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Factual accuracy comments log for the draft report Please fill in all parts of this form and return by email to: [email protected], or by post to: CQC PMS Inspections, Citygate, Gallowgate, Newcastle upon Tyne, NE1 4PA Account Number: Our reference: Location name: Location address: Page number e.g. Pg 10 Heading e.g. Is the Service Safe? Suggested changes with explanation e.g. change last sentence from 10 staff to 15 staff Well-led Not enough information on our novel appointment system – as well as appointments through day, we have defined time for paperwork/admin, deliberately engineered break points to ensure case discussion and support, home visiting triage, co-operative approach between duty and visiting doctor to cope with fluctuations in demand, and duty doctor available to triage any cases that arrive, the system is ready for 8-8 working should it arrive– we mentioned this in our intro presentation and on our evidence page No mention of the fact that we introduced telephone appointments 3 years ago for advice, reviews, paperwork, sick notes, results discussion (well before other surgeries), well received, convenient, effective with low conversion rate – we mentioned this in our intro presentation and on our evidence page No mention of safety built into appointment system (no more than 9 face to face appointments at any one time, protected admin time (free from interruption and distraction), cooperative approach between duty and visiting doctor to avoid one getting swamped with work) – we mentioned this in our intro presentation and on our evidence page No mention of specific feature of our home visiting policy which involves earlier visiting thereby avoiding bulge of admissions to hospital late afternoon/early evening (this is entirely in line with CCGs previous winter pressures initiative to help hospitals cope with surges in demand) ) – we mentioned this in our intro presentation and on our evidence page Our workload management policy was not only shared by LMC with all Derbyshire practices – it was actually highly commended (see October 2015 edition of Derbyshire LMC newsletter), there is no mention of this. The meeting of February 10, 2016 with clinical director Royal Derby, LMC and CCG chair, was postponed due to junior doctors strike, it is now scheduled for May 11, 2016 LMC is also involved in the meeting to discuss workload management P24 Well-led P24 Safe P14 Effective P16 Well-led P24 Well-led P24 N/a 1-557956698 INS1-561249064 Ivy Grove Surgery The Ivy Grove Surgery, Steeple Drive, Ripley, Derbyshire, DE5 3TH Safe/Effective No mention anywhere in the report of anything about our Recall system which has been developed from scratch, encompasses lab tests, procedures, DMARD monitoring, QOF recall) – we mentioned this in our intro presentation CQC decision CQC comments e.g. or X explanation of decision P14 Safe P14 Safe P14 Safe P14 Safe P14 Safe P14/22 Safe/Responsive P16 Effective P18 Effective P18 Effective P18 Effective P18 Effective and on our evidence page No mention of our defined process for distribution of results and workflows during leave/sickness) – we mentioned this in our intro presentation and on our evidence page No mention of our receptionists following in-house developed ‘RED’ list to ensure emergency patients (e.g. heart attack, stroke) are appropriately dealt with) – we mentioned this in our intro presentation and on our evidence page No mention of our process of ensuring that every patient seen in office hours and needing a two week cancer referral actually leave the building with a hospital appointment (ensures no patients are missed), and those seen out of office hours receive a phone call with the appointment from our admin team the next working day) – we mentioned this in our intro presentation and on our evidence page No mention of our lone working policy which has a secret ‘I am in danger’ code so that staff will know to discreetly call the police) – we mentioned this in our intro presentation and on our evidence page No mention of our anticoagulation service. This is an additional service which not all practices do. We have all trained staff and lead in this area) – we mentioned this in our intro presentation and on our evidence page No mention that we are a registered Yellow Fever Centre (again an additional service that not all practices do). Convenient for patients of other practices – we have provided a travel service for the practice up the road for the last 3 years as they do not have any trained staff to do it themselves) – we mentioned this in our intro presentation and on our evidence page No direct mention of additional services that we carry out – dementia screening, care home initiative, admission avoidance, CCG prescribing quality scheme, CCG winter pressures initiative etc (again not all practices do this) – we mentioned this in our intro presentation and on our evidence page Under consent to care and treatment, templates written exclusively for counselling and consent for implants, coils, injections, i.e., invasive procedures) – we mentioned this in our intro presentation and on our evidence page Under improving outcomes for people, no mention of our involvement in prescribing quality scheme using our unique alert system for (1) ensuring that patients at risk of acute kidney injury receive education about this (we met our 12 month target within about 6 weeks of starting this and have now reached 78% of the at risk group) and (2) deprescribing medications using a similar alert (met our 12 month target within 2 weeks) this was so effective that the medicines management team was interested to learn the technique so that the process could be shared more widely with other practices) – we mentioned this in our intro presentation and on our evidence page No mention at all of our extensive mail merge document system, which allows clinicians to generate hard-copy request and referral forms, which (1) are quick and easy, saving time in already pressured consultations, (2) form a contemporaneous record within the patient’s notes and (3) can be reprinted if lost by patients (happens more often that you think!) ) – we mentioned this in our intro presentation and on our evidence page Although mention is made of our wide ranging system of alerts, under ‘supporting patients’, no mention is made of our other alerts which we demonstrated to the inspection team on the day, e.g., patients who have a ‘do not resuscitate’ order, palliative care traffic light status, if patient is on admission avoidance or learning disabilities register, whether P7, P18 Older people P25 Well-led P22, P25 Responsive / Well-led P24 Well-led P24 Well-led P24 Well-led P24 Well-led N/a N/a P25 Well-led P18 Effective DMARD monitoring is overdue or up to date. This are all custom in-house programmed alerts developed over time from staff ideas to help improve care) – we mentioned this in our intro presentation and on our evidence page Over 75s day is not on March 2016, it will be held on May 18, 2016. Minutes of organisation meetings have been posted online on our improvements page Only one description of our newsletter, in that is it ‘regular’! This is a high quality publication, going for 14 years now, very popular with our patients, we work with other agencies to get articles for it (e.g., youth clubs, citizens advice, carers association), our patient group writes regularly in it, it is available in PDF format, online and of course paper format from reception desk. It is regularly within top few hits for ‘patient newsletter’ or ‘patient newsletters’ on google – this is due to good quality content which people want) – we mentioned this in our intro presentation and on our evidence page No direct mention of our mobile ready/smartphone site. Again not all practices have such a thing) – we mentioned this in our intro presentation and on our evidence page We have held Away Days for 20 years, well before they became fashionable or the norm No direct mention of our self-managing team leaders in reception and nursing (help to plan rotas, determine skill-mix, involved in interviewing for new staff etc) ) – we mentioned this in our intro presentation and on our evidence page No mention of professional rota software, dropboxes (cloud storage) for collaboration and ensuring documents safe and available at any time (e.g. business continuity plan) ) – we mentioned this in our intro presentation and on our evidence page No mention of any of our numerous links with outside agencies (slide 63 of our intro presentation), e.g. Amber Valley Collective, Sublocality, one of salaried Drs is chair of the CCG, work with LMC, part of EMIS service users group, IM&T, Primary Care Development, etc, including Sir Stephen Moss) – we mentioned this in our intro presentation and on our evidence page No mention of loyal staff and longevity of employment (4 employed >25 years, others from school leaving) – we mentioned this in our intro presentation and on our evidence page Under ‘continuous improvement’ as part of our forward thinking we are looking at other initiatives and aspiring to more improvements (these were mentioned in the intro presentation): overarching strategy for housebound patients and care planning, IT developments (e.g., laptop/iPad on home visits, texting service), active prescribing review, aspiring to become a training practice Inspection team asked for information on the significant improvements we had made to our IT systems – we provided comprehensive information on this on our CQC improvements page including information on how patient outcomes had improved as a result. However only two examples were mentioned. The CQC improvements page documents this all in great detail, but we are concerned that nothing is mentioned of our consistent approach to developing the IT Infrastructure over many years, backed up by evidence of meetings, presentations, protocols. There is also insufficient detail on our unique work with EMIS Web in developing all our own in-house templates, vast protocols, more on our alerts and why and how they improve patient outcomes, not only the pop-up alerts already mentioned, but others such as Acute Kidney Injury Initiative, Deprescribing initiative (as part of Prescribing Quality Scheme), in-house customisation of EMIS Web's lightning bolt function to provide quick and easy access to commonly used computer entries, templates and protocols enabling consistent and necessary data entry necessary for QOF and other work; vast array of mail merge documents developed in-house, e.g., referral forms, request forms, ranging from blood forms and X-ray requests; care planning with advice information sheet; huge variety of searches and reports to help aid care; developed Recall System from scratch to enable safe and efficient recall of any patient on QOF register, those needing repeat blood tests or procedures and drug monitoring for DMARDs Our website is unique and custom built, we work to strategy of providing quick and easy access to information with easy to remember web address shortcut ivy.gs promoted at every opportunity, in leaflets, right hand side of prescriptions, posters, online, we have variety of simple and easy to digest posters on website to inform patients of services and appropriate sources of help - example page on website or see posters e.g., surgery website facilities, minor injuries unit, telephone appointments, nurses appointments Newsletter articles series - Day in Life of...(surgery team member), Make the Most of your GP, Did You Know...? popular and informative articles to empower patients; enabling effective use of our services - see example newsletter with all three series; electronic subscriptions to newsletter subscription service nearly 200 subscribers; online services page - centralised page where online services can be accessed, allows repeat prescription ordering, viewing of aspects of record, booking and cancelling of online appointments convenient for patients; time-saving; medical advice pages to help patients to selfcare or to access appropriate help; unique postcode checker to allow prospective patients to see if they live within our practice boundary No mention of our other IT developments whilst these innovations are not directly involved in patient care, they free up time so that our staff can work on other jobs that are directly related to patient care, including use of dropboxes (cloud storage) allows collaboration between staff, safe backup of items (e.g., business continuity plan), remote access if needed; room rota shared online so that outside agencies can check availability without having to regularly trouble management, also management uploads updated rota directly back online again without needing to trouble IT lead (i.e., me!); professional rota software used to write clinician rotas, freeing up time for other job; system-wide annual leave planner which self-updates with bank holiday dates and accessible by all staff to allow booking of leave, calculation of entitlement, totalling of all types of leave, e.g., study leave, sickness leave, parental leave etc; management accounting spreadsheet to enable instant profit/loss, quarterly review statements, cashflow projection without having to spend time doing detailed analysis of current accounting situation; paper-light approach to work, using EDT (Electronic Document Transfer), OOH notifications listed on single sheet A4; all policies shared on practice intranet (Docman Library), with staff views and comments all audited P20 Caring n/a P17 Effective P14 Safe P16, P25 Effective, Wellled P16 Effective P14, P16 Safe, Effective No mention at all of our care co-ordinator and community matron, who together provide excellent care for elderly patients and those with long-term conditions – care coordinator contacts every patient on admission avoidance register who has been discharged from hospital, organises care, liaises with other agencies, our community matron carries out home visits autonomously on patients with long term conditions, polypharmacy, frail and elderly. They are a crucial and valued part of our team – we mentioned this in our intro presentation and on our evidence page No mention of extensive and consistent positive feedback from patients and others on our messages page – we mentioned this in our intro presentation Not enough information on our unique online locum pack, gives comprehensive insight into how we work, e.g., syringe drivers, who does which joint injections, doctors’ interests, layout of building, where toilets are etc, entire section on emergencies and contact details, e.g., safeguarding No mention that list of safeguarding contacts are all readily available in each consultation room, reception, also on template for safeguarding, and finally also in locum pack, so easily and readily available from multiple sources – we mentioned this in our intro presentation and on our evidence page and also demonstrated this on the day No mention of staff account of flu clinics – well led, team event, jovial relaxed atmosphere, all backed up with efficient protocol – we mentioned this on our evidence page, also specific flu page on website at flu page for patients No mention of our custom in-house programming of EMIS lightning bolt function that gives quick and easy access within consultations to most of the important protocols, templates, procedures, clinical findings, letters, enabling more efficient working – we mentioned this in our intro presentation and on our evidence page No mention at all of our drug monitoring protocols for DMARDs, QOF conditions, miscellaneous drugs, all backed up with unique 1 page drug monitoring chart giving all staff an easy to use reference – this has been used copied by other practices and commended by our Medicines Management team – we mentioned this in our intro presentation and on our evidence page (Include additional rows if required) Completed by (name(s)) Michael Wong and Charmagne Stephenson Position(s) Registered Manager/CQC lead and Practice Manager respectively Date 7/3/16