Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Blackdown Practice on 30 June 2016. Overall the practice is rated as outstanding.

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

• The practice had a strong communitarian approach.
• There was a strong commitment to providing co-ordinated, responsive and compassionate care for patients, particularly patients with long term conditions and older people who are frail and at risk of social isolation.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• There was a holistic approach to assessing, planning and delivering care and treatment to people using services. Examples included: risks to patients were assessed, well managed through the integrated approach to supporting patients who were vulnerable and/or had long term conditions.
• 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 all of the 27 patients we spoke with or who provided feedback, who used the service, family members and carers, and stakeholders were continuously positive about the way staff treated them and other patients. Patients said staff went the extra mile and the care they received exceeded their expectations. Patient’s also told us that it was easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day. 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.
• 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 experienced flexible services that aimed to provide choice and continuity of care. The practice was mindful of the rural isolation of many of the patients and brought services closer to home. These included: Retinal screening for patients with diabetes to reduce the associated risks with this condition; All three sites were well equipped so that patients could access the same services at branch surgeries, such as ear irrigation or regular testing of patients with blood clotting conditions.
• The Blackdown Practice was proactive in identifying carers and had a comprehensive overview of their needs and created ways to provide timely support for them.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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. Examples included: Collaboration with an adult social care provider to extend their services to include domiciliary care; driving up quality by collaborating with seven other GP practices in a federation.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

The practice was proactive in recognising the pressures on the NHS and a lack of adult social care services in the area and was a founding member of a patient focussed charity and continued to promote the services available to them. Patients had immediate and easy access to the many types of support available from the charity, including information, transport assistance support and social activities for vulnerable patients living in the community. Over 300 patients are supported each year by this service.

Integrated health and social care is strongly advocated and the practice has driven innovation in the integration of community services in the Blackdown Hills area through a long term health conditions project. The practice has developed a specific role of practice community matron providing patients with one point of contact and greater anticipatory care of vulnerable patients. This had reduced the number of unplanned hospital admissions by a third.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice