Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Acrefield Surgery on 13 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.
• Risks to patients were assessed and well managed.
• 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 they were able to get an appointment and there was 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 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.

We saw one area of outstanding practice:

We saw evidence that the partners drove continuous improvement and staff were motivated to participate in change. There was a clear proactive approach to seeking out and embedding new ways of delivering the service. For example, the practice participated in Productive General Practice (PGP), an organisation-wide change programme, developed by the NHS Institute for Innovation and Improvement which supports general practices to promote internal efficiencies, while maintaining quality of care. The practice shared with us several examples of positive impact on patient care and experience. For example, aligning annual blood recall for each chronic disease for patients with multiple co-morbidities and coordinating with the repeat prescribing process which resulted in integrated continuity of care, reduced the frequency of attendance at the surgery and provided better appointment efficiency for the practice. All staff we spoke with told us this had been a worthwhile exercise, had provided an insight into how their contribution to a process impacted on other members of the team and had, overall, improved efficiency. The practice additionally organised annual external facilitator-led team retreats which focussed on enhancing the efficiency of the practice, improving patient satisfaction and optimising staff teamwork and collaboration. Comments from a post-event staff survey included ‘very inspiring and informative’ and ‘very good everyone got their say’.

The areas where the provider should make improvement are:

• Ensure there is an effective system to track blank printer prescriptions through the practice in line with national guidance.
• Continue to review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Consider improving communication with patients who have a hearing impairment and how people who use the accessible toilet facility would alert staff in the event of an emergency.
• Undertake a health and safety risk assessment of the practice premises and display an appropriate warning sign on the door where the oxygen cylinder is stored.
• Develop an ongoing audit programme that demonstrates continuous improvements to patient care.
• Ensure all staff have completed all identified mandatory training, specifically fire awareness and infection control.
• Develop a system to monitor patients referred via the two-week wait referral pathway and consider providing patients referred with information.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice