Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr P A A Wood and Partners on 28 June 2016. Overall the practice is rated as good.

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. All opportunities for learning from internal and external incidents were maximised and shared within the practice and the locality.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example; The practice had worked with four other practices in the locality to implement and fund a community based service that enabled direct referrals for patients with gynaecology, musculoskeletal problems and diabetes to receive assessment and care by a consultant in their community instead of travelling to hospital. Patients were usually seen by a consultant within three weeks of referral and had undergone the relevant tests in preparation for their initial appointment. The core principles of the initiative was to provide a more cost effective service which was also more responsive in terms of speed of assessment and treatment for patients.
• The practice actively reviewed complaints for trends and how they were managed and responded to, and made improvements as a result.
• Risks to patients were assessed and well managed.
• The practice regularly reviewed policies and made changes to practice based on audits and updates.
• 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.
• Feedback from patients about their care was consistently positive and data from the GP patient survey was consistently high. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements, and staff told us that they were well-supported and felt valued by the partners.
• The practice’s senior partner used his leadership role within the CCG to keep the practice informed of new developments and opportunities

We saw several areas of outstanding practice:

• There was a practice initiative whereby the practice had developed an enhanced package of care for residential and care homes aligned to them which had resulted in a 9.1% reduction in visits to A/E department and a reduction of 22% in unplanned admissions to hospital in the preceding 12 months. This was funded by the practice.
• The practice had worked collaboratively with four local practices to implement a direct referral service so that patients could be seen by a consultant more quickly in their locality rather than travelling to hospital. This was initially funded independently by the practices and is currently being commissioned by the CCG on an ongoing basis and extended to a further seven practices locally.
• The practice actively contacted patients who did not attend for their cervical screening test and where patients did not respond to the third letter, a face to face appointment was made with the practice nurse to discuss their decision. This provided an opportunity to allay patients’ anxiety and provide additional information to help them make their decision. This resulted in an uptake for the cervical screening programme of 91% which was 10% higher than the CCG and national averages Exception reporting for this indicator at 2% was lower than both the CCG and national averages.
• The practice actively followed up patients who did not attend their hospital breast screening appointment by sending a letter to the patient advising of the importance of the test and providing them with the hospital telephone number and their breast screening number so that they could more easily make a new appointment. This had resulted in achieved an attendance rate of 85% for breast cancer screening which was 7% higher than the CCG average and 13% higher than the national average.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice