Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of The Whickham Medical Practice on 19 January 2015.

Overall, we rated the practice as good. Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was outstanding for providing services for older people.

We found some areas of outstanding practice, although there were some areas where the practice should make improvements. Our key findings were as follows:

• Feedback from patients was positive; they told us staff treated them with respect and kindness;
• Patients generally reported good access to the practice, with urgent appointments available the same day, although some felt it took too long to see a doctor of their choice;
• Patients we spoke with told us they felt they had sufficient time during their appointment. However, results of the national GP patient survey from 2015 suggested this was not always the case. 81% of patients thought the doctors and 77% thought nurses gave them enough time. These results were below the national averages (86% and 81% respectively).
• Patients’ needs were assessed and care was planned and delivered following best practice guidance;
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, reviewed and addressed;
• There was a clear leadership structure and staff felt supported by the management team. The practice actively sought feedback from patients;
• The practice was clean and hygienic, and good infection control arrangements were in place;
• A recent audit had been carried out on cancer referrals and diagnoses across the area. The results showed the practice had performed well, and had the highest rate of cancer referrals and very high screening rates. The Clinical Commissioning Group (CCG) had suggested other practices could learn from this.

We saw several areas of outstanding practice including:

• The practice had signed up to the Health Champions initiative, a project supported by NHS England and the Big Lottery Fund. A number of patients volunteered and had been trained to be Practice Health Champions (Practice Health Champions are people who voluntarily give their time to work with the staff in their local GP Practice or surgery to find new ways to improve the services that the practice offers, and to help to meet the health needs of patients and the wider community).

• There were a high number of elderly patients registered at the practice (14% of patients were over 75, compared to a national average of 9.6%); staff were aware that many of these people lived alone and may have felt isolated. Staff were proactively seeking new ways to support these patients and a new service was planned for the coming months. ‘Chatty champions’ were volunteers who would arrange to speak to patients each week to give them support and someone to talk to.

• Care plans had been prepared for 308 older patients, to help prevent avoidable hospital admissions. Data showed there was a decrease in the number of unplanned hospital admissions and during the Christmas period there were no unplanned admissions for this group of patients.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Take steps to review the risk assessment for legionella and implement any necessary actions.
• Clarify arrangements for the servicing and maintenance of the defibrillator.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

This practice is rated as Good overall. Previous inspection January 2015 - Good

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at The Whickham Practice on 8 May 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems to keep patients safe and safeguarded from abuse.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice organised and delivered services to meet patients’ needs. They took account of patient needs and preferences.
• Patients were able to access care and treatment from the practice within an acceptable timescale for their needs.
• There was a focus on continuous learning and improvement at all levels of the organisation. The practice proactively used performance information to drive improvement.

We saw areas of outstanding practice:

• The practice was proactive in their support and care of older patients who made up a large proportion of their patient population. This included identifying and supporting frail patients, effective arrangements for social prescribing, good management of long term conditions and comprehensive care planning. As a result they were able to demonstrate a reduction in non-elective admissions to hospital for this group of patients.
• For 2015/16 and 2016/17 (the latest published data available) the practice had attained 100% in the Quality Outcomes Framework (QOF) scheme for the care and treatment of patients with long term conditions. They had developed a personalised approach to ensure patients were involved in care planning activity.

However, there are areas where the provider should improve:

• The provider should retain a centralised record of clinicians safeguarding training so that there is managerial oversight of when updates are due.
• Sustain recent improvement to monitor and record action taken when the temperatures of fridges used to store medicines fall outside of the permitted range.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice