Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Downland Practice on 16 December 2015. Overall the practice is rated as good.

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.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.

• 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 (PPG).

• The practice had an effective governance system in place, was well organised and actively sought to learn from performance data, incidents and feedback.

We saw two areas of outstanding practice including:

• The Downland Practice had responded to the needs of the wider community and was providing an ultrasound scanning service. The practice uses a high quality scanner and offers scans for the abdomen including liver, gall bladder, abdominal aorta, pelvis and pregnancy assessment. This resulted in patients receiving scans at a more convenient location than travelling to hospital, often a shorter waiting time and one expectant mother told us the early pregnancy scans provided reassurance and continuity of care. The practice performs approximately 300 ultrasound scans each year and was regularly audited to demonstrate quality improvement as part of the clinical audit programme within the practice. Recent notable diagnoses following ultrasound scans include three cases of testicular cancer, a life threatening critical abdominal aortic aneurysm and 13 pregnant women have avoided hospital admission following first trimester pregnancy scans.

• The Downland Practice provides GP services to a local independent, specialist school for pupils with autism, moderate to severe learning difficulties and complex needs. There was specific designated GP point of contacts for the school (approximately 68 patients). Contact details of the designated GP were shared with the relevant staff and patients families, enabling continuity of care and quick access to the right staff at the practice. The designated GP had 16 years’ experience of working with patients with autism and could demonstrate regular and up-to-date autism specific training and undertook monthly ‘Looked After Children’ Health Reviews and updates from the Royal College of General Practitioners.

However, there was an area of practice where the provider needs to make improvements.

Importantly the provider should:

• Continue to review and monitor the performance and outcomes for patients with diabetes and COPD.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice