Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Len Valley Practice on 20 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 and an effective system for reporting and recording significant events.
• Risks to patients were assessed and well managed. However, the practice was unable to demonstrate that the volunteer drivers who delivered medicines to patients at home had received a Disclosure and Barring Service (DBS) check. The practice was aware of this before the inspection and was in the process of ensuring all volunteer drivers had appropriate DBS checks.
• Medicines and Healthcare products Regulatory Agency (MHRA) alerts were noted and acted upon in the dispensary. However, there was not an effective practice wide system to receive and act on MHRA Drug Safety Update alerts. Once the practice was aware of this, immediate action was taken to implement a practice wide system.
• 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 were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice maintained a register of military veterans and was in the process of auditing this patient group to help ensure they were receiving appropriate and timely care and support. The practice was encouraging these patients to identify themselves through signage at the practice and questions on the ‘new patient’ forms.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Some patients said it was difficult to get through to the practice by telephone during peak times and that there was sometimes a wait for an appointment with a GP. However, there was continuity of care and urgent appointments were available the same day.
• The practice maintained registers for patients who might benefit from extra support % of the practice list).
• The practice was engaging in clinical commissioning group (CCG) ‘Transforming Outpatients Project’ which had resulted in 113 patients not having to travel to secondary care for treatment.
• 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 management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice:

• Patients were empowered to have a voice within the practice through a collaborative partnership between the patient participation group (PPG) and the practice. The practice and PPG had a strong focus on working together on a multitude of projects, both in the practice and the wider community to promote healthy living and help ensure patients’ emotional and social requirements were given equal consideration as their physical needs. There was a commitment to promoting healthy living both in the practice and in the wider community. Staff from the practice had delivered health education talks in a variety of forums and there was a ‘Health Promotion’ room for patients to use at Lenham Surgery.

The areas where the provider should improvement are:

• Review staff and patient awareness of the availability of translation services.

• Continue to oversee the implementation of Disclosure and Barring Service (DBS) checks or carry out a risk assessment in order to demonstrate that volunteer staff are safe to undertake this role.

• Review the process for delivering medicines to patients in their home to help ensure that the cold chain is maintained.

• Continue, with the support of the patient participation group (PPG), to review and improve patients’ experience of the service, including in areas such as telephone access and access to GP appointments.

• Continue to receive and act on Medicines and Healthcare products Regulatory Agency (MHRA) alerts in all areas of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice