Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Combe Down Surgery on 15 June 2016. Overall the practice is rated as outstanding.

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

• The practice leadership and culture were used to drive and improve the delivery of high quality person centred care. The practice sought opportunities to deliver tailored care in the local community and improve health outcomes for patients.
• The practice’s key ethos valued working with partners across health and social care community and contributing to improvements in care and health for the wider population and positive health outcomes for patients.
• The practice was using innovative and forward thinking measure to address the changing face of primary care needs in the population.
• 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 been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice demonstrated a positive learning culture; opportunities for sharing learning were valued.
• The practice invested in the development of staff.
• Feedback from patients about their care was consistently positive.
• 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 a range of urgent appointments available the same day.
• The practice had developed weekly exercise classes for older patients delivered locally at the branch surgery to improve wellbeing and social support for older patients. Patients reported this service as excellent.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw several areas of outstanding practice:

One of the GPs had led a project and audit with the local hospital and a clinical commissioning group (CCG) prescribing adviser to review the medication advice being given to patients with Parkinson’s disease, as they recognised the impact and implications on patient condition if medicines were not given at the correct hours during the day. The audit gained data from all the practices across the CCG and asked all practices to amend the repeat prescriptions for the relevant medicines to give clear timings for patients, which was shown to significantly impact on quality of life. We saw a communication from the local hospital which supported a positive impact on symptoms for patients.

The practice GPs undertook a weekly ward round and regularly reviewed all the care plans of patients for patients who were registered with the practice and resided in the local nursing home (46 out of 48). Staff at the local nursing home confirmed care plans are individualised, regularly reviewed and medicines were also regularly reviewed with a pharmacist, the GP, the Nursing Home team and the patient. This had demonstrated a significant decrease (70%) in unnecessary hospital admissions.

The practice had tailored their yearly health check for patients with a learning disability (LD); they provided a 30 minute appointment with a specialist LD nurse followed immediately by a 20 minute joint consultation with the patients named GP. The patient’s carer (if relevant) and the LD nurse meet with the patient and GP and review the care, to identify any needs and formulate a written updated care plan

Areas where the provider should improve:

The practice should ensure it continues to take steps identify carers for their care and support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice