We inspected Delamere Medical Practice as part of our inspection programme on 23 May 2018. At that time, we found two areas of outstanding practice and the practice was rated good overall. After our inspection there was a serious significant incident at the practice. Because of that incident a complete review of staffing, systems and processes was undertaken to ensure that safe care, specifically for vulnerable patients was improved.
The practice informed us of the significant events, what had occurred and why and the immediate actions they had taken to maintain safety.
We decided to undertake an early annual regulatory review of the practice to ensure that any further risk had been minimised. The information submitted to us during the review indicated that significant improvements had been made in all areas of the service.
We decided to undertake an inspection of this service following our annual review. The inspection looked at the following key questions, safe, effective, responsive and well- led. We did not look at caring at this inspection but the rating from the last inspection was good and that has been carried forward.
At this inspection on 2 October 2019 we rated the practice as outstanding. 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 Outstanding overall.
We rated the practice as outstanding for providing Safe and Well Led services because:
- There was evidence that people were protected by a comprehensive safety system and a focus on openness, transparency and learning when things went wrong.
- Systems took account of current best practice and the whole team was engaged in reviewing and improving safety and safeguarding systems.
- People who used services were at the centre of safeguarding and were protected from discrimination.
- There were innovative approaches to providing integrated person-centred care.
- The practice had identified areas where there were gaps in provision locally and regionally and had taken steps to address them.
- The culture of the practice and the way it was led and managed drove the delivery of high quality person-centred care.
We rated the practice as Good for effective and responsive services because:
- People had good outcomes as they received effective care and treatment that met their needs.
- Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care. However, the patient satisfaction survey did not reflect overall patient satisfaction.
We saw several areas of outstanding practice including:
- The practice introduced an improved medicine review template because they found the standard template in the clinical system was not effective and did not reduce error. The new template pulled through the patient’s complete medical history, all prescribed medicines and questions that should be asked of the patient to ensure up to date guidelines were being consistently followed. The practice provided numerous examples where the new template had improved safe and appropriate prescribing. For example, it highlighted a patient with atrial fibrillation who was being under-dosed, a diabetic patient was needed to be referred back to secondary care services for review, a safeguarding incident that needed to be referred and an outpatient prescription request that needed to be questioned and clarified.
- The practice had introduced several in-house services for patients of their own practice and also patients of the wider North Trafford community and patients in the whole of Trafford. Those services included dermatology and minor surgery. Waiting times for minor surgery in Trafford had reduced from six months to two weeks.
- The practice introduced rigorous monitoring and maintenance of vulnerable patients and ensured that contact with those patients remained consistent when they were in crisis and reduced when they became stable.
- The practice had a large cohort of patients with mental health conditions and it was identified that there was a gap in service provision for patients with conditions that did not meet secondary care services. They employed clinicians with expertise in mental health including a mental health nurse and a GP and now provided a step up/step down service and psychological interventions for those patients.
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