Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Distington Surgery on 20th October 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.
• 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. 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.
• 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:

• The practice worked closely with local organisations to support the 7% of their patient list who they had identified as carers. Feedback from people who used the service, those who were close to them, and stakeholders was continually positive about the way staff treated people. We received an exceptionally high number of patient Care Quality Commission comment cards (174), all of which were positive about the service experienced. Results from the National GP Patient Survey showed how highly patients rated the care they received, for example 98% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 90% and the national average of 85%.

• The involvement of other organisations and the local community was integral to how services were planned. The practice had worked with the local council and other groups to help create a “health walk” in the village. They operated a service with the local post office to allow patients to collect their prescriptions from there, in response to cuts to public transport affecting patients’ ability to collect them from the surgery. They had started a fitness club which was now community run but which continued to be part funded by the practice.
• The leadership, governance and culture were used to drive and improve the delivery of high-quality, person-centred care. The practice had undertaken training on personality testing, which they believed had increased productivity and reduced workplace conflict. Staff told us that the personality tests had given them a better understanding of why people worked the way they did, and also about how they worked themselves, and felt that it had improved working relationships at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We were able to speak with five people who used the service (patients) who were in the waiting room when we visited. All of the patients we spoke with confirmed that they happy with the service they received from the GP’s and clinical staff. We saw staff speaking with people in a respectful manner and staff we spoke with understood the requirements for privacy, dignity and confidentiality. A patient who spoke with us told us, “Never had cause for complaint and staff are friendly”. Another patient stated that the, “Appointment system good. I don’t order prescriptions online but I am aware that this is available." One patient stated that the practice was, “Beautifully organised”, whilst another commented, “I like this surgery.”

The practice had a very active patient participation group who met three monthly. Patients we spoke with confirmed that they felt confident that the doctor understood their condition. Two of the patients we spoke with told us that the GP’s supported them well with their medical condition. One patient told us, “Dr Naylor was excellent when my wife was terminally ill.” Another patient explained, “I feel they will listen and do something.” We found that the practice was participating in a pilot project with regards to supporting carers.

We saw that the premises were adequately heated, lit and ventilated. It was clean and comfortable. There were infection control methods in place. The practice manager told us that staff had received mandatory and other training. We were able to verify this as training certificates were kept on staff files and the practice manager maintained a training matrix. We found that there were appropriate systems in place to enable the provider to assess and monitor the quality and safety of the service, protect people who used the service and improve outcomes for people.