Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acle Medical Partnership on 6 December 2016. The overall rating for the practice was good, with requires improvement for providing effective services. The full comprehensive report on the 6 December 2016 inspection can be found by selecting the ‘all reports’ link for Acle Medical Partnership on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 6 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good, and good for providing effective services.

Our key findings were as follows:

• The option to order prescriptions over the telephone was no longer available in the practice. The practice offered a prescription delivery service for patients requiring this. Due to the rural nature of the surrounding area this was a responsive change that saw deliveries sent to hard to reach locations.
• GPs were notified of uncollected medicines from the dispensary. These were reviewed on a weekly basis and where needed patients were contacted to clarify any reasons. We saw that a comprehensive log was kept.
• The practice had improved performance for their Quality and Outcomes Framework (QOF) but some further improvement was required.
• The practice had an effective audit programme in place which demonstrated improvements to quality of care.
• The practice was not yet providing extended hours’ appointments but had agreed to commence this from April 2018 onwards with their commissioners. From April 2018, the practice would be open on Mondays from 7am to 8pm and during lunchtimes the remained of the week. This was in addition to current opening hours. The most recent national GP Patient Survey data from July 2017 indicated that of the 120 patients that responded:

  • 80% were able to get an appointment to see or speak to someone the last time they tried compared to the local average of 89% and the national average of 84%.
  • 82% said the last appointment they got was convenient compared to the local average of 88% and the national average of 81%.
  • 62% were satisfied with the surgery’s opening hours compared to the local average of 79% and the national average of 76%.

• The practice had reviewed the coding processes and services available for carers. The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 161 patients as carers (nearly 2% of the practice list).
• Clinical leads had been appointed individual areas of responsibility when overseeing care delivery to patients.

There were two areas where the provider should make improvements:

• Continue to monitor and improve Quality and Outcomes Framework (QOF) performance.
• Continue to monitor and improve access to appointments.

We saw one element of outstanding practice:

• The practice had developed their approach to providing care to patients that lived in residential homes where the practice delivered care. The practice had developed a visit approach which combined advanced nurse practitioners and GPs skills and knowledge, including nutrition and multiple condition reviews. This had led to a 16% reduction in hospital admissions for these patients, meaning that the practice was the lowest performer for avoidable emergency hospital admissions within the CCG. This had led to a 64% reduction in cost between 2015/16 and 2016/17. Due to the success of this approach the practice had developed a national research project on which it was leading 300 practices to develop their approach.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acle Medical Partnership on 6 December 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 the practice had systems in place for reporting and recording significant events.

• Risks to patients who used services were assessed and well managed.
• The practice was proactive and responsive to patients’ needs.
• 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.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• Patients said it was not always easy to make an appointment with a named GP. However they were able to access urgent appointments available the same day.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour.

The area where the provider must make an improvement is:

• The practice must ensure that patients who require reviews for long term conditions are systematically recalled to see a clinician at the appropriate time.

The area where the provider should make an improvement is:

• Maximise the functionality of the computer system in order that the practice can run clinical searches, provide assurance around patient recall systems, consistently code patient groups and produce accurate performance data.

• There was scope to improve the recording of actions implemented as a result of national patient safety alerts and guidelines.
• The practice should improve the systems to assess, monitor and mitigate risks to patients who telephone order prescriptions and the systems in place to ensure medicines not collected by patients were notified to GPs.
• Ensure any actions and learning outcomes from quality improvement activities, such as clinical audits, are recorded and reviewed to ensure improvements have been achieved.
• Continue to develop methods used to proactively identify carers.
• The practice should ensure they continue to extend and prioritise work to ensure that patients (including working patients) can access appointments in a timely manner.
• Ensure there are systems in place to define which partner was responsible for which area within the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During this inspection we visited the main surgery in Acle, but did not visit the branch surgery in Reedham.

We spoke with 10 people who were waiting for their appointments to see a GP or a nurse during our inspection. They unanimously told us that they had very positive experiences of the service with regard to how they had felt respected and listened to by all staff working at the surgery and with the treatment that they had received from GPs and nurses.

People had received care and treatment after they had been assessed and examined and these notes had been recorded in their medical notes.

Safeguarding policies and staff training were appropriate. There were suitable arrangements in place to assure children and vulnerable adults that the service would ensure they were protected from abuse.

The premises were well maintained, comfortable and appeared clean. The building was a safe and suitable environment for people, which accommodated the range of activities and services provided.