Letter from the Chief Inspector of General Practice

This practice is rated as good overall. (At the previous inspection undertaken in October 2014, the practice received a good overall rating, with an outstanding rating for providing responsive services)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Darley Dale Medical Centre on 1 November 2017. This inspection was carried out under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

At this inspection we found:

• The partners invested high levels of funding in their practice team to provide sufficient capacity, and ensure there was adequate and trained administrative support to relieve pressures on clinical time.
• There was strong clinical leadership and we saw how this impacted positively upon the quality of the service. For example, the GP prescribing lead had overseen cost effective prescribing, and lower rates of antimicrobial prescribing.
• The practice had a live strategy which focussed on the new challenges faced by general practice. This was supported by the appointment of a strategic business manager, and a new premises development to provide an environment to respond to local patients’ needs.
• We spoke with community based health, social and care home staff who overwhelmingly provided us with positive feedback about their interactions with the practice team, In particular, we observed that the relationship with social care was driving responsive and compassionate care for patients, including keeping those at risk from harm safe.
• The practice had received the Derbyshire Dignity Award in 2013 and continued to aspire to maintain this achievement. At the time of our inspection, the practice had submitted an application to the county council as part of the biennial renewal which focused on their work with local care homes.
• Results from the latest national GP patient survey showed that the practice had performed above local and national averages in the majority of the questions about patient experience. This was particularly evident in relation to GP access and comments regarding being cared for in a dignified and respectful manner.
• Patients who responded that they were satisfied with the practice’s opening hours was marginally below the local and national averages. The practice was proactively looking to address this via a collaborative approach with other practices to implement an 8am-8pm hub service locally.
• The practice encouraged and supported staff to report incidents and near misses. When incidents did happen, the practice learned from them and improved their processes. Positive events were also recorded in recognition that sharing best practice was an equally valid means of learning, and a way to celebrate success.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Care planning was embedded within the practice to reflect individual’s patients’ needs and their own wishes. We saw that 8% of patients had at least one care plan in place at the time of our inspection.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Staff training records were up to date, and regular appraisals encouraged development at all levels.
• The practice had an established quality improvement programme. This included involvement in research.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected Darley Dale Medical Centre on 08 October 2014, as part of our new comprehensive inspection programme.

We visited the main surgery in Darley Dale. The practice had previously been inspected on 23 January 2014 and was found to be compliant with all regulations. For this reason, we did not visit the branch surgeries in Winster and Youlgreave.

Overall the practice is rated as good. Specifically, we found the practice to be outstanding for providing responsive services; and it was good for providing safe, effective, caring and well-led services. It was also good for providing services to all six population groups we inspected.

Our key findings were as follows:

• Patients were complimentary of the care they had received and reported being treated with dignity and respect. They expressed a high level of satisfaction with the arrangements in place for accessing the service and involvement in decision making.
• The practice had reliable safety systems including safeguarding, medicines management, risk management and infection and control.
• GPs and nursing staff assessed patients’ needs in line with NICE guidelines and best practice.
• Ongoing quality improvement work such as clinical audits, peer reviews and benchmarking was promoted to ensure improvements were made to patient care and staff knowledge.
• The appointment system and staffing arrangements were responsive to the needs of the patients. This ensured most patients were able to access same day and emergency appointments.
• The practice offered a variety of in-house services for each of the population group we inspected and these were managed effectively.
• The practice was well led, and both staff and patient feedback was acted upon to improve the service.

We saw several areas of outstanding practice including:

• High patient satisfaction levels in relation to phone access, opening hours and a good overall experience of making an appointment. The 2013/14 Public Health England and the national patient surveys showed the practice values were above the regional and national average.

• The practice’s involvement with community hospitals allowed the clinicians to provide care throughout the ‘patient journey’ and when their health needs increased. For example, patients receiving end of life care, management of acute illness and rehabilitation following a hip replacement. This was valued by patients and their carers as it allowed care to be provided close to home and an admission to the acute trust hospital was avoided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At the time of the provider completing their registration for Darley Dale Medical Centre they advised that they were not compliant with the requirements concerning infection control, premises or equipment. They submitted an action plan to tell us what actions they would be taking to ensure they were meeting these standards.

During this inspection we found that patients were being cared for in a clean, hygienic environment and that there were arrangements in place to reduce the risk and spread of infection.

The provider had taken appropriate steps to ensure that patients were protected against the risks of unsafe premises. We saw that patients, staff and visitors to the practice were protected from unsafe or unsuitable equipment.