Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Clarendon Surgery and Trinity Medical Centre (Branch Surgery) on 24th September 2015. Overall the practice is rated as Good.

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.

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.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. They monitored, evaluated and changed the services they offered to suit the needs of their population, increasing resources at peak times to meet demand. This was most apparent in relation to the telephone appointment system which was monitored on a daily basis, with evidence that patient demand, and not the practice, was managing any changes.
• The practice recorded, reported and shared significant events and complaints with the Clinical Commissioning Group (CCG), at neighbourhood meetings for peer review, support and continual improvement. They were also aware of the requirement to report necessary information to the Care Quality Commission and provided examples where this had been done.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
• 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 a clear vision which had quality and safety as its top priority. A business plan was in place and high standards were promoted and owned by all practice staff with evidence of team working across all roles.
• The practice became Investors in People (IPP) in March 1997 and has retained this status. The IIP is an accreditation that recognises the work an organisation does in empowering its employees to be at their best.
• They have been a training and teaching practice for GP Registrars and medical students for over 20 years.
• The practice aimed to build on its already developing processes such as data gathering and analysis, Plan Do Study Act (PDSA) cycles and tests of change, all of which were aimed at improving the quality of service provision for patients.

We saw several areas of outstanding practice including:

• The practice had introduced a telephone appointment system which increased and improved the flexibility of access to appointments. The system was evaluated on a daily basis and changed to meet the demands of the patients, increasing resources at peak times. The practice could demonstrate the impact of this system showing telephone access to a GP within the hour on a daily basis. Also evidenced was a reduction in the number of unattended appointments (DNA rates) and reduced use of the GP out of hours service which was reflected in very positive patient survey results.
• The practice had a very good skill mix which included advanced nurse practitioners (ANPs) and they were able to see a broader range of patients than the practice nurse. There was a preceptorship programme in place to support new ANPs to the practice.
• The practice could evidence that events of significance led to changes in working practice which increased safety not only in their own environment but also throughout the CCG including other GP practices and major hospitals.
• The practice was involved in many initiatives, local and national, around improving patient safety in general practice. These included, PRISM (around medicine safety), The Scottish Patient Safety Programme, Making Safety Visible and General Productive Practice which is designed to help the practice to support and build on quality improvements. This meant that the practice were continually reviewing the safety of their environments, their clinical practice and the services they offered to make sure that patients were treated in a safe and effective way at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Clarendon Surgery on 23 May 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.