Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 8:30am on 9 December 2014. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring and responsive services. It was also good for providing services for all population groups. We found the practice to be outstanding for being well led.

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, with the exception of those relating to infection prevention and control.
• 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 were able to get an appointment when they needed one, but there was often a wait to see the GP of their choice. Urgent appointments were available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Governance and performance management arrangements were proactively reviewed and reflected best practice. There was a clear leadership structure with a strong focus on staff education and training. All opportunities for learning from internal and external incidents were maximised and shared with staff and the patient partnership group (PPG).
• There were high levels of staff satisfaction and staff engagement, with staff at all levels actively encouraged to provide feedback and raise concerns. Staff felt supported and were offered training to upskill and develop within their roles. High standards were promoted and owned by all practice staff with evidence of team working across all roles. Staff achievement was celebrated and shared with the practice and patients.

We saw several areas of outstanding practice:

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and the patient partnership group (PPG). The practice encouraged wider engagement from patients to ensure they were represented in PPG work. They proactively sought the opinion of people in different equality groups so that these patients could contribute to the development of surveys carried out by the PPG. A virtual patient representative group was also created to encourage representatives from different population groups to share their views on the service. Feedback was acted on in a timely manner and shared with patients and staff. The practice valued feedback from the PPG and engaged them in other areas of the service. For example, PPG representatives attended clinical commissioning group and locality meetings, and supported human resources as independent observers and decision makers during staff interviews.

• The practice worked with other organisations to improve care outcomes, and tackle health inequalities. The practice helped organise health promotion events for patients, staff and the local community. For example, there was a monthly ‘Memory Café’ offered in partnership with the parish church (where the practice was located), and a local healthcare provider. The aims of the meetings were to provide practical information and support for patients living with dementia, their families and carers. The practice also hosted quarterly ‘Ask the Expert’ events which were jointly organised with a local healthcare provider. These were educational events where healthcare specialists and professionals in the subject area were invited to give presentations to patients and staff.

• There was innovative leadership and a culture of continuous learning for all staff. There was a rolling programme of audits as demonstrated by the 17 clinical audits undertaken in the last year. Six of these were completed audit cycles where the practice was able to demonstrate the changes resulting since the initial audit and identify improved outcomes for patients. Audits were carried out based on the needs of the practice population and in response to feedback and performance.

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

Importantly the provider should:

• Complete a comprehensive risk assessment to manage infection prevention and control.
• Assess the competency of non-clinical staff who undertake chaperone duties and provide support where gaps are identified.
• Have a system in place to show that emergency equipment has been checked.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice