We inspected Dr Balloch & Partners on 2 October 2014, as part of our new, comprehensive inspection programme. The practice had not previously been inspected.

The overall rating for this practice is good. We found the practice to be effective, caring, responsive to people’s needs and well-led. The quality of care experienced by older people, by people with long-term conditions, families, children and young people was good. Working age people (including the recently retired and students), those in vulnerable circumstances and people experiencing poor mental health also received good quality care.

Our key findings were as follows:

• The practice was a friendly, caring and responsive practice that addressed patients’ needs and worked in partnership with other health and social care services to deliver individualised care.
• There was a good range of appointments available for patients through extended opening hours, visits to local care homes and appointments at home for other patients who were unable to travel to the practice.
• The practice ensured learning from incidents and events through discussion, analysis and the cascading of the findings to the appropriate staff.
• Staff were supported to do their jobs through a system of regular appraisal and supervision. GP trainees were well supported to develop their practice.
• The practice was visibly clean and regularly audited to ensure the risks of the spread of infection were minimised.
• The practice actively participated in the local safeguarding children board and the lead GP attended meetings set up under the statutory framework for reviewing serious child protection cases.
• There was a clear culture of learning, improvement and innovation amongst staff who were supported by the open door policy operated throughout the practice.

We saw several areas of outstanding practice:

• Whenever GPs at the practice referred patients onwards for specialist treatment, every referral was subject of a peer-to-peer discussion with another doctor to ensure that the treatment pathway was appropriate to the particular patient’s needs. Thereafter the outcome of the referral was considered in the same way by both the requesting and reviewing doctor to ensure that the patient’s needs had been met and to take any mutual learning from it.

• The practice took a proactive approach to identifying potential safeguarding concerns regarding children. Notes for new patients and those attending accident and emergency, out of hours and urgent care services were scrutinised for any suggestion of safeguarding issues. If children failed to attend hospital appointments and parents declined an offer to rebook the GP would review the circumstances and make a safeguarding referral if they judged it appropriate to do so.

• The practice shared its learning and innovation with other practices in the CCG local area. This included the nurse-led review of COPD medication which resulted in positive outcomes for patients and significant cost savings for the practice. The nurse safeguarding lead was also accessible to other practices in order to share knowledge, expertise and provide support. An information sheet designed by a GP partner to be included in the personal child health record gave information on how to use health services appropriately when a child is unwell, such as calling a pharmacist or the GP instead of visiting accident and emergency. Subsequently the local CCG funded production of the sheets and recommended their use across the whole CCG area.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice