Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Berkeley Place Surgery on 8 September 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• The patient participation group (PPG) were well engaged and represented across a diverse range of professional backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness about patient services. For example, PPG members suggested rewording questions on the practice’s in-house patient survey, and information displayed on its waiting room screens, to make them easier to understand. The content of both areas has been changed as a result.
• 90% of patients were able to get an appointment to see or speak to someone the last time they tried compared with the Clinical Commissioning Group (CCG) average of 84% and the national average of 76%.
• The practiced worked closely with local services including a homeless shelter and volunteer transport schemes.
• The practice offered to the most appropriate patients the use of information and communication technologies in their homes, to support and self-manage long term conditions such as diabetes, epilepsy and Chronic Obstructive Pulmonary Disease, which causes long term breathing problems.
• The practice is participating in a social prescribing scheme to support people who attend their GP surgery but do not necessarily require medical care. Social prescribing supports people with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that can help improve their wellbeing and meet their wider needs.
• Staff had lead roles that improved outcomes for patients such as a care co-ordinator and a carers champion. Patients had access at the practice to drop-in clinics from outside agencies such as Cruse Bereavement Care.
• The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were visited by the practice nurse, assessed and, if necessary, booked for a same day appointment at the practice.
• 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.
• The provider was aware of and complied with the requirements of the Duty of Candour.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

We found two areas where the provider should make improvement:

• Continue to conduct clinical audits and embed these into its processes so that improvements made are implemented and monitored.
• Review the process through which carers are identified to enable the practice to engage with and support a larger proportion of the patient practice list.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Berkeley Place Surgery was in a listed building close to the centre of Cheltenham. Despite the building restrictions the provider had taken reasonable measures to make it as accessible as possible for people with disabilities. The new practice manager had started to encourage people to join the patient participation group to make sure the practice could learn and grow with the wishes of its patients.

The doctors at the surgery were able to see people at the surgery or in their own home. They also provided support for people who were resident at two local care homes. The practice had good systems in place for safeguarding both children and adults. It also had procedures in place to minimise the risk of infection for patients. We found medicines were managed appropriately by trained staff. The practice also had effective recruitment and selection procedures in place.

The Quality Outcomes Framework is an incentive scheme to improve clinical quality and patient experience in general practice. Each doctor at the practice had a responsibility for a part of this framework. A strategy and action plan had also been developed and updated on a continuous basis.

We spoke to one person who used the service who told us "my husband and I are very happy with the care we have received". We also saw other comments which included “I have been blown away by the superb doctors’; they have taken all our concerns seriously” and “As a long standing patient, the care has been excellent”.