Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Worthing Medical Group on 6 January 2017. Overall the practice is rated as outstanding.

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. Opportunities for learning from internal and external incidents were maximised.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• The practice supported and encouraged staff training and development. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Most patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice had provided staff with training on methods to promote positive interactions with patients.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice had been instrumental in making a successful bid to obtain funding through the Prime Minister’s Challenge Fund for additional patient appointments at four sites. They had written and won the bid and implemented the whole service for two localities.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, in developing a dedicated service for homeless patients, providing comprehensive care and support for patients living in nursing and care homes, and developing a measure to identify and support frail patients.

• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients said they found it easy to make an appointment with a GP. Where difficulties had been identified the practice had been proactive in reviewing and improving patient access to appointments.
• There was a strong and visible leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. There were high levels of staff satisfaction and staff spoke highly of the culture.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw three areas of outstanding practice:

• The practice developed a system to identify severely frail patients who were not identified by other risk programmes. The practice had used this system to identify an additional 187 severely frail patients. They offered these patients comprehensive reviews and had worked with other professionals to support these patients and develop care plans. The practice was liaising with their computer supplier to roll out this system to other practices in the area and nationally.
• The practice offered a dedicated service for homeless patients based at Health Central Surgery. Approximately 150 homeless patients used this service. There were dedicated GPs and advanced nurse practitioners working at this service and also a number of staff with additional expertise in mental health and substance misuse. All newly registered patients had an initial 30 minute GP appointment and a 30 minute nurse appointment. Support was provided for substance misuse and alcohol difficulties, sexual health advice, as well as routine health assessments and treatments. The service provided outreach to homeless shelters and participated in a forum for services providing support to homeless people to share local knowledge. The practice had received positive feedback from patients using this service. As a result of patient feedback, the practice had developed cards explaining patients’ right to register at other practices despite having no fixed address. Patients were given copies of these cards to give other practices if they encountered difficulties.
• The practice provided services to 777 older patients living in nursing and care homes. There was a dedicated GP and advanced nurse practitioner each day at the practice and a separate phone line was provided so that staff at nursing and care homes could quickly contact the practice for advice. Practice staff provided monthly education sessions and training events to nursing and care home staff. Approximately 20 staff from 20 homes attended a recent training event. Training topics included Deprivation of Liberty Safeguards, wound care, end of life care, and support for workers undertaking phlebotomy training. We saw evidence of positive feedback about this service from other health care professionals.

• The practice had a well-developed business plan which set out its vision, supporting objectives and the strategy for achieving them. There were a number of examples of how the practice had turned its vision in to reality. For example, playing an instrumental role in setting up and successfully bidding to obtain funding from the Prime Minister’s Challenge Fund to provide additional minor illness and minor injuries clinics at four sites across Worthing. They had written and won the bid and implemented the whole service for two localities. As a result this provided increased access for all patients in these localities to urgent appointments during weekdays from 8am until 8pm and at weekends from 10am until 2pm. This helped ensure patients were seen by the right person at the right time.

The area where the provider should make improvement is:

• Introduce systems to ensure that all necessary building risk assessments and maintenance actions are undertaken and documented for all sites.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with seven patients who attended the practice on the day of our inspection, two of whom were members of the practice's PPG. They all spoke highly of the care and support provided by the practice. One said, "They are very responsive to comments and concerns raised by the group and put things right.” Another said, "I am thoroughly satisfied with the services provided.” We also spoke with two other patients by telephone after the inspection. They all said that staff were friendly and helpful and they could usually get an appointment when they needed to. They all felt well informed and involved in decisions about their care. One patient said it is an “Excellent practice” and another patient said it is a “Wonderful practice”.

We spoke with four GPs, the practice manager, the deputy practice manager, two nurses, one health care assistant and two reception staff. They all said they received sufficient training to undertake their roles. They all felt well supported in their roles through supervision, informal mentoring, regular practice meetings and annual appraisal. One GP said “This is an exceptionally well organised and supportive practice.”

We found that the practice had policies and procedures in place to safeguard children and vulnerable adults and that staff were aware of their roles and responsibilities in relation to this. This meant that patients who used the service were protected from the risk of abuse.

The practice regularly sought the views of patients through surveys and the Patient Participation Group. Their views were used to improve the service. We saw that learning took place from significant events. This meant the practice had an effective system to monitor the quality of service that patients received.