the most appropriate
(DNAR) form is completed to record this in their records to
doctor and followed up the same day.
protect them from the risk of receiving inappropriate
Consent to care and treatment
treatment. We spoke with a representative from three carehomes that the practice provided care and support to. They
There were mechanisms to seek, record and review
confirmed that DNARs were reviewed by GPs from the
consent decisions. We saw there were consent forms for
practice and that GPs reviewed new DNARs that had been
patients to sign agreeing to minor surgery procedures. We
put in place whilst a patient was in hospital.
saw that the need for the surgery and the risks involvedhad been clearly explained to patients. We saw a minor
Health Promotion & Prevention
surgery audit for 2013–2014 had been carried out at the
The practice offered all new patients registering with the
practice which included consent to treatment. The audit
practice and patients aged 40 to 75 years old a health
demonstrated that 100% of minor surgery procedures
check with the practice nurse. Well women and well men
carried out on patients had written consent in place.
checks were available for patients on request. The practicenurse carried out weekly vaccination sessions for children
We saw signed consent forms for children who had
in line with the Healthy Child Programme. We saw that the
received immunisations. The practice nurse was aware of
percentage of children who had received the appropriate
the need for parental consent and what action to follow if a
vaccination at the appropriate time ranged from 90 to
parent was unavailable. There were leaflets available for
100% which was in line with the Clinical Commissioning
parents informing them of potential side effects of the
Group (CCG) regional average. A travel vaccination
immunisations. The GPs and nurses that we spoke with
programme was also carried out at the practice which
demonstrated a clear understanding of the importance of
included the vaccination for yellow fever.
determining if a child was Gillick competent especiallywhen providing contraceptive advice and treatment. A
Family planning services were provided by the practice for
Gillick competent child is a child under 16 who has the
women of working age. Three clinical audit cycles had
Dr Law & Partners Quality Report 08/01/2015
Are services effective?(for example, treatment is effective)
been completed exploring the percentage of women who
The practice nurses offered healthy living advice and
had received long acting reversible contraception (LARC)
support to patients. This included referrals to weight
when emergency hormonal contraception had been given.
watchers and council physical activity exercise classes for
The first audit cycle demonstrated that 83% of women had
patients who needed a weight management programme.
been provided with LARC. Following a raise in awareness
We saw that one of the council exercise classes was
amongst clinical staff and the introduction of information
specifically for women from the black minority ethnic
packs in consulting rooms, the third clinical audit cycle
population group. All patients with a learning disability
demonstrated that 100% of women were offered LARC to
were offered an annual physical health check and provided
prevent unwanted pregnancies. All six of the practice
with healthy living advice leaflets in an easy read format.
nurses were trained in performing cervical smears and
Flu vaccination was offered to all patients over the age of
Chlamydia screening kits were available in the toilets for
65, those in at risk groups and pregnant women. The
young patients to access discreetly. Condoms were also
shingles vaccination was offered according to national
available free on request.
guidance for older people.
Dr Law & Partners Quality Report 08/01/2015
Are services caring?
Patients we spoke with on the day of our inspectionconfirmed that they had never overheard anything
Respect, Dignity, Compassion & Empathy
confidential at the reception desk. The practiceswitchboard was located upstairs away from the reception
We reviewed the most recent data available for the practice desk so telephone conversations could not be overheard.
on patient satisfaction. This included information from 126patients who took part in the GP patient survey. The GP
The practice told us that they had a high turnover of
patient survey is an independent survey run by Ipsos MORI
temporary patients registered with them at one time. This
on behalf of NHS England. We also reviewed data from a
was due to a nearby housing association that
survey of 526 patients undertaken by the practice's Patient
accommodated temporary residents and a nearby
Participation Group (PPG). PPGs are an effective way for
residential drug and alcohol addiction centre. The practice
patients and GP practices to work together to improve the
informed us that they had a policy to accept homeless
service and to promote and improve the quality of the care. patients and any patient who lived within their practiceThe evidence from these sources demonstrated that
boundary irrespective of race, culture, religion or sexual
patients were satisfied with how they were treated and that preference. They told us all patients received the samethis was with compassion, dignity and respect. For
quality of service from all staff to ensure their needs were
example, data from the national GP patient survey showed
that 98% of patients described their overall experience of
There was a clearly visible notice in the patient reception
this practice as good or very good. This was 10% above the
area stating the practice's zero tolerance for abusive
Clinical Commissioning Group (CCG) regional average.
behaviour. We saw an example where the practice had
Ninety-four per cent of practice respondents said the GP
actioned this policy following an incident.
was good at listening to them and 96% said the GP gavethem enough time. All these scores were above the CCG
Care planning and involvement in decisions about
regional average.
care and treatment
The GP patient survey information we reviewed showed
Patients completed CQC comment cards to provide us with
patients responded positively to questions about their
feedback on the practice. We received four completed
involvement in planning and making decisions about their
cards and all were positive about the service they
care and treatment and generally rated the practice well in
experienced. Patients said they felt the practice offered an
these areas. For example, data from the national patient
excellent service and staff were friendly, helpful and
survey showed 81% of practice respondents said the GP
respectful. They said staff treated them with dignity and
involved them in care decisions and 89% felt the GP was
respect and never patronised them. We also spoke with 18
good at explaining treatment and results. Both these
patients on the day of our inspection. Seventeen out of the
results were above average compared to the CCG regional
18 patients we spoke with told us they were satisfied with
the care provided by the practice and said their dignity andprivacy was respected.
Patients we spoke to on the day of our inspection told usthat health issues were discussed with them and they felt
Staff and patients told us that all consultations and
involved in decision making about the care and treatment
treatments were carried out in the privacy of a consulting
they received. They also told us they felt listened to and
room. Disposable curtains were provided in consulting
supported by staff and had sufficient time during
rooms and treatment rooms so that patients' privacy and
consultations to make an informed decision about the
dignity was maintained during examinations, investigations choice of treatment they wished to receive. Patient
and treatments. We saw that consultation treatment room
feedback on the comment cards we received was also
doors were closed during consultations and that
positive and aligned with these views. One of the GP
conversations taking place in these rooms could not be
partners offered alternative therapies for patients who
preferred non-invasive, drug free pain relief treatment. Staff
We observed staff were careful to follow the practice's
told us that translation services were available for patients
confidentiality policy when discussing patients' treatments
who did not have English as a first language.
in order that confidential information was kept private.
Dr Law & Partners Quality Report 08/01/2015
Are services caring?
There were 80 patients on the practice's learning difficulties with care and concern with a score of 82% for nurses. Theseregister. We saw that annual health reviews were carried
results were above the CCG regional average. The patients
out for patients with learning difficulties using the Cardiff
we spoke with on the day of our inspection and the
Health Check template. At the end of the review the patient
comment cards we received were also consistent with this
was provided with a health action plan which was agreed
survey information. For example, patients described the
with them. We saw two examples where the health action
care they received as excellent and of a higher standard
plan was provided in an easy read format so that patients
than other practices they had previously been registered
understood it. There were 68 patients on the practices'
register for patients with mental health difficulties. There
Notices in the patient's waiting room and on the practice
was a system in place to ensure that patients with mental
website sign posted patients to a number of support
health difficulties received an annual health review. We saw groups and organisations. The practice provided support
there was a care plan template to enable GPs to plan the
for carers and had developed a carer's register working with
care for patients with mental health difficulties. The staff
the Carers Association for South Staffordshire (CASS). We
told us that the recall system for patients with long term
saw that GPs had access to electronic leaflets that they
conditions, such as diabetes or high blood pressure, had
printed off to provide advice and support to carers
recently been updated. Patients were called for a review of
regarding certain conditions. The practice website provided
their care and treatment on their birthday and were
a direct link to the carer's association which provided
provided with an extended appointment at a time
financial and practical advice and applications to the
convenient for them. Changes to the recall system for
carer's health respite break fund.
annual reviews were clearly communicated to patientsthrough the patient newsletter.
Staff told us families who had suffered bereavement were
Patient/carer support to cope emotionally with
called by their usual GP and offered a GP consultation if
care and treatment
required. However, patients we spoke with on the day ofinspection who had suffered bereavement told us they had
The GP patient survey information we reviewed showed
not received this support. Some staff were also unclear of
patients were positive about the emotional support
where to direct patients to for bereavement support and
provided by the practice and rated it good or very good in
there were no information leaflets on display in the
this area. For example, 92% of patients surveyed said the
last GP they saw or spoke to was good at treating them
Dr Law & Partners Quality Report 08/01/2015
Are services responsive to people's needs?(for example, to feedback?)
regular membership of 14 patients with an age range of 30to 60 years. PPG meetings were held on a monthly basis
Responding to and meeting people's needs
and the minutes were available on the practice's website.
The practice had implemented many suggestions for
We found the service was responsive to patients' needs and improvements and made changes to the way it delivered
had sustainable systems in place to maintain the level of
services as a consequence of the PPG feedback. These
service provided. The practice was innovative and willing
included the introduction of text messaging to remind
to take on new approaches to meet the needs of their
patients when their appointment was and the
patients. We saw that the practice offered an
management of patients who regularly failed to attend for
anti-coagulation monitoring and dosing clinic for patients
their appointment.
on warfarin (a medicine that is given to stop clots formingin the blood). A practice nurse led the clinic and was
The practice had achieved and implemented the gold
supported by a GP through the practice's buddying system.
standard framework for end of life care. They had a
The clinic supported up to 75 patients removing the need
palliative care register and had regular internal as well as
for them to travel to the hospital and provided patients
multidisciplinary meetings to discuss patients and their
with their test results immediately. The practice had also
families' care and support needs. As a consequence of staff
opted into the Flo hypertension monitoring system which
training and better understanding of the needs of patients,
enabled patients to monitor their own blood pressure
the practice had 23 patients on their end of life register. The
using a text messaging service. This included a 20 minute
practice had developed a personalised care pathway for
patient education session and the loan of a blood pressure
the care of the dying patient which involved advanced
monitoring devise. The patient texted their results to Flo.
planning and symptomatic support. It was supported by an
The GP analysed the results weekly and responded with
end of life policy and a palliative care policy and protocol.
the appropriate advice. This system ran alongside the
Tackle inequity and promote equality
practice's own system for monitoring high blood pressure
The practice had recognised the needs of different groups
and offered choice to patients who preferred to use text
in the planning of its services. The practice staff told us
messaging as part of their management.
there was a nearby housing association that
The needs of the practice population were understood and
accommodated temporary residents. They told us there
systems were in place to address identified needs. The NHS was also a nearby residential drug and alcohol addictionLocal Area Team (LAT) and Clinical Commissioning group
centre. The practice had a policy to accept patients living in
(CCG) told us that the practice engaged regularly with them
these areas as a temporary resident to ensure they had
and other practices to discuss local needs and service
access to primary medical services during their time there.
improvements that needed to be prioritised. We saw
The practice informed us they had a policy to accept
minutes of meetings where this had been discussed and
homeless patients and any patient who lived within their
actions agreed to implement service improvements and
practice boundary irrespective of race, culture, religion or
manage delivery challenges to its population. This
sexual preference. They told us all patients received the
included A&E referrals and the introduction of an urgent
same quality of service from all staff to ensure their needs
care dashboard. The dashboard provided practices with
the facility to identify frequent attenders to A&E. The use of
Patients with learning difficulties were provided with an
special notes when sharing information between the
annual health review and health advice leaflets in an easy
practice and the out of hours service was also discussed
read format. The primary care mental health team offered
and plans put in place to support practices in the use of
appointments at the practice. This enabled patients with
this service.
mental health difficulties to receive counselling and
The practice had an active Patient Participation Group
treatment in surroundings that were familiar to them and
(PPG) to help it to engage with a cross-section of the
maintained their discretion. The practice had completed
practice population and obtain patient views. We spoke
170 care plans for some of their most vulnerable patients.
with the chair of the PPG who explained their role and how
The majority of these patients were elderly and included all
they worked with the practice. They told us there was a
Dr Law & Partners Quality Report 08/01/2015
Are services responsive to people's needs?(for example, to feedback?)
their patients in care homes as well as housebound and
There were arrangements in place to ensure patients
mobile elderly patients. Representatives from three of the
received urgent medical assistance when the practice was
care homes confirmed care plans had been put in place
closed. This was provided by an out-of hours service. If
with the agreement of the patient.
patients called the practice when it was closed, there wasan answerphone message giving the telephone number
We saw that the premises and services met the needs of
they should ring depending on the circumstances.
patients with disabilities such as hearing and mobility
Information on the out-of-hours service was provided to
difficulties. We saw there were baby changing facilities and
patients on the practice's website, in the patient's practice
that breast feeding mothers were offered a private room in
guide and displayed in the reception area.
which to feed their babies.
There were arrangements to ensure that care and
The practice population was 91.5% British or mixed British.
treatment was provided to patients with regard to their
Whilst the majority of the practice population were English
disability. There was a hearing loop system available for
speaking there was a four per cent eastern European
patients with a hearing impairment and clear signage
population which was increasing. Staff told us they had
informing patients where to go. There was a wheelchair
access to a telephone translation service if a patient did not available for patients with mobility problems, a disabled
speak English.
toilet and disabled parking spaces. Consulting rooms were
Access to the service
situated on the ground floor of the practice making rooms
The practice opened 8am until 6pm Monday to Friday. The
easily accessible for patients. The waiting area was large
practice opened from 8am to accommodate working age
enough to accommodate patients with wheelchairs and
patients. It was closed from 12.30pm until 1.30pm on
prams and allowed for easy access to the treatment and
Thursdays for staff training. Appointments could be booked consultation rooms.
up to four weeks in advance, by telephone or face to face.
Listening and learning from concerns and
There were also a limited number of online appointments
available. Emergency appointments were provided on the
The practice had a system in place for handling complaints
day or the GP rang the patient back. Six of the 18 patients
and concerns. We saw their complaints policy was in line
we spoke with told us that getting through on the
with recognised guidance and contractual obligations for
telephone to book an appointment could be difficult
GPs in England. There was a designated responsible person
however, 15 of the 18 patients we spoke with told us they
who handled all complaints in the practice. Patients were
were satisfied with the timing of the appointments they
made aware of how to complain by a poster in the
reception area, through the practice's website and
The practice told us the demand for appointments was
information in the practice leaflet. Reception staff informed
continually increasing with patients transferring from other
us they tried to deal with complaints at source and
practices. They recognised that patient satisfaction with
informed the practice manager immediately. We looked at
access to appointments had fallen from excellent to
the practice's complaints register for 2013-2014 and saw
difficult in the latest GP patient survey. They showed us a
they had received 19 complaints. We saw that all
summary of four appointment audits that had been carried complaints had been investigated, analysed andout throughout 2014. We saw changes to the ratio of on the
responded to in a timely manner. Where learning had taken
day and pre-bookable appointments had been made to try
place there was a system in place to share learning with
to meet patients' requirements. Changes to the practice
staff members.
boundary had also been trialled and text messaging
Staff told us that there was an open and transparent
reminders introduced. A robust system had been put in
culture in place and their concerns were listened to. We
place to address patients who constantly failed to attend
saw there was a whistleblowing policy in place. Staff we
for their appointments. The practice informed us there
spoke with were aware of why whistleblowing was
would be on-going monitoring and that they had been
important and who to go to if they had any concerns. They
working with the PPG, LAT and CCG to address this issue.
were also aware of where to locate the policy if they
Spokespersons for these groups confirmed they had.
needed to refer to it for support
Dr Law & Partners Quality Report 08/01/2015
Are services well-led?
(for example, are they well-managed and do senior leaders listen, learn
and take appropriate action)
The practice held weekly business meetings and six weeklypartners' meetings. The practice manager held regular
Vision and Strategy
meetings with the administrative staff and the lead nurseheld regular team meetings with clinical staff. We looked at
The practice had a clear vision to deliver high quality care
minutes from the last partner's meeting which contained
and promote good outcomes for patients. There had been
updates from the nursing and administrative meetings. We
several staff changes at the practice over the previous year
saw that performance, quality and risks had been
but the management team were in the process of
considering their three to five year business plan. Thepractice values were clearly displayed in the waiting areas,
The practice held a General Medical Services (GMS)
in the staff room, on their website, in their patient charter
contract with NHS England for delivering primary care
and patient practice guide. It stated, ‘Our aim is to offer the
services to their local community. As part of this contract,
best personal care to you and your family'.
quality and performance was monitored using the Qualityand Outcomes Framework (QOF). The QOF rewards
We spoke with 13 members of staff and they all understood
practices for the provision of 'quality care' and helps to
and demonstrated the vision and values and knew what
fund further improvements in the delivery of clinical care.
their responsibilities were in relation to these. The
We looked at the QOF data for this practice which showed it
practice's strategy to achieve their vision placed a high
was performing in line with national standards scoring 99.4
emphasis on supporting staff through education, training
out of a possible 100 points.
and embracing new and innovative ideas. We saw thatprogress against delivering this was monitored and
The practice used clinical audit to monitor quality and
reviewed at the GP partner's business meeting. We looked
systems to identify where action needed to be taken. The
at the minutes from this meeting which included
practice had completed a number of clinical audits, for
monitoring of education and training; finance;
example the prescribing of Strontium Ralenate, a medicine
commissioning and federation; staffing and personal;
used in the treatment of osteoporosis. Following an alert
information technology and communication; contract
from the Medicines and Healthcare Products Regulatory
arrangements and clinical governance. We saw there was
Agency (MHRA) relating to Strontium Ralenate and
system in place whereby the lead practice nurse and the
cardiovascular safety the practice reviewed all patients
practice manager shared updates from the nursing and
prescribed this medicine to consider whether or not to
continue treatment. The first audit cycle identified that
eight patients were receiving this medication. All patientswere called in for a review of their medication. A second
There was an effective governance framework in place to
audit cycle identified that all the patients had received a
support the delivery of good quality care. The practice had
medication review and their prescription stopped where
invested in a governance system. The system contained
clinically indicated and replaced by an alternative.
around 170 policies which could be download and adaptedto meet the practices' needs. We saw that the practice had
The practice had robust arrangements for identifying,
downloaded the appropriate policies for its service and
recording and managing risks. The practice manager
adapted them to reflect the needs of their patients. The
showed us their risk log which addressed a wide range of
practice manager and senior GP partner told us this
potential issues, such as Control of Substances Hazardous
ensured that all areas of service delivery followed best
to Health (COSHH), asbestos, fire safety, buildings
practice and were up to date. The practice manager had a
maintenance, access to appointments and prevention of
management task planner in place for 2014-2015 which
the legionella virus. We saw that the risks were regularly
identified when each policy was due to be reviewed. We
discussed at team meetings and updated in a timely way.
saw that policies had been reviewed in line with the task
Risk assessments had been carried out where risks were
planner. Staff we spoke with were aware of where to locate
identified and action plans had been produced and
the policies if they needed to refer to them for support or
implemented. For example, we saw there was subsidence
and cracks in the plaster at the practice. We were shown
Dr Law & Partners Quality Report 08/01/2015
Are services well-led?
(for example, are they well-managed and do senior leaders listen, learn
and take appropriate action)
risk assessments, action plans, quotes and timeframes for
and why it was important. Whistleblowing occurs when an
the repair work to be completed. A fire risk assessment and
internal member of staff reveals concerns to the
asbestos management plan had been completed which
organisation or the public, and their employment rights are
confirmed that the building was safe.
Leadership, openness and transparency
The practice recognised the importance of the views of
There was a clear leadership structure with named
patients and had systems in place to do this. This included
members of staff in lead roles. For example there was a
the use of patients' comments, analysis of complaints,
lead nurse for infection control, a GP lead for training and
patient surveys and working in partnership with the Patient
development and a GP lead for safeguarding. We spoke
Participation Group (PPG). Results of patients' surveys and
with 13 members of staff and they were all clear about their PPG comments were shared with patients through theown roles and responsibilities. They told us they felt valued, practice website. We saw that the PPG had developed anwell supported and knew who to go to in the practice with
action plan and the practice had worked with the PPG to
any concerns.
carry out the issues within the action plan. The chairperson for the PPG confirmed that they had a very good
The lead nurse at the practice was also the chair of the
working relationship with the practice and that the partners
local practice nurses' forum. The lead practice nurse was
were open and honest and listened to what they said.
not available to speak with on the day of our inspection.
Another nurse at the practice told us that they and practice
Management lead through learning &
nurses from other practices found this forum informative,
supportive and provided peer review. We looked at the
The practice had been a GP training practice for qualified
minutes from the last forum which showed that current
doctors to become general practitioners since 1992. The
issues were discussed and the opportunity to compare best ethos of learning and improvement in terms of knowledgepractice between services was provided. For example, with
and skills was evident throughout the inspection. There
the approach of winter, updates and discussion had taken
was a lead GP responsible for the induction and overseeing
place regarding vaccinations for influenza, pneumonia and
of the GP registrar's training. We spoke with a GP registrar
shingles. The GP partners told us they recognised the
who told us there was strong leadership within the practice.
leadership role their lead practice nurse held within and
There was a buddying system in place to support GP
outside of the practice and were committed to supporting
registrars that provided them with a named GP who they
her. The lead nurse at the practice also sat on the regional
had direct access to for advice and support. The senior GP
practice nurse panel and had promoted student nurse
partner told us that they had been asked by the deanery of
placements in general practice.
the local university to support two GP registrars whoneeded additional support to complete their GP training.
We saw minutes that demonstrated that meetings such as
The GP registrars went on to successfully complete their
team, business and partners' meetings were held on a
regular basis. Staff told us that there was an open culturewithin the practice and they had the opportunity and were
We were shown evidence that staff in all roles were
happy to raise issues at team meetings.
provided with a thorough induction process. We saw that
Practice seeks and acts on feedback from users,
staff had access to a range of training opportunities. We
public and staff
looked at records which showed that all staff training wasup to date. The lead practice nurse had completed an
Feedback and comments by staff were encouraged,
extended nurse prescriber's course alongside a health
listened to and acted upon. The practice actively
assessment module. This had enabled them to lead in
encouraged the participation and involvement of staff
areas such as health reviews for patients with learning
through annual appraisals. Team meetings were held for
difficulties. The practice had reviewed the effectiveness of
staff and they were encouraged to add items to the agenda
these additional skills and had committed to supporting
that they wished to discuss. Staff told us they felt involved
another practice nurse through the extended nurse
and listened to within the practice. There was a
whistleblowing policy available for staff at the practice andstaff we spoke with understood what whistleblowing was
Dr Law & Partners Quality Report 08/01/2015
Are services well-led?
(for example, are they well-managed and do senior leaders listen, learn
and take appropriate action)
Staff told us that the practice supported them to maintain
The practice had completed reviews of significant events
their clinical professional development through training
and other incidents. There was no system in place for
and mentoring. We looked at three staff files and saw that
recording when learning had been shared with staff but the
regular appraisals took place. Staff told us that the practice
senior GP partner told us staff were informed via meetings
was very supportive of training and that they had weekly
and on a one to one basis. For example, we saw a patient
practice based learning sessions which included such
had become very aggressive towards a member of staff. We
issues as learning from audits and complaints and guest
saw that appropriate action was taken by the practice to
speakers from outside of the practice. We saw there was a
protect other staff. The practice informed us that staff had
meeting schedule for the whole of the year which was
been reminded of procedures to follow in the event of this
clearly displayed in the staffroom. Staff were also provided
with protected learning time each week to ensure that theirmandatory training was up to date. The partners from thepractice valued learning and improvement and we saw thatthis had a regular agenda item in the partner's businessmeetings.
Dr Law & Partners Quality Report 08/01/2015
Source: http://www.wetmoreroadsurgery.co.uk/website/M83051/files/Final_CQC_Report.pdf
The American Society of Hypertension, Inc. • MES 24th Annual Scientific Meeting and Exposition • The San Francisco Marriott • May 6 – May 9, 2009 health-care reform offers challenges, opportunities for ash members Economic crisis has long-term implications for research Th e com bi n ed ch a llenges of health-care reform and economic stress
Earth and Planetary Science Letters 287 (2009) 434–441 Contents lists available at Earth and Planetary Science Letters The relationship between riverine lithium isotope composition and silicateweathering rates in Iceland N. Vigier , S.R. Gislason K.W. Burton , R. Millot , F. Mokadem a CRPG-CNRS, Nancy-Université, 15 rue ND des Pauvres, 54501 Vandoeuvre les Nancy Cedex, Franceb Univ. of Iceland, Icelandc The Open University, Milton Keynes, UKd BRGM, Metrology, Monitoring, Analysis Division, 3 Av. Claude Guillemin, BP 6009, 45060 Orleans Cedex 2, France