Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Pulborough Medical Group on 5 January 2017. Overall the practice is rated as outstanding

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.
• Risks to patients were assessed and well managed.
• The practice used innovative and proactive methods to improve patient outcomes. For example as a result of a review of venous leg ulcer management the practice was able to demonstrate a significant improvement in healing rates
• 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.
• Feedback from patients about their care was consistently positive.
• 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 worked proactively with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. As a result of this work patients had access to a wide range of services including mental health services, specialist dermatology, ear nose and throat, podiatry, audiology physiotherapy and citizens advice.
• 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, Pulborough Patient Link group (PPL). For example, as a result of feedback from the PPL the practice had installed additional phone lines and increased the number of call centre staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. The partnership included the practice manager and the advanced nurse practitioner. The practice had a clear vision to deliver health care in a flexible and innovative way to meet patient choice and to improve access to services for its largely elderly, rurally based population. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice

• The practice had taken the lead on working with other organisations and its patient participation group to ensure services were more accessible to its predominantly elderly, rurally based population and also to those who were vulnerable or suffering deprivation. By providing providers with space and facilities the practice had significantly increased the range and frequency of services available to its patients within its premises so that patients did not have to travel. As a result of the practice’s proactive approach to providers, services had expanded over the years to include consultant led mental health services, counselling, cognitive behavioural therapy, hearing aid provision, ear, nose and throat services, podiatry, alcohol and drug addiction support, consultant paediatrics and citizens advice.
• The practice had been proactive in ensuring that the mental health needs of its patients were met. It had identified that 35% of its work was mental health related and that these patients had to travel outside the area to receive the specialist help they required.In recognition of the fact that travel for these patients could be challenging the practice sought to provide a better option. The practice approached the local community trust and worked with them to establish a ‘mental health hub’ at the primary care centre and ensure that a counselling service for patients was provided on a daily basis. Following the success with this, the practice was asked to extend this service all patients in West Sussex to support the wider rural area
• The practice used innovative and proactive methods to improve patient outcomes. After identifying that demand for leg ulcer management clinics was increasing and that healing rates were declining the practice undertook a review of venous leg ulcer management. This led to the introduction of a new protocol and integrated approach which included the establishment of a specialist leg ulcer clinic. This was run by a practice nurse who had been especially recruited by the practice and supported by them to train as a specialist in compression and wound management. The practice had also invested in specialist equipment to aid assessment and diagnosis. As a result the practice was able to show that healing rates had increased from 60% in 2014 to 85% in 2016.
• The practice had identified 532 patients as carers (About 4% of the practice list). Written information was available to direct carers to the various avenues of support available to them. There was a dedicated page on the practice’s website providing information and advice for carers.

The areas where the provider should make improvement are:

• Review exception reporting rates for the quality and outcomes framework and ensure appropriate action is taken to reduce rates where they are above the local and average.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with one patient during our inspection visit. We received written feedback from a relative of a patient and we spoke with seven patients on the telephone following our visit. They had all attended the practice on the day of our inspection for an appointment. These patients were randomly selected. We spoke with staff that included; the practice manager, a practice nurse, two receptionists and a general practitioner (GP). We also spoke with two representatives of the Patients Participation Group referred to as the Pulborough Patient Link (PPL).

We used a number of different methods to help us understand the experiences of patients who used the service. We spent time talking with patients and observing the interactions between staff and patients. We reviewed records and systems.

When registered the provider declared compliance with all outcome areas.

We found that patients were treated with respect and had treatment options discussed with them. Patients felt involved in their care and treatment.

We saw that there were effective infection control measures in place to prevent the spread of infection.

We looked at the processes that the practice had in place to ensure the patients who used the service were protected from abuse. These processes ensured staff had an understanding of adult and child abuse and what to do if it was suspected. Recruitment practices protected patients.

We found that patients understood how to make a complaint or how to raise concerns. They were helped to complete this process if necessary. The provider responded to complaints and kept these under review.