Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Falkland Surgery on 23 June 2015.

Overall the practice is rated as good.

The overall rating for this service is good. We found the practice to be good for delivering safe, effective, caring, responsive services and for being well-led. 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 across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice engaged effectively with other services to ensure continuity of care for patients.

• The practice understood the needs of the local population and planned services to meet those needs.

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

• 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.

We saw areas of outstanding practice:

• The practice was involved in research development to help support best clinical practice. For example, the practice led a pioneering scheme to identify patients who were identified as high risk and had a likelihood of developing diabetes within the next 20 to 30 years. A practice GP designed and implemented the project and diabetes tool to improve detection of diabetes among 100,000 patients in the local Clinical Commissioning Group for which they won an award.

• The practice worked with the patient participation group (PPG) to organise patient education meetings. These were held at the practice and were open to any patient who wished to attend. Recent topics covered included; resuscitation, first aid, heart disease and men’s health. We were told these education meetings were very well attended.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with three people who used the service and two members of the patient participation group. People told us that they were satisfied with the care and treatment they received. One patient told us “they are all superb here. If I need any information I can always ask and they will explain things in a way I understand”.

Patients who used the service were protected from the risk of abuse. Patients we spoke all said they felt safe using the service and had confidence in the GPs and nurses abilities.

We found the consulting rooms and waiting area clean and tidy. Patients we spoke with said they had no concerns about hygiene standards within the practice. GPs and nurses washed their hands and wore appropriate protective clothing during examinations.

Patients were cared for, or supported by, suitably qualified, skilled and experienced staff. We saw records that showed there were effective recruitment and selection processes in place.

The practice sought the views of patients and acted upon the feedback received. There was an effective system in place to identify, assess and manage risks relating to the health, welfare and safety of patients.

This practice is rated as Good overall. (Previous rating from inspection carried out in June 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 Falkland Surgery on 31 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. When incidents did happen, the practice learned from them and improved their processes.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed urgent support and treatment. The practice had acted following below average feedback about access to appointments. The telephone system was in the process of being upgraded and additional staff had been recruited to offer a wider range of appointments.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• Patient feedback about receiving compassionate care and treatment was consistently positive.
• The practice used technology to improve patient care and reduce risk.
• The practice was proactive in reducing the risk of patients developing long term medical conditions. For example, it identified and acted with patients at risk of developing diabetes.
• Patients with long term conditions could access support to deal with the psychological issues surrounding their physical condition. Talking therapy was available at the practice premises.
• The practice was active in supporting patients to deal with social issues as well as their physical health by providing clinics for social workers at the practice.
• At the time of the inspection the practice was unaware that exception reporting (the removal of patients from monitoring due to either contra indication of treatment or failure to attend for review) in 2017/18 had risen from the previous year.

We saw one area of outstanding practice:

• The practice had completed a review of 472 patients who had a record of non-specific allergy. This resulted in 440 patients having a specific allergy entered in their records to support safer prescribing and treatment.

The areas where the provider should make improvements are:

• The practice plan for increasing uptake of cervical screening requires monitoring and review to evaluate progress.
• The practice provided evidence that training in identifying signs of sepsis had been undertaken. The effectiveness of this training requires review with non-clinical staff.
• The practice should improve the system of reporting the removal of patients with long term conditions to more accurately reflect those that have not received the treatment and monitoring included in the national QOF incentive scheme.

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

Please refer to the detailed report and the evidence tables for further information.