Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at White Horse Surgery and Walk In Centre on 7 October 2014. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, members of the patient participation group, interviewed staff of all levels and checked that the right systems and processes were in place.

Overall the practice is rated as good. This is because we found the practice to be good for providing safe, effective, caring, responsive, well-led services. It was also good for providing services for all population groups.

Our key findings were as follows:

• White Horse Surgery and Walk In Centre is a busy, high activity practice that we found was working hard to keep pace with the increasing demands of rapidly increasing patient registrations.
• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. Lessons were learned and communicated widely to support improvement. Information about safety was recorded, monitored, appropriately reviewed and addressed. Risks to patients were assessed and well managed. There were enough staff to keep people safe.
• Data showed patient outcomes were at or above average for the locality. NICE guidance is referenced and used routinely. People’s needs are assessed and care is planned and delivered in line with current legislation. This includes assessment of capacity and the promotion of good health. Staff have received training appropriate to their roles and further training needs have been identified and planned. The practice can identify all appraisals and the personal development plans for all staff. Multidisciplinary working was evidenced.
• Data showed patients rated the practice higher than others for several aspects of care. Patients said they were treated with compassion, dignity and respect and they were involved in care and treatment decisions. Accessible information was provided to help patients understand the care available to them. We also saw that staff treated patients with kindness and respect ensuring confidentiality was maintained.
• The practice reviewed the needs of their local population and engaged with the NHS Local Area Team (LAT) and Clinical Commissioning Group (CCG) to secure service improvements where these were identified. Patients reported good access to the practice and a named GP and continuity of care, with urgent appointments available the same day. The practice had good facilities and was well equipped to treat patients and meet their needs. There was an accessible complaints system with evidence demonstrating that the practice responded quickly to issues raised. There was evidence of shared learning from complaints with staff and other stakeholders.
• The practice had a clear vision and strategy to deliver this. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and regular governance meetings had taken place. There were systems to monitor and improve quality and identify risk. The practice proactively sought feedback from staff and patients and this had been acted upon. The practice had an active patient participation group (PPG). Staff had received inductions, regular performance reviews and attended staff meetings and events.

We saw several areas of outstanding practice including:

• Primary medical services were available to patients registered elsewhere or not registered at all, via a walk in service.
• An interpreter service was available for patients whose first language was not English and we saw there was a multilingual computerised touch screen booking in system available to all patients in the reception.

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

The provider should:

• Review the risks associated with not monitoring or recording the temperature of areas, other than refrigerators, where medicines are stored securely.
• Review the risks of storing sterile and other clean equipment in dirty utility rooms.
• Ensure all relevant staff have up to date knowledge of the Mental Capacity Act 2005.
• Review their whistleblowing policy and complaints procedure policy to ensure contact details of relevant complaints bodies are available to staff and patients.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice