Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S D Milligan and Dr H M Lovatt on 19/04/2016. 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.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice was rated first in the clinical commissioning group (CCG) area for the percentage of their patients who had had advanced care plans (ACP) discussed. Advance Care planning is key means of improving care for people nearing the end of life and of enabling better planning and provision of care.
• Patients said they were truly respected and valued as individuals and were empowered as partners in their care. Patient satisfaction with their care was much higher than local and national averages. For example, in the National GP Patient Survey 97% of patients said the last GP they saw was good at involving them in decisions about their care, compared to the national average of 82%.
• The involvement of other organisations and the local community was integral to how services were planned and ensured patients’ needs were met.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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. For example, 100% of patients said that the last time they wanted to see or speak to a GP or nurse from their GP surgery they were able to get an appointment (national average 76%).
• 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 several areas of outstanding practice:

• There was a strong, person-centred approach to supporting carers and those they cared for. For example, people who were cared for were given a “hospital passport” for use in emergency admissions to hospital. This contained the carer’s contact details, as well as information which could assist staff in secondary care with personalised care planning.
• The practice worked with the local primary school to offer an annual “treat teddy” session to pupils to promote awareness about health issues and their treatment.
• The practice used key indicators based on guidance from the Scottish Intercollegiate Guidelines Network (SIGN) to measure and drive improvement in the care of diabetes. This was in reponse to data which showed the practice had a higher than local average prevalence of the disease, but that overall performance for diabetic patients was average. Data from 2015/16 showed improvements not only in each individual SIGN indicator, but also in the number of patients who were meeting all the identified targets.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice