Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Moxon and Partners (Burton Croft Surgery) on 17 November 2016. Overall the practice is rated as Outstanding.

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. There was a genuinely open culture in which all safety concerns raised by staff and people who use services were highly valued as integral to learning and improvement. We saw a formal meeting for the review and discussion of medicines, good practice guidelines and safety alerts. This ‘Learning Meeting’ ensured that information was disseminated to the right people in a timely manner.
• Data from the most recent National GP Patient Survey showed that 95% of patients would recommend the surgery to someone new to the area and 99% of patients said the last appointment they got was convenient.
• The practice gathered feedback from patients and it had a very engaged and proactive patient participation group (PPG), who liaised closely with staff and influenced practice development. Changes were made to the way it delivered services as a consequence of feedback from patients and the PPG.
• Feedback from patients about their care was consistently and strongly positive. The PPG had carried out a survey of 500 patients in January 2016 with a response rate of 74%, 99% of patients said their overall experience of the surgery was positive and they were treated with care and respect.
• Nursing staff carried out “spot checks” of each other competencies, for example, when conducting blood tests or administering vaccinations to ensure that their practice met national guidance and good practice.
• We saw comprehensive safe systems and processes that promoted good quality, safe care for patients.
• The practice had a clear pro-active 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 with them and the staff team.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• We saw a culture of audit that was strongly embedded into the day to day management of the practice.
• Patients with palliative care needs were well supported at the practice. A GP at the practice had undertaken additional qualifications in this area and supported a local hospice. He disseminated good practice to the team regularly at multidisciplinary meetings. Patients were also reviewed with specialist community staff.
• The reception team had implemented a twice daily ‘huddle’ to review tasks, workloads and respond to urgent matters. This was a focussed, documented discussion that improved patient safety by ensuring the workload was continually reviewed, well managed and organised.
• Patients who had complex needs were supported to receive coordinated care and we observed innovative and efficient ways of delivering joined up care for patients. For example, we saw a patient recall system whereby coded letters were sent to patients asking them to attend for reviews. This code was then used by the reception team to ensure that the correct length of appointment was allocated, reducing the need for the patient to explain their condition and allowing a review of multiple issues to take place at the same time.

We saw areas of outstanding practice including:

• The practice had employed a Matron and a part time Care Homes Nurse to review and proactively support the care of approximately 170 older people living in care homes registered with the practice and also other patients living in their own homes. The matron conducted a daily review of unplanned admissions, accident and emergency (A&E) attendances and hospital discharges. These patients were then reviewed by the matron, lead health professional or the GP as appropriate. As a result, the practice could evidence they were 38% lower than the national average for A&E attendances and 28% lower than the national average for unplanned hospital admissions. An unplanned admissions audit was undertaken quarterly.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice