Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Appletree Medical Practice on 18 April 2016. Overall the practice is rated as good. Specifically, we found the practice to be good for providing safe, effective, caring and well-led services. It was outstanding for providing responsive services.

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. All opportunities for learning from internal and external incidents were maximised.

• Risks to patients were assessed and well managed overall.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• The practice used clinical audit to drive quality improvement within the practice

• Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. We found many positive examples to demonstrate how patient’s choices and preferences were valued and acted on.

• The practice worked closely with four other GP practices (Belper five sublocality), Derbyshire Community health service NHS Foundation Trust (DCHS) and the local community in planning how services were provided to ensure they met patients’ needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG).

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

• Staff were committed to improving the services for patients and the wider community; and volunteered to pilot new ideas and innovations before they were rolled out across the local area

We saw areas of outstanding practice:

• The practice worked in collaboration with four local practices on a project to drive improvement in care for older people and reduce emergency admissions from care homes. This had resulted in an 8% reduction in emergency admissions in the preceding 12 months.

• The practice staff and PPG had engaged with patients aged 17 to 24 and with students (also referred to as community ambassadors) from the local school. The PPG had student representation at their meetings for the past three years.

• The commitment by practice staff, allied health professionals and empowerment of the PPG to offer: a range of compassionate and additional services to support carers and people at risk of social isolation was outstanding. For example, The PPG facilitated a bi-monthly carers’ forum which enabled carers to seek peer support, form friendships and be empowered with information relating to their caring role and people they cared for. This forum has been running since November 2011 and attendance averaged 15 to 20 people. In addition, a tea party had been held for older people at risk of isolation and with multiple health needs in February 2016. The practice planned to continue offering this service to patients.

The areas where the provider should make improvement are:

• Ensure a protocol is in place for following up children who do not attend hospital appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Appletree Medical Practice on 22 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.