Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clare House Surgery on 21 January 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.
• There were innovative approaches to providing person centred care with risks to patients 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.
• Eighty four patients expressed high levels of satisfaction about all aspects of their care and treatment at the practice during the inspection. They said they were always 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 staff responded immediately to their request and found it easy to make an appointment with a named GP for continuity of care, with urgent appointments available the same day.
• The practice facilities had been refurbished to a high standard and was well equipped to meet their needs.
• There was a strong leadership structure and staff said they 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.
• The leadership, governance and culture of the practice put quality and safety as its top priority in delivering person centred care and treatment. We saw many examples of this throughout the inspection, which was a common thread seen in the areas of outstanding practice.

We saw four areas of outstanding practice:

• Patients individual needs and preferences were central to the planning and delivery of tailored services.Following feedback from patients, the practice altered the appointment system.This is completely flexible and set up in a way that suits patients so they have autonomy to decide when to have a face to face appointment with a GP or nurse as opposed to a telephone consultation.

• A systematic approach is taken to working with other organisations to improve care outcomes, tackle health inequalities and obtain best value for money for people living in Tiverton. Clare House Surgery has embraced the concept of living well and is facilitating the integration of services to specifically bring care and treatment closer to home for patients and we saw many examples of this. For example, there were several GPs with specialist interest qualifications enabling the practice to provide extended dermatology and surgical services normally seen in hospitals.

• The practice takes a truly holistic approach to assessing, planning and delivering care and treatment to people who use services. The whole practice team is given a verbal handover every day so that the needs of vulnerable older patients and those with mental and chronic health conditions are known.This daily monitoring of these patients andco-ordination across the team aimed to reduce the risk of unplanned hospital admissions for these patients.

• A respiratory disease nurse specialist is a member of the British Lung Foundation and works collaboratively with a nearby practice in Tiverton to deliver a hospital based rehabilitation programme for patients with long term respiratory diseases.Patients experienced an integrated service with a rolling programme of referrals, continuity of treatment and expertise from these nurses on the rehabilitation course.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice