Letter from the Chief Inspector of General Practice

We inspected this service on 28 April 2015 as part of our new comprehensive inspection programme.

The overall rating for this service is outstanding. We found the practice to be good for providing safe and effective services and outstanding for providing caring, responsive and well led services.

The practice was outstanding at providing services for older patients and patients with long term conditions. The practice was good at providing services for families, children and young patients, the working age population and those recently retired and patients experiencing poor mental health.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from incidents were maximised.

• 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 worked closely with other organisations and with the local community in planning how services were provided to ensure they met the needs of patients.

• Information about how to complain was available and easy to understand.

• The practice held regular multidisciplinary clinical team meetings to discuss the needs of complex patients, for example those with end of life care needs or children who were considered to be at risk of harm.

• The practice had an open culture that was effective and encouraged staff to share their views through staff meetings and significant event meetings.

We saw several areas of outstanding practice including:

• Weobley Surgery had looked for innovative ways to develop services for patients in their area. They had been involved in a number of pilot schemes such as the provision of a specialist clinic to review all patients with Atrial Fibrillation (heart disease) who may be at additional risk of a stroke. These reviews resulted in positive outcomes for patients. The practice shared their learning from these and other pilots they engaged in with the CCG area.

• The practice had an equipment fund that was registered with the charities commissioners and managed by a committee of patient representatives. This fund enabled the purchase of additional equipment to be used for the benefit of patients. The practice told us that they contributed to this fund-raising by asking for donations rather than charge fees for some forms they were requested to complete. The fund had enabled them to purchase and loan equipment to patients such as syringe drivers (for pain management), heart monitoring recorder to aid diagnoses, blood pressure monitoring machines, an audiometer to assess hearing, and defibrillators in all GP cars for restarting a person’s heart in an emergency. There was a community defibrillator attached to the outside of the building for the use of the village first responder.

• The practice showed a high level of commitment to the needs of patients receiving palliative care and recognised that many of them wanted to receive the highest quality of care and support to enable them to die with dignity in their own home or care home. Effective systems were in place to ensure they received their end of life care in line with their expressed preferences. The practice operated a direct one to one on-call rota to provide individual care and support to patients in their end of life.

• The practice was one of the highest performing practices in Herefordshire for the care for diabetic patients. The practice had 300 patients diagnosed with diabetes. A dedicated community dementia worker provided clinics at the practice. There was a high uptake of flu vaccines (100% which was higher than the national average of 93%) and foot examinations (96% which was higher than the national average of 88%) for diabetic patients.

• Weobley Surgery was leading on trials for a standardised approach to practice nurse appraisal documentation. This documentation was to be used in the completion of appraisals towards continued professional development, leading to revalidation for nurses. The outcome of the trial was to share the documentation with all practices within the county. One of the GPs also coordinated a monthly educational evening in conjunction with a neighbouring practice. The evening was open to all local practices and consultants, and other experts were invited according to the learning needs identified by the group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice