Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashgate Medical Practice on 31 August 2016. Overall the practice is rated as good.

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

• There was an effective system in place for the reporting and recording of significant events. The practice had adapted a system from a neighbouring practice termed learning opportunities to share (LOTS) to encourage incident reporting at all levels within the practice. This encouraged staff to raise events, however minor or significant, with the resulting impact of issues increasingly being reported. Learning was applied from all events to enhance the delivery of safe care to patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• A regular programme of clinical audit and research reviewed patient care and ensured actions were implemented to improve services as a result. 
• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to deliver effective and responsive care to keep vulnerable patients safe.
• The practice had an effective appraisal system in place, and was committed to staff training and development. The practice team had the skills, knowledge and experience to deliver high quality 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.
• The practice analysed and acted on the patient and staff feedback they received, and worked with a proactive Patient Participation Group (PPG) to enhance patient experience.
• Information about how to complain was readily available to patients. Improvements were made to the quality of care as a result of any complaints received.
• Results from the national GP survey and feedback from patients we spoke with during the inspection demonstrated some dissatisfaction with the appointment system. The practice was aware that access was problematic and had taken action to address this. This matter remained under review by the practice as they strove to improve access.
• Longer appointments were available for those patients with more complex needs. A GP triaged calls and ensured that any patient requiring an urgent appointment was seen on the same day.
• There were elements of the practice’s quality monitoring arrangements, and the actions taken to reduce risks, that required strengthening. For example, the practice had not arranged for Disclosure and Barring Service (DBS) checks on two staff who had been trained to act as chaperones. In addition, some medicines management issues such as the checking of medicine expiry dates lacked sufficient oversight and required more robust management. However, the practice took immediate action to rectify these issues.
• The practice had modern purpose-built facilities that were well-equipped to treat patients and meet their needs.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said that the GPs and managers were approachable and always had time to talk with them.
• The practice had a clear vision for the future and the aspirations of the partners were in line with the CCG strategy of delivering high quality care closer to the patient’s home.

We saw the following area of outstanding practice:

• The practice had commenced an in-house pharmacy pilot project from September 2015. This placed a prescribing community pharmacist within the practice for four days each week. The pharmacist had made 2,173 patient contacts between September 2015 and April 2016, approximately 75% of which were face to face consultations. This had a significant impact in releasing additional GP consultation capacity, and providing expert advice and support to patients and the practice team with regards to medicines related issues.

The areas where the provider should make improvement are:

• Consider the frequency and oversight of regular reviews for emergency medicines so that they are available when needed.
• Review procedures to monitor prescriptions, including the destruction of prescriptions assigned to a named GP after leaving the practice.
• Ensure the practice cold chain policy is implemented, supported by staff training, and with regular monitoring arrangements to provide assurance that it is being followed.
• Review procedures to ensure all staff who act as a chaperone receive appropriate DBS clearance. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice