Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Bernays & Whitehouse Group Practice, Grove Surgery, Solihull on 17 May 2016. Overall the practice is rated as outstanding.

There are two surgery locations that form the practice; these consist of Grove Surgery and their sister practice Shirley Medical Centre. There are approximately 20,000 patients of various ages registered and cared for across the practice and as the practice has one patient list, patients can be seen by staff at both surgery sites. Systems and processes are shared across both sites. During the inspection we visited both locations. As the locations have separate CQC registrations we have produced two reports. However where systems and data reflect both practices the reports will contain the same information.

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

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, through discussions at clinical meetings the practice had setup alerts for possible serious conditions, to support the GP with their examinations.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, the practice offered an in house counselling service.
• The practice had defined and embedded systems in place to keep people safeguarded from abuse. There was a system in place for reporting and recording significant events and staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses.
• Risks to patients were assessed and well managed.
• Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment; results were circulated and discussed in the practice.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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.
• All opportunities for learning from internal and external incidents were maximised.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Feedback from patients about their care was consistently positive.
• The limitations of the building posed difficulties for the practice, but this was well managed. Car parking was limited due to the residential area the practice was situated in.
• 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.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. We saw evidence that multidisciplinary team meetings took place every six weeks. Staff spoke positively about the team and about working at the practice.

We saw several areas of outstanding practice including:

• The practice has set up a dementia café every three months to support patients and their carers at their sister practice Shirley Medical Centre with the support of the patient participation group (PPG). The practice opened this up to the local community and had a positive response and is now looking to develop this further, with the support of local agencies and the practice staff who are dementia friends.
• The practice has started a weight clinic on a Saturday morning with an open invitation to all patients. We saw evidence to confirm effective weight loss had been achieved.
• As a result of incidents in outside of the practice that had to come light through appraisals and discussions at clinical meetings the practice decided to set up alerts that highlight possible ‘serious conditions. The practice has produced specific leaflets for patients so they are fully involved and aware of the possible complications and the importance of seeking medical help should any of the symptoms appear. For example, Cauda Equina. This is a rare but very significant and serious complication of sciatica/back pain which can result in permanent nerve damage.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice