Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Belvidere Medical Practice on 2 June 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding in providing caring and responsive services. We found it good for providing safe, effective and well led services. It was also outstanding for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable and people experiencing poor mental health.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, empathy, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day. The practice provided extended hours appointments with their GPs, respiratory nurse and counselling service. The practice had also increased the flexibility and length of time of their GP appointments to 12 minutes instead of 10 to ensure patients’ needs were met.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from patients, which it acted on.

We saw the following areas of outstanding practice:

• The practice employed a care co-ordinator to support and facilitate care for vulnerable patients. For example, the practice had identified 110 frail and vulnerable patients registered with their practice and 96 of these patients had an agreed care plan in place. The care co-ordinator also co-ordinated three monthly health reviews by a GP and telephoned patients following any hospital admissions to check on their health and wellbeing. In addition, they proactively supported young carers and liaised with voluntary organisations such as the British Red Cross young carers service to support this vulnerable group.
• Extended hours appointments were available with the GPs, respiratory nurse and the practice’s counselling service.
• The practice employed a counsellor for patients experiencing mental health difficulties such as low mood, depression and anxiety. For 2014-2015 the practice had made 57 referrals to this service and 317 counselling sessions had been provided for these patients. Fifty-two out of 62 patients with a diagnosis of dementia had received an annual health review in the last 12 months.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

• Introduce a system to review significant events over time to identify any trends in the type of incidents that may have occurred at the practice.
• Introduce a risk log to ensure that identified risks are monitored and rated and mitigating actions recorded to reduce and manage the risk.
• Ensure that all the staff receive regular appraisals.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice