Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr CAM Brennan and Partners on 26 January 2016. Overall the practice is rated as good.

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. All opportunities for learning from internal incidents were maximised.

• 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 thoroughly assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Feedback from patients about their care was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice provided a high level of support to patients and their families, who were nearing the end of life.

• Information about services and how to complain was available and easy to understand.

• 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 invited a number of support organisations to provide a range of educational and advisory events for practice patients.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• Patients said they were able to get appointments when they needed them, with urgent appointments available the same day.

• Patients did not find it easy to contact the practice via telephone and reported that appointments could be frequently delayed.

• 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 practice had a robust governance system in place to ensure that risks were identified and monitored and improvements to the service were made.

• The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice:

• Feedback from patients, carers and families about the care and treatment received was consistently and strongly positive. We found many positive examples to demonstrate how the practice prioritised high quality end of life care and bereavement support for patients, families and carers. For example, the GP partners provided routine home visits for all palliative care patients and one of the partners provided their personal contact details to families for patients in the last few days of life, to ensure they received continuity of care outside of the practice’s standard opening hours.

• The practice benefited from a pharmacy co-located next to the health centre and they maintained close links with this service. We were given many examples where GPs were able to take prescriptions and medicines on urgent home visits pre-emptively, so patients received their medicines immediately. Where the medicines were not required by patients, the practice and pharmacy had an arrangement whereby they could be returned to the pharmacy with the prescription. Reception and administrative staff also worked closely with the pharmacy and ensured that those patients’ prescriptions requested at the end of the day were all received by the pharmacy prior to the practice closing to avoid delays in processing of prescriptions.

• The practice had arranged for a number of educational and support events for practice patients, in conjunction with the Patient Participation Group (PPG). For example, a diabetes information evening was held in October 2015 where an external speaker from a national diabetic charity offered advice on diet and exercises and provided information leaflets for patients. A practice nurse and a representative from the health lifestyle advisory service were also present to provide information to patients. The practice nurses also used this evening as an opportunity to provide flu immunisations to their diabetic patients and the PPG encouraged patient feedback by promoting the NHS Friends and Family Test. Of those 37 who attended the event across the three practices, 21 patients received the flu immunisation.

• The practice had robust governance arrangements in place, which included the use of work plans to address key areas of quality improvement; a comprehensive policy schedule outlining all policies and procedures, all review dates and the named staff member for updating the policy; and a comprehensive programme of continuous internal audits to monitor performance which were discussed in monthly management meetings. All management meetings were between the business manager and the partners of the three practices co-located in the shared premises which encouraged a culture of shared leaning and development.

The areas where the provider should make improvements are:

• Implement a clear system for tracking and monitoring the use of prescription pads across the practice.

• Provide an online appointment booking facility and establish ways to improve telephone access for patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice