Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acorn Surgery on 9 January 2017. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs were accessible and supportive.
• There was evidence of an all-inclusive team approach to providing services and care for patients.
• Feedback from patients about their care was consistently positive.
• Staff said they were proud to work at the practice and felt they delivered good quality service and care to patients.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they meet patients’ needs. For example the introduction of a dedicated mental health service at the practice.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• The practice staff had a very good understanding of the needs of their practice population and were flexible in their service delivery to meet patient demands; such as providing flexible GP appointments when required.
• There was good access to clinicians and patients said they found it easy to make an appointment. There was continuity of care and if urgent care was needed patients were seen on the same day as requested. Consultations were available through Skype.
• Patients’ needs were assessed and care was planned and delivered following local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice promoted a culture of openness and honesty. There was a nominated lead for dealing with complaints and significant events. All staff were encouraged and supported to record any incidents. There was evidence of good investigation, learning and sharing mechanisms in place.
• The practice complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)
• There were safeguarding leads in place and systems to protect patients and staff from abuse.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example the practice had reviewed the appointment system and significantly improved access to appointments for patients.

We saw some outstanding practice:

• There was a proactive approach to understanding the needs of different groups of people, with a focus on people living in vulnerable circumstances. These included support for patients who were homeless, seeking refuge and those with alcohol dependency and substance misuse.
• The practice aimed to reduce unecessary hospital attendance, with a range of practice based clinics and services. For instance ‘no scalpel vasectomy’, acupuncture, anticoagulation monitoring services and working closely and collaboratively with the on site pharmacy which delivers direct HIV services, and with the GUM clinic which operates from the same building.
• There was a proactive approach to safeguarding, with GP leads in place to support a high number of children who were at risk.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure they met patients’ needs promptly. For example: a pilot project for enhanced mental health needs and an alcohol support service to facilitate ‘home detox’ for patients.
• The practice team proactively promoted health awareness and self-care in the community by the GP lead and practice team attending local nursery, primary schools and local community events. They have also been selected by the NHS England to deliver a supported self-care pilot programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice