Letter from the Chief Inspector of General Practice

This practice is rated as good overall.

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at High Green Medical Practice on 12 February 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. They took a proactive approach in relation to safeguarding children and vulnerable adults.

• There were reliable systems for managing medicines and equipment, with systems in place to ensure that any alerts and guidance were reviewed and acted upon.

• Patients with long-term conditions had not always received an annual review of their healthcare needs, but the practice was aware of this and was working to encourage patients to attend.

• The practice encouraged the take up of child immunisations and cervical smear tests by promoting the importance of these to mothers and coordinating appointments to facilitate easier attendance.

• The practice’s uptake for cervical screening was in line with CCG and national averages.

• Patients with a learning disability were offered reviews of their healthcare needs and the practice worked with local specialist services to encourage uptake of these reviews.

• The practice had a programme of quality improvement activity in place and there was evidence of audits being used to help drive improvement.

• The most recent published Quality Outcome Framework (QOF) results showed that the overall exception reporting rate was 20%, compared with a national average of 10%. The practice was aware of their higher than average exception reporting and lower than average QOF results. We were told this was due to specific patient characteristics. They were taking a proactive approach to improve on this and encourage more patients to attend for their health reviews. There were systems in place to monitor their progress in this area.

• Interpretation services were available for patients who did not have English as a first language. Some staff were multi-lingual and able to speak to patients in other languages.

• Comments received during our inspection showed patients felt that they were treated in a caring and compassionate manner and their dignity was respected. These comments were more positive than the results from the July 2017 annual national GP patient survey which had showed patients’ satisfaction with how they could access care and treatment was significantly below local and national averages for some indicators. The practice had taken action to address this and feedback during our inspection indicated some patients were experiencing improvements.

• The practice demonstrated an understanding of the needs of their patient population and described steps they took to help ensure their patients accessed appropriate care and support.

• Openness, honesty and transparency were demonstrated in the way incidents and complaints were dealt with. Staff felt that they could raise concerns and would have no hesitation in doing so.

• The practice sought the views of patients in a variety of ways, including using a virtual patient participation group, face to face discussions with a smaller group of patients who acted as a consultative group and carrying out their own internal survey.

The areas where the provider should make improvements are:

• Continue to manage and monitor processes to improve outcomes for patients.

• Improve opportunities for the uptake of national screening programmes for bowel cancer and breast cancer.

• Continue to address the issues highlighted in the national GP survey in order to improve patient satisfaction, including access to appointments.

• Consider developing the patient participation group to formalise how patients are involved in monitoring the quality of the service and helping to drive improvements.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice