Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parkgate Surgery on 11 February 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• The practice delivered services to a higher than average proportion of older patients and had good working relationships with the 15 care homes contained within the practice boundary.

• The practice demonstrated a thorough awareness of the needs of its patient population and had put measures in place to improve outcomes for patients identified as being at risk. This was particularly evident in the work undertaken around provision for older patients and those at risk of hospital admission. The practice closely monitored its quality improvement work to ensure a comprehensive understanding of the impact it had on patient outcomes.

• The practice had implemented additional nursing time specifically to facilitate home visits to over 75 year olds, housebound and frail patients. The practice also employed a care coordinator who oversaw administration tasks relating to those patients at risk of hospital admission.

• The practice had produced a branded folder in which patients could store their hand held personalised care plan. This made it easily identifiable and so facilitated information sharing with other professionals and gave patients an increased sense of ownership of their care.

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised. The practice logged and categorised incidents in order to monitor trends and allow them to better predict where problems may arise.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example they carried out opportunistic screening for atrial fibrillation during a weekend flu vaccination clinic which resulted in three new diagnosis.

• Feedback from patients about their care was consistently and strongly positive. Patients told us that they felt valued and were always made to feel like a priority by staff.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. Multidisciplinary team meetings were held in the practice on a weekly basis, and care plans for complex patients drawn up jointly with other professionals to ensure the best care was provided.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example the telephone system had been updated following patient feedback that it could be difficult to get through to the practice by phone.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

We saw several areas of outstanding practice including:

• The practice was engaged in a comprehensive programme of clinical audit which allowed them to clearly demonstrate quality improvement and how this improvement had been achieved. This allowed the practice to have a robust understanding of its performance. Key areas of improvement included a significant reduction in emergency admissions, an increased prevelance of atrial fibrillation and reduction in prescribing of hypnotics. For example the practice could demonstrate how emergency admissions into hospital had been reduced by 95% over an 18 month period, and attendance at other secondary care services reduced by 50%.

• The practice was proactive in identifying clinical risks, and then taking rapid action to address and mitigate these risks. Once identified they were discussed at the next weekly clinical meeting, assigned to a nominated GP lead as well as having administration time identified to support the resulting work undertaken to make improvements.

• Staff had received carer awareness training to give them the skills to screen and identify those patients with caring responsibility.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice