Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection January 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Oustanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those retired and students – Good

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people living with dementia) - Outstanding

We carried out an announced comprehensive inspection at Bentley Surgery on 4 December 2017 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. Care and treatment was  always delivered according to evidence- based guidelines, for example in relation to prescribing medicines for an irregular heart beat.
• Frail older people were well supported by the practice-employed care coordinator and their engagement with social prescribing.
• Staff involved and treated patients with compassion, kindness, dignity and respect.The practice was above average for its satisfaction scores on consultations with GPs and nurses.
• Patients found it easy to use the appointment system and reported that they were able to access care when they needed it.
• There was innovation and service development and improvement was a priority among staff and leaders.

• Data showed that the practice was performing highly when compared to practices locally and nationally.
• At the core of the practices ethos, was learning and development across all staff groups.
• Feedback from patients was consistently positive and higher than local and national averages.

We saw areas of outstanding practice:

• The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice. In October 2016 the practice linked with three neighbouring practices to hold quarterly meetings with the wider multidisciplinary team which included a respiratory nurse, community geriatrician, a representative from the local social prescribing initiative, palliative care nurses, district nurses, heart failure nurse, social services and the falls team. This provided the opportunity to review those patients considered most at risk and a forum for sharing best practice and learning through review of case studies.

• The practice ensured that patients with complex needs, including those with life-limiting progressive conditions, were supported to receive coordinated care in innovative and efficient ways.The practice employed a care co-ordinator nurse to review and implement care plans for those patients whose circumstances may make them vulnerable. Initially, patients were assessed using a risk stratification tool which included review of patients living with dementia, learning difficulties, frailty, at risk of hospital admission, housebound, residing in care home or those with multiple long term conditions. The care co-ordinator had identified 140 patients at risk and 89% of these patients had consented to an enriched summary care record.

• ​Staff encouraged and supported patients to be involved in monitoring and managing their health.For example, a GP encouraged a group of patients to establish a support group for people with fibromyalgia. (Fibromyalgia is a long term condition that causes pain all over a persons body). The group met monthly at the practice and people from other practices were invited. The GP would attend with updates about therapies and treatments.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bentley Surgery on 07 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working age people and people experiencing poor mental health. The practice is rated as outstanding for people whose circumstances make them vulnerable.

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.
• 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 with urgent appointments available the same day.
• 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.

We saw areas of outstanding practice:

• The practice was involved in the local CCG’s enhanced safeguarding pilot and was one of only two practices carrying out assessments of Looked After Children.
• The practice was piloting an Electronic Palliative Care Co-ordination Systems (EPaCCS) for the management of patients receiving end of life care.
• The practice had organised health checks for members of the public at a local community festival.
• The practice made special provisions for patients from traveller communities who were known to temporarily move out of the practice area from time to time.
• Transgender patients sought out the practice because of the open and accepting culture.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice