Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Downton Surgery on 13 October 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 practice worked closely with a local charity that provided patient transport for practice and hospital appointments.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had their alcohol consumption recorded in the preceding 12 months, which exceeded both the clinical commissioning group (CCG) average of 93% and national average of 90%.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their records in the preceding 12 months, which exceeded the national average of 88%.
• Patients had access at the practice to drop-in clinics from outside agencies such as those specialising in bereavement care.
• The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary booked for a same day appointment at the practice.
• 91% of patients found it easy to get through to the practice by telephone compared with the national average of 73%.
• 87% of patients were able to get an appointment to see or speak to someone the last time they tried compared with the national average of 76%.
• The practice was proactive in addressing patient need by helping to develop a ‘Virtual Ward’ for patients aged 75 years and over who are considered to be at risk of unplanned hospital admissions. The Virtual Ward is a weekly meeting with the GPs and community health team and enables medical, nursing and social care to be directed appropriately. The Virtual Ward consists of a maximum of 30 patients at any point in time.
• 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.
• The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the CCG and was available on referral.

We found one area where the provider should make improvements:

• The provider should seek support to recruit more members to its patient participation group, to better reflect the patient population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with five patients who attended the surgery on the day of our inspection. They all told us they were happy with the service. One person said “I have been coming here years and I like to see the same doctor and the nurse. They are very good at respecting privacy and dignity".

The GPs worked with people living in the community who were in the care of other providers such as mental health services. GPs carried out regular visits to two local nursing homes and worked with services supporting people with learning disabilities. The surgery had district nurses and health visitors based at the premises who would contact them if they had any issues they needed to raise about patients registered with them.

Staff were aware of their roles and responsibilities with regards to protecting people from abuse or the risk of abuse. All staff we spoke with, including administration staff, were fully aware of their responsibilities to report any concerns both internally within the surgery and to external organisations.

We saw evidence the practice also checked and maintained proof of a person’s qualifications or registration with the appropriate professional body. For example, a copy of General medical Council (GMC) registration or Nursing and Midwifery (NMC) registration and qualifications.

Reception and clinical staff we spoke with were all aware of the complaints procedure policy and how to respond should a patient complain about the service. They told us they tried to resolve any concerns straight away if at all possible; otherwise they were referred to the practice manager in accordance with the practices complaints procedure.