Letter from the Chief Inspector of General Practice

We inspected this service on 4 November 2014 as part of our new comprehensive inspection programme.

The overall rating for this service is good. We found the practice to be good in the safe, effective, caring, responsive and well-led domains. We found the practice provided good care to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health. 

Our key findings were as follows:

• Patients were kept safe because there were arrangements in place for staff to report and learn from key safety risks. The practice had a system in place for reporting, recording and monitoring significant events over time.
• There were systems in place to keep patients safe from the risk and spread of infection.
• Evidence we reviewed demonstrated that patients were satisfied with how they were treated and that this was with compassion, dignity and respect. It also demonstrated that the GPs were good at listening to patients and gave them enough time.
• The practice had an open culture that was effective and encouraged staff to share their views through staff meetings and significant event meetings. 

We saw an area of outstanding practice including:

• The practice provided an Xpert Diabetes Programme (XDP). The aim of this programme was to provide patients with the knowledge, skills and confidence necessary to self-manage their diabetes. This programme was supported by the GP partners as they placed a high value on patient education and self-management of long term conditions. The national database figures for 2014 showed improved outcomes for patients such as weight loss, reduction in HbA1c (blood sugar levels) and reduced cholesterol. We saw that very positive comments had been received from patients who had attended one of these courses.

However, there were also areas of practice where the provider needs to make improvements. 

In addition the provider should:

• Carry out a Legionella risk assessment in line with guidance from Health and Safety Executive to assess any potential risk at the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with nine patients and seven members of staff.

When patients received care or treatment they were asked for their consent and their wishes were listened to. One patient told us: "Yes I give consent. I am quite trusting of them and go along with what they recommend". We found that when minor surgery had been carried out that consent had been requested from patients before the surgery had commenced.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. The patients we spoke with provided positive feedback about their care. A patient told us: "We get excellent care". Patients received their medicines when they needed them and their medicines were regularly reviewed.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

The premises were suitable for their intended purpose. We found that they were clean, organised, had been well maintained and appropriate for patients with restricted mobility.

The provider had systems in place for monitoring the quality of service provision. There was an established system to regularly obtain opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.

This practice is rated as Good overall. (Previous rating January 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Elgar House on 2 October 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. The practice discussed incidents, learned from them and improved their processes in order to prevent a recurrence.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines and best practice.
• There was a cohesive, loyal practice team.
• Patients told us that staff treated them with compassion, kindness, dignity and respect and involved them in decisions about their care and treatment.
• Patient feedback on the level of care and treatment delivered by all staff was very positive.
• The practice had Armed Forces Veteran friendly accreditation.
• The practice promoted the Parkrun initiative for adults and children and was a certified Parkrun practice.
• Patient satisfaction results remained mixed with regard to telephone access. The practice had taken action as a result. For example, extra staff now manned the telephones at peak times.
• Continuous learning and improvement was actively encouraged at all levels of the organisation.

The areas where the provider should make improvements are:

• Continue to monitor and act on the results of patient satisfaction surveys in order to meet the needs of the patient population.
• Undertake a review of coding to ensure that patients receive care and treatment that meet their needs.
• Proactively encourage the uptake for cervical screening in order to ensure that appropriate care is provided.
• Consider ways to increase the identification of carers.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice