Letter from the Chief Inspector of General Practice.

We carried out an announced comprehensive inspection at Bottisham Medical Practice on 25 January 2016. Overall the practice is rated as good.

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

• 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.

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example referrals were made to a local outreach sexual health service, in addition a GP and the practice manager attended the local college and provided information and signposting for students at the college.

• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• 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 staff and patients, which it acted on.

• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw areas of outstanding practice:

• The practice had developed an easy read pre-health review document for patients who have a learning disability. This used words and pictures in an easy read format to help patients with a learning disability to better understand and respond to questions about their health, illness, lifestyle and treatments. This ensured GPs had the basic and necessary information about the patient and their symptoms prior to their health review. The practice had identified 16 patients on the practice list with a learning disability. Face to face annual reviews were undertaken by GPs and a practice nurse.

• The practice provided support to one nursing home with 156 beds and one residential home with 56 beds. This included support for 10 patients, formerly from a secondary care establishment with complex neurological requirements. The practice had developed an emergency visit request pro forma for residential and nursing homes which ensured GPs had the basic and necessary information about the patient and their symptoms from the staff prior to a home visit. This included specific patient details, the reason for the requested visit and the time the concerns were first raised and by whom. This ensured the GP had all the information relating to the patient’s condition should the member of the staff go off duty and could then provide timely, accurate and bespoke care and treatment when required.

• The chairman of the Patient Participation Group (PPG) was a volunteer Health Walk team leader and led the practice Health Walking Group which met fortnightly under the umbrella of the County Council’s Walking for Health. With patients consent, GPs could refer patients to the group to promote activity and well-being. Some members of the group regularly joined the walking group however there was scope for patients to join the walks on an ad hoc basis.

• The practice worked with the PPG to increase links with the teenage patients. The practice had recently added a teenager page to its website which provided links to the NHS Choices live well pages for teenagers. The practice manager was working with the information technology students at the local secondary school, to review the teenager pages on the practice website with the intention to make these pages more appealing for this group of patients. This work was on-going, however the practice anticipated this would enable and encourage teenage patients to access services that would meet their needs.

• The practice worked with the local secondary school to review the annual personal, social, health and economic (PHSE) student survey, completed by students aged 16 -18 to assess where there may be gaps in the provision of care. The previous year’s PHSE survey highlighted a high incidence of self-harm amongst teenagers. The practice worked to refer such patients to support services. However, the practice had noted that local services were limited due to a lack of resources within the local mental health trust. One GP partner was the practice and local commissioning group lead for mental health, and we were told was in the process of developing appropriate mental health services for the locality.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Bottisham Medical Practice had a proven track record on safety with a prevailing culture of learning from incidents and alerts to ensure patients received care that was safe. For example, the practice followed a process known as significant event analysis (SEA) to ensure lessons learned from such events could be shared by all staff.

There were safe processes and systems in place such as those for responding to a medical emergency and those for ensuring the practice was clean and operated hygienically. All staff were properly trained to recognise and respond to abuse.

Patients at the practice experienced care and treatment that was in line with established guidance. The practice ensured it was effective by completing clinical audits to identify where improvements might be made.

Staff were trained and supported to develop within their role and to maintain their standards of clinical practice. The practice worked well with other service providers, promoted good health and supported patients to prevent ill-health.

Patients received a caring service at Bottisham Medical Practice. Patients were treated with dignity, respect, compassion and were involved in making decisions about their care and treatment. The practice scored highly on satisfaction rates in the national patient survey for its caring approach.

The practice understood the needs of its patient population and provided services to meet their needs. This was particularly the case with two local care homes and the students at a local community college.

The practice was accessible with a range of appointments available. This was also supported by the views of patients canvassed as part of the national patient survey.

The practice was well-led with a culture of learning, clear lines of accountability and effective management structures in place. The practice was supported by an active patient group that both provided feedback on services and helped to create initiatives to improve patient outcomes.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We reviewed the information available to us about Bottisham Medical Practice on 8 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.