This practice is rated as Good overall. (Previous inspection February 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 recently retired and students – Good

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive inspection at Chew Medical Practice on 16 January 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. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice had supported the introduction of a weekly choir group for new mothers experiencing postnatal depression.The choir had developed into a support network for all new mothers as a vehicle to prevent problems developing.
• The practice worked closely with village agents who acted as a support network for those patients who were experiencing hardship, health issues or were isolated in their community.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a focus on continuous learning and improvement at all levels of the organisation, through regular clinical audits, participation in national research projects as well as being a teaching practice for all levels of medical and nursing students, and GP trainees.

We saw one area of outstanding practice:

• The practice had introduced an Early Home Visiting Scheme (EHVS). The purpose of this was to ensure that frail elderly patients could be assessed and a management plan commenced to help prevent hospital admission. We saw evidence that demonstrated that admissions had reduced from 180 per 1000 patients in the four months before the scheme to 153 per 1000 patients in the four months after the scheme started. The practice had the lowest admissions rate to Accident & Emergency and acute admissions in the Bath & North East Somerset (BANES) area, despite having a higher than average population of elderly patients.

The areas where the provider should make improvements are:

• Fully embed arrangements for management oversight of systems and processes in relation to medical alerts and infection control.
• The practice should invite patients who are also carers for an annual health check.

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 at Chew Medical Practice on 3 February 2016. Overall the practice is rated as good.

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. Opportunities for learning from internal and external incidents were maximised.

• 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.
• Information about services and how to complain was available and easy to understand.
• Patients said they could access appointments with a GP, although not always their GP of choice. The practice had a good system to provide urgent advice and appointments available the same day.
• 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 staff were involved in the vision of the practice.
• The provider was aware of and complied with the requirements of the Duty of Candour.

• There was a strong ethos of patient centred holistic care which was embedded throughout the practice team.

We saw two areas of outstanding practice:

The practice had worked proactively with the local secondary school to promote safe sexual health clinics and advice in response to a local high teenage pregnancy rates. This had demonstrated a decline in teenage pregnancy rates. The practice wrote to all 13 year olds to promote the services and support available. The practice had worked with the local secondary school to provide support and counselling.

The practice had a system to see patients in surrounding villages on an ad hoc basis without prebooked appointments for those who could only attend when transport allowed. A local coach service attended the local villages (with no transport links) and brought patients to the practice. All these patients would be seen by a nurse or a GP dependant on their needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice