Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Alpha Medical Practice on 31 May 2017. Overall the practice is rated as good.

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

• During our inspection we received positive feedback from patients and staff. 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 clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse. Significant events, incidents and complaints were used as opportunities to drive improvements.

• Although we saw that was shared learning during meetings, we found that the locum nurses and locum GPs could not always attend the meetings; these clinicians worked at the practice on a regular basis.

• The practice took a proactive approach to understanding the needs of different groups of people, this included identifying patients with different cultural needs in order to offer them support where needed. For example, the practice had tailored their end of life care to meet the specific cultural and religious needs of their population.

• The practice was committed to working collaboratively with other services and healthcare professionals. For instance, the practice worked closely with a pharmacist from the clinical commissioning group to significantly improve antibiotic prescribing rates. The practice was also working with Cancer Research UK to improve cancer screening rates.

• Carers were offered a range of support including annual reviews and flu vaccinations, 1% of the practice’s list had been identified as a carer.

• On the day of our inspection the practice could not provide assurance to support that the long term locum nurses received regular supervision and that they were all annually appraised. Shortly after our inspection took place, the senior GP partner provided assurance regarding peer support plans for the nurses and had successfully arranged to have peer support for nursing provided by the local clinical commissioning group (CCG) which was due to commence on 5 June 2017.

• There were accessible facilities in the practice for patients with mobility needs. The practice had a hearing loop for patients with hearing impairments. There were translation services available at the practice and some staff members could also speak a variety of languages including Punjabi and Urdu. Information was made available to patients in a variety of formats and in different languages. The practice also utilised its text messaging and online appointment service for deaf patients to book appointments and to request translation services where needed.

• In addition to patients aged 40 and over, the practice opportunistically screened patients for diabetes. This resulted in the practice’s high rates of diabetes diagnosis and above average QOF performance for diabetes care. The practice also took part in various diabetes research projects such as an integrated diabetes care model with Heart of England NHS Foundation Trust. An analysis of the project highlighted improvements in diabetic management and a total of 70 patients were discharged from secondary care after joint intervention by primary and secondary care.

The areas where the provider should make improvements are:

• Strengthen the clinical oversight of long term locum clinicians, gain assurance that peer support and supervision is in place where needed and ensure that learning is formally shared with long term locum staff to support the practice’s learning culture.

• Continue to identify carers in order to offer them support where needed.

• Ensure that a tighter monitoring process is implemented to support the practice nurses when administering vaccines using patient group directions (PGDs).

• Continue to focus on improving cancer screening rates.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice