Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr AJM Murdoch’s Practice.

We carried out a comprehensive inspection on 19 November 2014. We spoke with patients, members of the patient participation group and staff, including the management team.

The practice was rated as good overall.

Our key findings were as follows:

• All staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal incidents were maximised to support improvement.
• The practice was proactive in using methods to improve patient outcomes. Best practice guidelines were referenced and used routinely. Patients’ needs were assessed and care planned and delivered in line with current legislation.
• Feedback from patients was consistently positive. We observed a patient centred culture and found strong evidence that staff were motivated and inspired to provide kind and compassionate care. They worked hard to overcome obstacles to achieving this.
• The practice reviewed the needs of their local population and had initiated positive service improvements for patients that were over and above their contractual obligations. They implemented suggestions for improvements as a consequence of feedback from the patient participation group.
• The practice had a clear vision which had quality and safety as top priorities. High standards were promoted and owned by all practice staff with evidence of team working across all roles. There was a strong governance structure in place. The leadership culture was open and transparent. The practice had a clear understanding and commitment to the needs of staff. We found high levels of staff satisfaction.
• The quantity and quality of audits completed by the practice over the last year. The clinical audits we reviewed were very comprehensive and to a high standard. We saw that a number of non-clinical audits had also been completed.

We saw several areas of outstanding practice including:

• The practice adopted a wide definition of hard to reach groups and had devised and implemented a strategy in relation to each. Identified groups included people from lower socio economic groups, homeless people, lone pensioners and teenagers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Cornerstone Practice on 5 December 2018 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall and good for all population groups.

We found that:

• There were gaps in the practice’s governance arrangements resulting in risk management processes not being comprehensive, for example in respect of training oversight.
• Staff found it difficult to locate some key practice policy documents. We found some policies lacked sufficient detail to appropriately describe the process to which they related.
• The practice had systems to identify and investigate safety incidents so that they were less likely to happen again. When incidents did happen, the practice learned from them and improved their processes.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff told us of a strong team ethos at the practice and that they felt supported by the partners and management.
• The practice had implemented a programme of quality improvement work which included clinical audit. We saw examples of audit work resulting in improvements to patient outcomes.
• The practice proactively engaged with other services and stakeholders and worked to improve services available to patients locally.

The areas where the provider must make improvements as they are in breach of regulations are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Formalise methods of gaining assurance that staff working in advanced roles are doing so within their competencies.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice