Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Delamere Medical Practice on 1 December 2015. 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 a system in place for reporting and recording significant events. Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when there were unintended or unexpected safety incidents, not all staff followed the same process to report them and lessons learned were not always communicated widely enough to support improvement.

• Risks to patients were assessed and well managed.

• Data showed some patient outcomes were low compared to the locality and nationally. However audits had been carried out, and we saw evidence that these audits were driving improvement in performance to improve patient outcomes.
• 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.
• 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 and the provider was aware of and complied with the requirements of the Duty of Candour.
• Patients said they found it difficult to get through on the telephone and were not always able to make an appointment when they needed to. However all patients had 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. However, there was no information on the practice website or a practice leaflet about opening hours, appointment times, how to access an appointment, what clinics were offered or what to do when the practice was closed.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. However, privacy was compromised and long queues caused congestion at reception during busy times.

The areas where the provider should make improvement are:

• Lessons learned were not always communicated widely enough to support improvement. The practice should continue to develop systems to improve feedback and communication between GPs, nursing, administration and reception staff.

• Access at reception should be reviewed to alleviate congestion and increase patient confidentiality.

• The practice website should be updated to include information about opening times, clinic availability and access for patients during and out of hours.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The practice had an up to date consent policy. All members of staff we spoke with understood the principles of obtaining consent, including issues relating to capacity.

The practice had a patient’s charter in place and policies and procedures which gave up to date guidance for staff. Policies included dignity, chaperone and teenage confidentiality.

Patient told us: “I always get seen when I need to and we have had a really good package of care for my son’s on-going health needs.” “I am always happy when I come, always get the right guidance.” "I haven’t had a bad experience, it doesn’t matter which GP I see. I once needed a home visit and I couldn’t have asked for better."

Staff were able to demonstrate clear understanding of their roles and responsibility to safeguarding patients. One member of staff told us: “Everybody’s got a responsibility.”

All areas of the practice were clean, tidy and well maintained. The infection control policy clearly set out people's roles and responsibilities and requirement for staff to attend annual training.

The practice had a suggestion box in the reception area for patients to provide comments. Feedback was also sought from patients through an annual survey. We saw the results from the survey carried out in 2012 and were shown copies of the survey due to be carried out in 2013. Feedback from the 2012 survey was positive.