Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fleetwood Surgery on 13 May 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• Throughout our inspection we noticed a strong theme of positive feedback from staff, patients and other organisations who worked with the practice. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. The practice was committed to working collaboratively and worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.
• The practice implemented suggestions for improvements and made changes to the way it delivered services because of feedback from patients and from the patient participation group (PPG).
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. The provider was aware of and complied with the requirements of the duty of candour.

• 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.

• Patients said they found it easy to make an appointment with a named GP 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 a clear vision which had quality and safety as its top priority and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

• The practice used social media to reach their younger patients. They shared health promotion advice (such as self care and smoking cessation) and practice specific information such as feedback and improvements made. The page had 94 followers at the time of our inspection. The practice has identified a lack of young people representation in their Patient Participation Group (PPG) and used this media to encourage younger people to join the group. The practice manager regularly reviewed the page for patient feedback in order to address issues and improve the service. 

• A GP at the practice had developed a comprehensive Personal Care Plan template which had been shared with the CCG and adopted by other health care providers. This plan was then co-written with patients through discussion and completion of a questionnaire. Based on the plan a number of ‘what if’ scenarios were documented to assist the patient, their carers and other health care providers to provide safe and effective care in accordance with the patient’s wishes.

• The practice took a proactive approach to understanding the needs of their patients who were carers. Practice data highlighted that there were 168 carers on the practices register and 3.7% of the practices list had been identified as carers. There was a dedicated carer’s lead in place and carers were offered support and regularly reviewed by the practice.The practice recognised the links between carers experiencing other conditions such as depression and offered opportunistic depression screening.

• The practice used various innovative IT methods to improve patient care. One GP developed a system which automatically generated a printed paper slip when a patient was prescribed opiates. This reminded patients of the side effects of this medicine. Patients diagnosed with COPD (Chronic Obstructive Pulmonary Disease) were encouraged and educated to use a telecare system. Currently four patients monitored their own vital signs and text these to the practice. A further 72 patients had been invited to take part in this scheme. This gave patients greater autonomy over the care of their condition and helped to identify issues early. The practice had also recently begun to take part in a local pilot to provide video consultations to patients.

• A transient population of overseas students from the local Nautical College were registered with the practice. A Health Care Assistant attended registration sessions at the college to allow students to be registered in a timely manner with limited disruption to their educational timetable.

However there were areas of practice where the provider should make improvements.

• The practice website should be updated to reflect current opening hours.

• Continue to ensure all staff have annual appraisals.

• Infection Control Audits should be conducted annually.

• Systems to ensure all policies are regularly reviewed and updated should be strengthened.

• Documentation of complaints should provide a clear audit trail of the responses given.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice