We carried out an announced comprehensive inspection at Dunsville Medical Centre on 16 April 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for older people, people with long term, conditions, families, children and young people and people experiencing poor mental health population groups. We rated this practice as outstanding for people whose circumstances may make them vulnerable. 

We rated the practice as requires improvement for providing safe services because:

• The practice did not consistently have clear systems and processes to assess and mitigate risks to keep patients safe.

We rated the practice as good for providing effective, caring, responsive services and well led services because:

• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We saw areas of outstanding practice including:

• Staff, teams and services were committed to working collaboratively and have found innovative and efficient ways to deliver more joined-up care to patients. In March 2017 the practice and six neighbouring practices developed the proactive primary coordinated care pathway. The practices hosted the pro-active care team, which included three pro-active care nurses, who visited frail, vulnerable or older patients in their own homes and implemented an advanced care plan with the patient/family/carers.  Initially, patients were assessed using a risk stratification tool  The pro-active care nurse had identified 130 patients at risk and have care plans in place. Of that 38 patients had consented to an enriched summary care record.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients (Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and improve systems to record and report safety concerns, incidents and near misses.

• Develop a programme or schedule of clinical audit activity which will lead to improvements to patient care and outcome.

• Review and improve systems to record all complaints

• Review and improve systems to monitor patients prescribed high risk medicines.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care