Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Village Surgery on 5 October 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Learning outcomes were shared with staff.
• Risks to patients were assessed and well managed. Health and safety precautions had been taken which included checking that equipment was fully working and safe to use and infection prevention and control measures were in place.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Comment cards we received from patients showed that they felt they were treated with compassion, dignity and respect.
• The practice cared for 158 residents in 13 nursing/care homes and worked closely with care staff to provide proactive ongoing care
• The practice collaborated with local practices and worked with Derbyshire Community Health Services(DCHS) to develop the community matron role, and provide a service for patients with multiple long term conditions to be reviewed by a dedicated team on a weekly basis to plan their care.

• The practice worked with the local women’s refuge, children’s home and a supported living facility for people with a learning disability.
• The practice engaged with two local practices on a project to provide co-ordinated care for frail and elderly people with complex needs who were vulnerable and so at risk of admission to hospital. The practices received funding to support a dedicated GP resource to lead the weekly collaborative meetings with the community team where complex cases were discussed and plans agreed. Analysis had not yet been completed, however, the practice were confident that there had been a reduction in admission rates for this group of patients in the preceding 10 months.
• A reception manager was the appointed practice ‘Carers’ Champion’ to develop the identification and support of carers and had identified 2.3% of the practice list as carers. This has been supported by the local carers connect services who attended the surgery monthly to encourage patients who may be carers to utilise the services available to them.
• A total of 93% of patients with a serious mental health condition had a comprehensive care plan documented in the preceding 12 months. This was slightly higher than CCG and national averages which were 92% and 98% respectively. Exception reporting for this indicator was also slightly lower than CCG and national averages. Recently published data for 2015/16 showed that this figure had increased to 97%.
• The practice supported their local food bank by providing a base for food items to be brought in by the local community. These  were then collected by the food bank to distribute locally.

• The practice used audits to drive improvement and had completed 27 audits during the preceding tow years.
• Information about services and how to complain was available and easy to understand..
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice:

• The practice provided an ‘enhanced nursing beds’ service to patients at the end of their lives. This enabled patients to be discharged earlier from hospital into an enhanced nursing bed at a local nursing home for a period of up to two weeks. This allowed for the patients condition to be stabilised and symptoms managed prior to going home.
• The practice initiated a recall system where a dedicated administrator identified vulnerable and forgetful patients and provided the list monthly to GPs for those patients whose test or injection was due.
• The practice were committed to providing services closer to home as they believed that their population responded more favourably to this and were more likely to attend for treatment at the practice than in secondary care.

However the providers should

• Continue to review patient satisfaction with access to appointments and to evaluate the impact of the steps taken to address this

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out this inspection to follow up on one area of non compliance from our previous visit. We did not speak with patients or staff as part of this inspection. However, we reviewed the action plan the provider sent us, detailing how they were going to address these issues.

Risk assessments had been completed for all non clinical staff that did not have required recruitment checks in place. The practice manager told us staff would be asked during their annual appraisal if they had any convictions to declare. Disclosure and Barring checks were being completed for all clinical staff.

We spoke with five patients, two GPs, the nurse practitioner, two reception staff and the practice manager during our visit. Patients told us they were satisfied with the care and treatment they received.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. Comments about the service included “A brilliant service,” and “All staff have a caring attitude.” Patients told us about the regular check-ups they received. One patient said “Twice a year they check my blood pressure.” Another patient told us “I get an appointment through the post every six months, with a form for my bloods.”

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

Risk assessments had not been completed for staff who had been employed prior the current recruitment checks being in place.

The provider had systems in place for monitoring the quality of service provision. There was an established system for regularly obtaining opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.