This practice is rated as Good overall. (Previous rating March 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive at Air Balloon Surgery on 14 June 2018, as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• At out inspection in March 2015 we recommended that the provider should review the processes for recalibrating equipment to include equipment held in individual GPs bags. Also review care plans for patients with a diagnosis of a dementia to ensure they are all up to date; and review the confidentiality of conversations taking place in the top floor consultation rooms. All these areas had been addressed and improvements put in place.

We saw one area of outstanding practice:

The practice had employed a mental health nurse to improve access with mental health needs by providing support in areas such as: on the day urgent appointments; comprehensive reviews of care plans; and ongoing monitoring of compliance with medicines.

The areas where the provider should make improvements are:

• Review arrangements to make sure that all relevant agencies are correctly notified when a significant event occurs, particularly if it relates to safeguarding.
• The practice did not have an arrangement in place to search patient records to identify overdue screening, to enable them to contact the patient to remind them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Air Balloon Surgery on 12 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for patients with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia). Some services for older patients were outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP 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 upon.

We saw areas of outstanding practice, these included:

• The practice is a member of the Prime Ministers challenge fund “One Care” pilot project which aims to use technology to improve access to primary care, manage demand effectively and improve the quality and consistency of care delivered both in hours and out of hours. One care is already providing pre bookable weekend appointments to patients who might otherwise be admitted to hospital. E-consultations are also provided to improve the possible access routes for patients for practice consultations.

• The nominated GPs made three times a week ward round visits to patients in an adjacent nursing home. They carried out routine monitoring and to use information gathered to update care plans for the most vulnerable patients although the care plans for people with a diagnosis of dementia had not always been updated. Twice weekly ward rounds were carried out at two other residential homes for older patients as well as a home for people with a learning disability.

• GPs from the practice were involved in a pilot study in the use of the Edmonton Frailty Scale to inform decisions where patients lacked capacity to make decisions about future care needs. This assessment tool is a brief, valid, reliable tool which can be used by clinicians without special training in geriatric medicine to assess the frailty of the older patient. It assesses 10 domains including cognitive impairment, balance and mobility.

• Practice staff recognised the needs of vulnerable patients and made additional efforts to support them. They spent over two hours helping a non-English speaking patient to complete a registration form and providing additional support; adapting a treatment room to accommodate a vulnerable patient so they could receive a minor injuries procedure without the need for a hospital admission.

• All patients diagnosed with diabetes were offered and provided with a personal care plan to manage their diabetes where it was their choice to have one. The care plan enabled the patients to record test results, maintain a foot risk status with help from the nursing team and develop a plan for their diabetes reviews and establish a personal action plan. These care plans were seen as helpful and motivating by the patients with whom we spoke.

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

Importantly the provider should;

• Review its processes for recalibrating equipment to include equipment held in individual GPs bags.
• Review care plans for patients with a diagnosis of a dementia to ensure they are all up to date.
• Review the confidentiality of conversations taking place in the top floor consultation rooms.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice