Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Barrie and Partners on 25 July 2016. Due to unforeseen circumstances a change of lead Care Quality Commission inspector took place and a further focused inspection was undertaken on 14 December 2016.

Overall the practice is rated as Outstanding.

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. The systems in place included reporting to external agencies such as the National Reporting and Learning System (NRLS).
• Risks to patients were assessed and well managed. The practice regularly reviewed their risk registers and took action appropriately. For example, learning from a serious case review for general practice led the practice to implement a policy to ensure a risk assessment was undertaken, and actions taken for patients who had not attended their appointments.
• Practice staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Some GPs had specialist’s skills and worked within secondary care for example, a diabetes specialist centre, and A+E department. Other GPs had specialist skills such as managing patients with eating disorders, advance pre hospital/trauma care, sexual health, and managing pain by using acupuncture. These skills were maximised by the practice to enhance the care to their patients.
• Patients said they were treated with compassion, dignity, and respect and they were involved in their care and decisions about their treatment. Data from national GP Survey showed that 91% of patients said that the last GP they saw or spoke to was good at involving them decisions about their care compared to the CCG average of 84% and the national average of 82%.

• Information about services and how to complain was easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.

• The patients had easy access to a variety of health leaflets and information and ensured that these were given to patients when appropriate.

• The practice worked proactively to ensure that patients on their learning disability register received their annual health reviews. The CCG recognised their high achievements, and requested the systems and processes were shared with other local practices.

• There was a clear strong leadership structure and staff felt engaged, supported and valued by management. The practice proactively sought feedback from staff and patients, which it acted on.
• New ideas were encouraged and several services had been integrated into the practice through the work of staff members, for example the dispensary staff had identified high amount of waste from stoma products. The management team approached the specialist stoma nurse who attended the practice and undertook face to face reviews with patients.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had a robust and comprehensive range of governance arrangements that were regularly reviewed to ensure their effectiveness.

Outstanding elements;

• When designing their new premises the partners were forward thinking and demonstrated innovation. They ensured that opportunities to provide additional services were maximised, providing their patients with services closer to home. For example, they included the specialist power supply required to run the mobile breast screening units, and for patients that required input from the pulmonary rehab service, a room was designed, and fully equipped by the practice with various pieces of essential apparatus. The practice had specialist skills for managing diabetes within the practice team. The practice had invested in a Neurothesiometer, a diagnostic instrument that assessed vibration sensitivity thresholds; this enabled the GP to access the risk of foot ulceration which patients with diabetes are at higher risk of developing. At the time of the inspection 25 additional clinics were provided, the practice team had been instrumental in approaching the providers, setting up and managing the day to day running of these services. The practice had implemented some of these services successfully for their patients and now extended this to include patients from other practices. The practice met the costs of providing or part funded most these services.
• In 2009 the practice invested in the specialist equipment required to provide microsuction to their patients to safely remove ear wax. The practice had been able to treat patients quicker and more effectively with this equipment with positive outcomes. Younger, older and patients with more complex needs had been treated in the practice rather than referred to the local hospitals. In 2014, the practice was contracted to offer this service to other practices. Three GP partners are trained to deliver this service and are supported by consultants from secondary care.

• The practice used proactive methods to improve patient outcomes and these methods were shared with other practices. For example, the practice had worked extensively on producing effective admission avoidance processes. Data on admission avoidance for the period 2015/16 provided by the local CCG showed that the practice was amongst the best performing practices against emergency admissions, accident and emergency attendances and outpatient attendances in the area. The practice worked proactively to ensure that patients on their learning disability register received their annual health reviews. The practice had been asked to share its processes surrounding learning disability reviews with the CCG so that other practices can use them to improve their review rates.

There were areas where the provider should make improvements are:

• Ensure that a clear audit trail for prescription stationery is embedded

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The provider had policies and procedures in place to uphold people’s dignity and to recognise their diversity and human rights. Patient records indicated where formal consent had been obtained for procedures or investigations. The chairman of the Patient Participation Group (PPG) told us that the PPG had an “…open relationship…” with the practice. They told us that practice staff regularly attended meetings and discussed issues with the group.

We looked at 10 computerised patient records. Each record was completed clearly, in a consistent style. People we spoke with were positive about the services provided and told us that they would recommend the practice to others. One patient described the practice as “Brilliant. I can’t fault it.” They told us that the staff were excellent and that they had a very good relationship with their GP.

The practice had its own over-arching safeguarding policy, dated December 2013. It also followed the local safeguarding policies for the protection of children and vulnerable adults. Staff members were able to tell us about how they would raise concerns if they suspected that a patient may be at risk of abuse.

The practice monitored the quality of the services provided. The systems included audits, patient feedback and the investigation of significant events, to help in delivering safe and effective care. The practice undertook annual patient surveys. The PPG had agreed that the results of the 2013 survey were “…excellent.”