Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Ransome Practice on 22 November 2016. 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example,they were currently involved in the ‘Gold Standard Framework in Primary Care, Silver Programme for End of Life Care’. They had identified the 1% of practice population in the last year of their life and were developing advanced care plans for these patients.

• In August 2015 staff identified they had a higher ratio of patients documented as having a fall. The practice value was 51.2 per 1000 people being admitted to hospital related to a fall compared to 40.5 per 1000 people for the CCG average. A protocol was developed to review patients at risk of falls which included a blood test to detect vitamin D deficiency, standing and sitting blood pressures checks, review of medication and follow up of patients discharged from hospital. Those with a deficiency were prescribed vitamin D supplements and were also referred to a specialist falls service run by the local community NHS trust. As a result, in August 2016, the number of patients admitted to hospital related to a fall fell to 41 per 1000 people which was just above the CCG average of 40 per 1000 people.

• Feedback from patients about their care was consistently positive.
• 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. For example, patients and members of the group fed back they would like access to a female GP. The practice were in the process of recruiting a female GP to start the following month.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw some areas of outstanding practice:

• The partners and practice manager were committed to the continuing development of staff skills, competence and knowledge and was integral to ensuring high-quality care. Staff were proactively supported to acquire new skills and share best practice. The partners fostered a learning environment to enable the practice to both develop and learn thereby support recruitment and retention. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality. Staff were supported to communicate compassionately and effectively with patients. The practice manager had compiled a list of helpful phrases to use when dealing with patients who may be distressed, needed reassurance or during bereavement. Staff told us they found the phrases particularly useful when speaking with patients over the telephone and also provided consistency in their approach.
• The patient participation group held monthly carer's afternoons at the practice to offer advice and support. The events were well attended and staff would contact known carers to inform them of the event if they had not attended the practice recently. Speakers were invited to attend to provide advice and support. For example, representatives from charities and local support groups to provide knowledge of services available in the local area. Patient participation group members and practice staff baked cakes and provided snacks for the events. Entertainment was also provided through quizzes, bingo and raffles. The events were well established and in excess of 30 people attended each month. The group told us they received overwhelming feedback from carers how it supported them to have engagement with others in similar situations and also to find out about what is happening in the local community.

• All patients with type II diabetes were cared for at the practice. A practice nurse and GP were both trained to initiate insulin medication if required. Patients told us the service offered was very good and informative and helped them manage their condition. They received regular check ups and it was also a benefit as they could access specialist care near to home and they did not have to travel to hospital which was six miles away. 

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice