Letter from the Chief Inspector of General Practice

We visited Sawston Medical Practice on the 10 June 2015 and carried out a comprehensive inspection. The overall rating for this practice is outstanding. We found that the practice provided a safe and caring service. They were outstanding in the relation to their effectiveness, responsiveness and in being well led.

We examined patient care across the following population groups: older people; those with long term medical conditions; families, babies, children and young people; working age people and those recently retired; people in vulnerable circumstances who may have poor access to primary care; and people experiencing poor mental health, including those with dementia. We found that care was tailored appropriately to the individual circumstances and needs of the patients in these groups. The population groups were rated good, with older people and those with long term conditions rated as outstanding.

Our key findings were as follows:

• Feedback from all the patients we spoke with and received comments cards from was positive. Patients told us they were treated with dignity, care and respect. They were involved in decisions about their care and treatment and were highly complimentary about the care that they received from the practice.
• The practice addressed patients’ needs and worked in partnership with other health and social care services to deliver individualised care to patients.
• The needs of the practice population were understood and services were offered to meet these. The practice offered a rapid access clinic for patients to be seen urgently. This included a visiting GP, who was available from 8:00am to 6:00pm to undertake home visits. Patients were satisfied with the appointment system.
• Feedback from representatives from care homes where patients were registered with the practice was very positive in all areas.
• There was a clear leadership structure with delegated authority for decision making. All the staff we spoke with told us they felt very well supported by their peers and by the managers.
• The practice proactively sought feedback from staff and patients. There were numerous examples of how the practice had positively responded to these. These included a weekly staff newsletter, redesigning the practice website and talking to community groups about the most effective way of them accessing health services.
• The practice operated from a purpose built building and had a dedicated emergency treatment room and a separate room for treating patients with methicillin-resistant staphylococcus aureus (MRSA). MRSA is a type of bacteria that's resistant to a number of widely used antibiotics.

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

• Improve the arrangements for the security of blank prescription forms.

We saw a number of areas of outstanding practice:

• The practice offered a rapid access clinic for patients to be seen urgently. This included a visiting GP, who was available from 8:00am to 6:00pm to undertake home visits. The practice published monthly performance data for appointments, consultations and waiting times. The practice had low average waiting times, for March 2015 this was 4.7 minutes.
• Patients with long term conditions were recalled at least annually for an appointment to have all relevant tests undertaken. The results were then reviewed by one GP who advised on the most appropriate action for the patient. If patients did not require further intervention, this was not provided. This reduced the need for patients to attend numerous appointments, promoted self care and ensured their care and treatment needs were managed holistically.
• The practice delivered medicines to some villages, where there were central collection points. Staff also delivered medicines to some patients who were housebound and were extending this to patients who had difficulty in collecting their medicines. Staff who delivered these medicines had undertaken a Disclosure and Barring Service check to help ensure their suitability for undertaking this role.
• The practice ran a walking group every Tuesday which was available for patients to help them maintain their health and well-being.
• The practice provided an ear micro suction service for its own patients and also non-registered patients. This was requested by the Clinical Commissioning Group due to a lack of provision in the area. This reduced the need for patients to travel to hospital clinics.
• Health passports, which had been developed by the practice, were given to all patients with long term conditions and to all new patients who registered at the practice. This enabled them to keep a record of their health status, to set their own health goals and monitor their progress towards their goals. Patients could also seek support from the practice to do this. The passport had simple text and illustrations which helped make it simple to follow.
• Staff received a weekly newsletter which updated them with important information and included the positive achievements of staff.
• A staff survey was undertaken annually and the practice's response included both improvements to work processes, including staff training and also social events.
• A breastfeeding room and a separate baby changing room were available for patients to use.

• The practice worked closely with The John Huntingdon Trust. This is a charity that works in conjunction with the Citizens Advice Bureau. The practice made referrals to The John Huntingdon Trust so that patients, particularly those who were vulnerable, were able to receive support for issues that were not medical in nature.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice