Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Church Hill Surgery

on 2 May 2017. Overall the practice is rated as good.

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

• Since November 2016, the registered provider of Church Hill Surgery had changed and the principal GP was the sole provider. Practice staff we spoke with told us significant changes had been made, including the employment of three GPs who had previously worked as long term locums in the practice.

• There was a clear leadership structure, practice staff we spoke with told us that the principal GP and practice manager had involved them in developing their business plan to encourage future developments and offer greater services to their patients.
• The practice proactively sought feedback from staff and patients, which it acted on. The Patient Participation Group had recently been reformed and the members we spoke with were passionate about the changes and the greater involvement of patients.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had systems to minimise risks to patient safety. However, the practice had undergone extensive building works to extend the practice and a qualified person had not reviewed the previous risk assessment for the prevention of legionella disease. The previous risk assessment deemed the building to be low risk. The practice took immediate action and arranged for a qualified person to undertake a review.
• Practice staff were aware of current evidence based guidance, and had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The clinical staff discussed these and patient cases at regular meetings. Clinical staff told us they always had access to a GP for advice. We noted the practice did not undertake formal one to one peer meetings with clinicians in protected time to review consultations and share learning. The practice told us with the addition of three new GPs in post, protected time would be given to formalise clinical supervision to enhance the support already in place. The practice took immediate action and arranged protected sessions for clinical staff to enhance the supervision already in place..
• Results from the national GP patient survey, published in July 2016, showed patients were treated with compassion, dignity, and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it very easy to make an appointment and there was continuity of care, with urgent appointments available the same day. The practice offered 12 minute appointments as standard and longer appointments if appropriate.
• The practice had achieved 100% for the standard childhood immunisations.
• In 2015, the practice had extended the premises providing additional clinical rooms had upgraded other clinical rooms to a high standard and provided more car parking. The practice was well equipped to treat patients and meet their needs.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

The practice directly employed an outreach team to manage patients that were vulnerable and needed additional care. The team consisted of a GP and three nurses, one community based, one nurse practitioner and a practice nurse. The team worked closely with other health professionals such as a care co-ordinator and social worker. All practice staff were engaged with this team, including the dispensary drivers who delivered medicines five days per week to patients that needed them. Other local charities and support groups such as the Cinnamon Trust (a local charity that cared for patients dogs when needed) support the team to ensure patients were support to remain at home. The CCG had supported the project and data they provided showed a significant reduction of the number of avoidable admissions. The CCG planned to roll out this model of care to other practices in the locality.

We saw areas where the practice should make the following improvements:

• Embed the practice plan to provide protected time to undertake formal clinical supervision of all clinical staff enhancing the supervision already in place.

• Review and monitor the system used to record the results from regular safety checks undertaken and ensure that they are updated timely and any actions are investigated and completed.

• Update the risk assessment for the management of Legionella’s disease and ensure any actions are completed in a timely way including those related to water temperature management.

• Collate the practice registers to identify all patients who are vulnerable to ensure there is comprehensive oversight enabling practice staff to be informed of patients with more complex needs.

• Review the system for recording all feedback including verbal to ensure trends can be identified and improvement encouraged.

• Review the systems and processes in place to ensure consistent coding of medical records is used to provide accurate performance data.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice