Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Drs Irwin, Goodwin and Fargnoli on 17 March 2016. Overall the practice is rated as outstanding.

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

• 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.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• 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.
• Feedback from patients about their care was consistently and strongly positive.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that 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.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. For example, the practice implemented a lymphoedema clinic following patient request. This meant that patients requiring this service did not have to travel to secondary care providers.
• The practice recognised the lack of public transport for patients to get to the practice, and organised a patient led transport scheme. This service was promoted to new patients in the practice newsletter and on the patient participation group (PPG) notice board.
• The practice worked alongside the PPG to develop education events for patients. They organised a ‘Dementia Day’ held at the practice, which was well attended and well received by patients. Furthermore, the PPG were in contact with local schools and had a plan in place to present health education sessions. The practice recognised the barriers to engaging with younger patients, and was keen to build positive relationships and promote good health.
• The practice was innovative and proactive in setting up new services in the area. For instance, the practice promoted exercise programmes to patients identified as at risk of cardiovascular disease at NHS health checks. The senior partner at the practice had organised for a weekly parkrun to take place nearby after recognising the need for local, free of cost exercise groups in the area. We received positive feedback from patients about these services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During this follow up visit, we did not need to speak with patients about the service. However, we did speak with patients during our initial visits on 24 and 25 February 2014.

When we returned on 19 June 2014, we spoke with the practice manager and with some staff. We checked the emergency equipment and reviewed the records of the monthly checks that were being completed to assess the quality and safety of clinical equipment and the consultation rooms. We found these quality assurance checks were effective so that patients could be assured that the clinical equipment was safe for use.

Patients we spoke with told us that they could book an appointment at a time that suited them. Not all patients were able to see a GP of their choice. We found that patient records were accurate and up-to-date. Regular reviews had been completed for each patient to ensure their health care needs were being met. Patients we spoke with told is they did not like having their conversations over heard.

The provider gave the safeguarding of patients the priority and attention it deserved. All of the staff we spoke with were able to describe how safeguarding of patients was effectively provided for. Patients we spoke with told us that they always felt safe at either of the provider's surgeries.

The provision of hand wash facilities, protective clothing, staff training and their knowledge of infection prevention and control measures meant that patients were cared for in a visibly clean environment. Cleaning was provided at both surgeries to an appropriate standard.

Regular environmental, equipment, health and safety and other audits of staff training had been completed. However, we found that these were not always effective in identifying errors and omissions. The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of patients who use the service, but this was not always an effective system.