Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Heartwood Medical Practice on 21 September 2016. 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. There were effective systems in place to support staff to report and record significant events. Learning from significant events was shared will all relevant staff and stakeholders.
• Risks to patients and staff were assessed and well managed. The practice had a range of risk assessments in place.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had received training which provided them with the skills, knowledge and experience to deliver effective care and treatment.
• Feedback from patients about their care, and their interactions with all practice staff, was generally positive. Patients said they were treated with compassion, dignity and respect.
• Information was displayed in the waiting area and on the practice website which told patients about how to complain.
• Patients said they were generally able to access appointments when they needed them. The practice was continually working to improve patient access to appointments and had recently introduced sit and wait appointments after morning and afternoon surgery.
• The practice used clinical audits to improve patient care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice worked effectively with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe.
• There was a strong and proactive leadership structure within the practice, and staff felt well-supported by management.
• The practice worked closely with their patient participation group (PPG) to review and improve the services it delivered.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

In response to a high number of care home patients the practice had implemented a number of support measures for these patients. For example:

• The advanced nurse practitioner undertook regular wards rounds at care and nursing homes
• One of the GPs had provided training for care staff in the identification of urinary tract infections.
• The practice had put together a care home support pack for their local care homes. Support packs contained a wide range of information including information about visit requests; early observations templates; management of coughs and colds; information about falls and pain information.
• Data showed that there had been a reduction in requests for nursing home visits. For example, in March to May 2014 there were 150 requests compared with 99 requests for the same period in 2016.

A total of 321 patients within the practice aged over 18 had a care plan in place. This was equivalent to 4.1% of the practice population and was significantly higher than their target of 2%. Where a care plan was discussed and agreed, patients were provided with a ‘gold card’ which gave patients access to a bypass telephone number to enable them to access services more quickly where this was required. Patients were then offered telephone or face to face access to clinicians as required. Nursing and care homes were also provided with the gold cards to ensure they received the same level of service.

The areas where the provider should/must make improvement are:

• The provider should continue to review and monitor access arrangements to ensure improvements reflect positively on A&E attendances and emergency admissions

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with five patients during our inspection. Patients told us they felt they were treated well and all staff were polite. All of the patients told us they got an appointment when they needed one. They told us that same day appointments were available if they needed an urgent appointment, or the on call GP telephoned them to discuss their concerns Patients told us they felt involved in their care and were able to ask questions. One patient told us, “Brilliant practice, all of the doctors are good.” Another patient said, “Best practice I have been to.”

We saw systems were in place to obtain written or verbal consent from patients prior to any procedures being undertaken.

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

We saw that staff were offered training opportunities in relation to their specific role, as well as essential training. Staff received an annual appraisal and developed their personal training and development plan.

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