Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Roberts, McKenzie, Plumley, Hassas, Kirkland, Allen, Rose & Helm (Putneymead Medical Centre) on 24 November 2016. Due to unforeseen circumstances related to Care Quality Commission staffing we extended the inspection to a second visit on 6 January 2017. 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 in place for reporting and recording significant events.
• Most risks to patients were assessed and well managed. However we noted that some equipment used to respond in an emergency had expired.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the clinical 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.
• 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was outward facing and supported other practices to provide services that benefited their local population.
• There was a clear leadership structure and staff felt supported by management. The practice proactively 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 two examples of outstanding practice:

• The practice ran an in-house counselling service. A minimum of between six and 10 counselling sessions were provided per week. The three counselling rooms within the practice were operational 12 hours per day five days per week with additional sessions on Saturdays. The practice told us that between 110 and 120 patients were seen at the counselling service every week. The practice had collated information in respect of assessing the impact of counselling by comparing patient scoring on the Patient Health Questionnaire (PHQ – test used to assess severity of depression) and the Generalised Anxiety Disorder Assessment (GAD – test used to assess severity of anxiety symptoms) both before and after they had undertaken counselling. Of the 62 patients reviewed the practice identified a 73% of these patients showed an improvement in PHQ scoring while 82% had improved GAD scores. The practice had also conducted a survey of patients using the counselling service featuring six questions. Ninety seven percent of the 170 patients asked stated that their counsellor listened to them and treated their concerns seriously and 90% had confidence in their counsellor’s skills and techniques.
• The practice supported four practices in parts of the Clinical Commissioning Group which did not have sufficient numbers of staff to complete NHS health checks during 2014 and 2015. The number of health checks had increased in three of the practices, where comparative data from 2013/14 was available, in 2014/15 by 37%, 113% and 257%. In 2015/16 one of the practices declined the practice’s continuing support as they felt sufficiently resourced to provide the checks independently. The other two practices increased the number of health checks in 2015/16 comparative to 2013/14 by 382% and 886%. It was estimated that the support from the practice’s healthcare assistants enabled an additional 1290 health checks to be undertaken in these practices between 2014 and 2016.

The areas where the provider should make improvement are:

• Review systems and process for checking the expiry dates of equipment used in an emergency.
• Provide appropriate escalation and support contact details in all complaint responses.
• Improve the identification of patients with caring responsibilities to be able to provide appropriate support and signposting

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice