This practice is rated as Outstanding overall. (Previous inspection October 2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

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 retired and students – Good

People whose circumstances may make them vulnerable – Outstanding

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

We carried out an announced comprehensive inspection at Alton Street Surgery on 21 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients said that they found the appointment system straightforward to use and reported that they were able to access care when they needed it. Routine appointments were always available on the same day.
• The GP partners and management team were forward thinking. There was a strong commitment towards development and integrated care.
• The practice was presented with a highly commended award by the Herefordshire Carers’ Association in 2017 in recognition of their work for carers.
• The practice was a hub for community health groups. For example, Herefordshire Carers’ Support and Dementia Action Alliance.
• A self-care station in reception offered practical advice on managing conditions. It enabled patients to be more actively involved in their own self-care programme.
• The practice implemented suggestions for improvements and made changes as a consequence of feedback from patients and from the patient participation group.
• The practice placed a great deal of emphasis on training for trainee GPs, medical students as well as for their own staff.
• The practice was accredited with the Primary Care Clinical Research Network at Warwick University.

We saw an area of outstanding practice:

• The practice took an holistic person centred care approach to people living with mental health issues. For example, a GP chaired the Ross Mental Health and Wellbeing Steering Group, which was instrumental in setting up initiatives such as the Ross Dementia Centre and the GP had developed a poetry support group. Feedback from people using the services identified positive outcomes.

The area where the provider should make improvements is:

• Continue to encourage the uptake of cervical screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 3 October 2014. We have rated this practice as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. We found the practice provided good care to older people; people with long term conditions; families, children and young people; the working age population and those recently retired; people in vulnerable circumstances and people experiencing poor mental health.

Our key findings were as follows:

• The practice has experienced turnover of staff and a shortage of GP partners. Despite this it has continued to provide a service which most patients can access easily and about which they are positive.

• The practice had implemented the ‘Gold Standard Framework’ for patients who were nearing the end of their life. The Gold Standard Framework ensures patients are involved in decisions about their care and treatment for as long as possible.

• The practice had the highest number of patients with a learning disability within the Clinical Commissioning Group (CCG) area and every patient with a learning disability had had their annual health check.

We saw several areas of outstanding practice including:

• One GP had developed a support group for patients with a mental illness using poetry to engage with patients.

• The practice worked with the PPG in an innovative way to maximise the number of patients who had a flu vaccination.

There were some areas where the provider should make improvements. The provider should:

• Develop their recruitment processes to ensure that they obtain all of the required information for new staff when they are appointed.

• Ensure that the safeguarding lead has completed training in safeguarding children and adults at a level appropriate to that role.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Most patients we spoke with were happy with the service they received. One patient said, “I always feel comfortable and I recommend the surgery”. Another patient told us that they had, “No problems whatsoever”.

We found that patients could choose to sign up to a well-publicised online consultation group. This enabled them to respond to survey questions and express their view about how the surgery was run.

Patients were treated with respect and the staff understood the need to deal with patients in a confidential manner.

There were suitable numbers of staff with appropriate qualifications working at the practice. The surgery had contingency plans in place to deal with any unexpected staff shortages.

We found that medicines kept in the surgery were stored in a safe and secure way. The staff regularly checked the medicines to ensure that they remained in date.

We found that the practice had appropriate internal audit systems in place to monitor and improve the quality of the service it provided.