Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 18 March 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Requires Improvement

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/focused inspection at Laurel House Surgery on 4 January 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.

• The Quality Outcome Framework (QOF) results for 2016/17 showed that clinical exception reporting for patients with long term conditions, such as asthma, COPD, diabetes and patients experiencing poor mental health were significantly higher than local and national averages. We foundthat patients had had their records reviewed by a GP before exception reporting was agreed including patients who had not attended for an appointment on three occasions. The documentation seen was robust.

• 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 it.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Staff employment references including verbal references should be appropriately documented.

• Continue to update policies and procedures including the implementation documentation to support the one to one sessions held with the Advanced Nurse Practitioners/nurse prescribers.

• Consider Mental Capacity Act training for all clinical staff.

• Consider improvement in telephone access for patients and survey patient opinion on access to the practice.

• Review complaints procedures to include recording informal complaints received. Ensure that all complainants have the parliamentary health ombudsman details documented in the practices response letter.

• Address the issues highlighted in the national GP patient survey in order to improve patient satisfaction, including appointment access and ease of access to the practice by telephone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Laurel House Surgery on 18 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable 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.
• Risks to patients were assessed and well managed.
• 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.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it difficult to get through to the practice on the telephone to book an appointment.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by the management. The practice proactively sought feedback from staff and patients which it acted on.

We saw one area of outstanding practice:

• The practice manager had developed a comprehensive electronic system to record, monitor and respond to clinical and non-clinical risks to patients and staff at the practice. The practice manager used the system to draw together all identified risks to patients and the practice. This was used to provide an overarching plan and framework of what the practice was doing well, where it needed to improve and what they would do to achieve this.

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

Importantly the provider should:

• Review the telephone access to the practice for patients trying to book appointments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice