Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Marshes (also known as The Snaith & Rawcliffe Medical Group) on the 3 & 4 August 2016. We visited the main surgery in Snaith and the branch surgery at Rawcliffe during the inspection. 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.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had 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.
• 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 were able to get same day appointments and pre bookable appointments were available.
• 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 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.
• The practice had a very active Patient Liaison Group which worked with the practice to make improvements.

We saw several areas of outstanding practice:

• The practice worked closely with a local voluntary driving service to enable their less mobile patients to attend the practice to see the practice nurses and /or GPs. There were 126 patients registered to use the service and 426 journeys had been made to the practice in the past 12 months which saved more than one home visit per day.
• The practice had introduced a service where patients had been taught to administer their own injections for long acting contraception. If patients were interested in self-administering the nurse demonstrated how to give the injection. The patient was also given an information sheet and video for them to take home and review. At the next visit if the patient wanted to self-administer the nurse assessed the patient was safe to give their own injection. The nurse had supported 22 of the 72 patients using long action contraception to change to the self-administered method in the previous 12 months so they then only had to attend the practice once a year instead of four.

• The practice had a very active Patient Liaison Group PLG which worked with the practice to make improvements, for example; one of the PLG members had worked with a GP to review the number of attendances at the branch site and used the information to inform a decision about opening hours and PLG members were included on interview panels when the practice recruited new staff. At the suggestion of a PLG member the practice had held a ‘Family Fun Day’ in May 2015 for members of the public. Practice staff diagnosed two patients with diabetes and seven patients with hypertension from opportunistically checking them whilst they visited the family fun day.

• The practice was involved in the ‘Productive General Practice’ programme, which encouraged staff to openly review the service and determine where they could improve. One area that staff had identified for improvement was to increase their collection of smoking data. A question was added to the appointment self- check in screen to collect smoking data. From April to November 2014, 2593 patients had had their smoking status recorded and 597 were given smoking cessation advice. From April 2015 to November 2015, 4653 patients had their smoking status recorded and 713 were given smoking cessation advice.

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

Importantly the provider should:

• Implement a near-miss record for the dispensary to identify trends and patterns in errors.

• Improve the arrangements in the dispensary for recording when balance checks for medicines have been carried out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice