Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Mary’s Surgery on 16 July 2015. Overall the practice is rated as good.

We found the practice to be safe, effective, caring, responsive to people’s needs and well-led. The quality of care experienced by older people, by people with long term conditions and by families, children and young people was good. Working age people, those in vulnerable circumstances and people experiencing poor mental health also received good quality care.

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. Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Patients said they were treated as individuals and that they were involved in their care and decisions about their treatment. Patients described the practice as caring, helpful and friendly.
• Patients could speak on the telephone and make an appointment with a named GP. Routine as well as urgent appointments were available on the same day.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned. The practice valued the importance of quality, improvement and learning and were actively involved in clinicians’ education and training and in primary care research.
• There was a clear leadership structure and staff felt supported by management. The practice worked closely with its patient participation group and proactively sought feedback from staff and patients. They listened to what patients told them and made improvements accordingly.

We saw areas of outstanding practice:

• The practice provided International Normalized Ratio or INR blood monitoring (a blood test to review and monitor the effectiveness of long term blood thinning medication), for their patients as evening appointments, as a domiciliary service for housebound patients and from a local supermarket.

• The practice was committed to primary care development and education. They took an active part in clinicians’ education and primary care research and encouraged staff at all levels to develop their knowledge and skills.
• GPs provided 24 hour cover, seven days a week, to an inpatient rehabilitation ward at a local hospital and often provided patients on end of life care personal 24 hour and weekend contact information to ensure continuity of care.
• Practice information was available in a number of languages both on the practice website and within the practice. The practice also provided sign language support for patients with reduced hearing and large font for both practice information and the website for patients with limited visibility.

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

Importantly the provider should;

• Improve the arrangements for the security of blank prescription forms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with several people who attended the surgery during the course of this inspection. All of the people we spoke with made positive comments about the friendly attitude of the doctors and nurses. We noted that nurses and doctors met and greeted people in the waiting room and escorted them to the treatment rooms. One person said, "I have usually been treated with respect by all staff and doctors. I have no complaints to make".

A mother with their child made a less positive comment about how it had taken them a longer than satisfactory time to arrange an emergency appointment for her baby by telephone. Overall, every person we spoke with told us they had managed to arrange an appointment for the same day, when it had been necessary.

We found some concerns about the management of medication that was collected by people from their local village store and out of date vaccines kept at the surgery.

The premises appeared to be clean and well maintained, although certain pieces of furniture and furnishings presented a hygiene risk.

Staff reported they had received suitable support and supervision from their managers.