Letter from the Chief Inspector of General Practice

The Green Practice and Clevedon Riverside Group merged in April 2015 to form the Clevedon Medical Centre. We carried out an announced comprehensive inspection at Clevedon Medical Centre on 1 September 2016.

Overall the practice is rated as good.

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

• The leadership, governance and culture were used to drive and improve the

delivery of high-quality person-centred care.

• 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. For example, the area had a high number of older people and the practice employedan Elderly Care Nurse who managed the patients living in care homes, providing proactive care and advice regarding patients and education to the staff in the homes.

• Feedback from patients about their care was consistently positive. Patients told us that the care that they received exceeded their expectations.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example they worked closely with the nearby nurse led minor injuries unit and were able to see children and young people when requested.

• 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. For example they used an audible tannoy for calling patients to appointments and as a result of feedback from patients, were introducing an electronic visual call system.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had introduced a new clinical team for urgent care in 2016 to improve accessibility to a clinician. The team comprised Advance Nurse Practitioners, a Physician Associate, Nurse Prescribers, a Practice Pharmacist and an Acute Care Practitioner. This provided additional same day appointment capacity for minor illness appointments. Feedback from the patient participation group members was positive and they told us that they were able to get appointments when they needed them.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• 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 some areas of outstanding practice:

• The targeted assessment protocol for the areas of increased health risk in patients diagnosed with Down’s syndrome was in line with best practice and addressed the needs of a vulnerable minority group. We saw findings were used by the practice to improve services. For example, they had identified specific risks for these patients and additional measurements and checks were included in the Learning Disability annual review.

• The practice ran a free half-day course annually for North Somerset sixth form pupils who were interested in a career in medicine. The course was called 'Widening Access to Medicine' and had run for seven years with an average of 15 students per year. The course content had also been shared with the Royal College of General Practitioners and another local practice as a way to support future recruitment into primary care.

The areas where the provider should make improvement are:

• The practice should proactively demonstrate that they can prove that and that patients are happier with phone access and opening hours. Patients need to feel that they have made an improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice