Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Exmoor Surgery on 19 November 2015. 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.
• Risks to patients were 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients mostly said they found it easy to make an appointment and that 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.
• 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 provider was aware of and complied with the requirements of the Duty of Candour.

We saw one area of outstanding practice:

The practice carried out ring fenced, regular, monthly reviews of high risk patients including those assessed as at high risk of re-admission to hospital, house bound, under palliative care, with advanced chronic illnesses, and high intensity hospital users. The reviews were part of a wider multidisciplinary approach to care and support for complex and vulnerable patients and involved hour long home-visits by one of the practice’s doctors who is the CCG Macmillan Lead GP. A recent full cycle audit of these arrangements has shown a 50% reduction on use of A&E, urgent care centre and community services following intervention for these patients.

The area where the provider should make improvement is:

Ensure alerts on records for patients on high risk medicines are actioned at the appropriate time in all cases.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice