Letter from the Chief Inspector of General Practice

This practice is rated as outstanding overall. (Previous inspection October 2016 – Good overall with outstanding for providing effective services.)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Oustanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at Dr Gordon McAnsh on 17 November 2017. We carried out this routine inspection as part of our inspection programme.

At this inspection we found:

• The practice had sustained and continue to improve the high level of achievement since the last inspection, and had improved in areas including responsiveness and well led.

• For the fourth consecutive year the practice achieved 100% on the Quality Outcomes Framework and had high achievement in many areas across the health indicators measured. There were clear systems and processes in place to manage exception reporting ensuring each patients was reviewed by the GP.

• The practice had a highly effective and well manged quality improvement process in place in order to identify where they might improve. They had a continuous programme of, and had completed, 38 audits and there was a whole cohesive practice approach to improvement.

• The strong leadership, embeded governance structure and culture were used to drive and improve the delivery of high-quality person-centred care. All staff were involved in the development of the practice and were proud of their achievements.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Staff ensured that care and treatment was delivered according to evidence- based guidelines.

• The practice patient satisfaction data was in line with, or above, local and national averages for outcomes on the National GP Patient Survey published in July 2017. Some areas had improved from the 2016 data. Patients reported they were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service. There were several examples of where the practice had gone the extra mile for patients.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care. The practice understood the needs of the services users and regularly engaged in the local community.

• Care provided was reflective of the needs of the population including those who were registered as temporary residents. The appointment system was adjusted in holiday periods to employ more staff to meet these extra patient’s needs, and also to ensure the high quality of service could continue.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• Patients spoken to on the day of inspection reported that the practice was a caring environment and we saw evidence of several examples of where the practice had provided caring services. The practice considered themselves part of and engaged with the local community supporting such events as the annual carnival and regularly fundraising for local charities and support groups and regularly held health awareness campaigns. The practice used these campaigns as a way to complete opportunistic health checks and to promote the practice and healthy living. This was also an opportunity to engage with the public and improve rapport with patients. Where their vulnerable patients were at risk of falls and could not get a carer to assist them to the surgery, staff would walk them to and from the surgery. They also delivered medicines to the homes of these patients to ensure they had adequate supplies. The practice was a dementia friendly practice and was proactive in phoning patients who may have memory problems to ensure they attended appointments.

• The town of Wells next the Sea experienced widespread flooding through the town, the practice staff liaised with the local flood warden, and made direct contact with their patients who had chosen to remain in their own homes. The practice was aware of those who may have become vulnerable due to adverse weather conditions. They were able to ensure that they had adequate supplies of provisions and medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as outstanding overall. (Previous inspection October 2016 – Good overall with outstanding for providing effective services.)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Outstanding

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Oustanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at Dr Gordon McAnsh on 17 November 2017. We carried out this routine inspection as part of our inspection programme.

At this inspection we found:

• The practice had sustained and continue to improve the high level of achievement since the last inspection, and had improved in areas including responsiveness and well led.

• For the fourth consecutive year the practice achieved 100% on the Quality Outcomes Framework and had high achievement in many areas across the health indicators measured. There were clear systems and processes in place to manage exception reporting ensuring each patients was reviewed by the GP.

• The practice had a highly effective and well manged quality improvement process in place in order to identify where they might improve. They had a continuous programme of, and had completed, 38 audits and there was a whole cohesive practice approach to improvement.

• The strong leadership, embeded governance structure and culture were used to drive and improve the delivery of high-quality person-centred care. All staff were involved in the development of the practice and were proud of their achievements.

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. Staff ensured that care and treatment was delivered according to evidence- based guidelines.

• The practice patient satisfaction data was in line with, or above, local and national averages for outcomes on the National GP Patient Survey published in July 2017. Some areas had improved from the 2016 data. Patients reported they were truly respected and valued as individuals and were empowered as partners in their care, practically and emotionally, by an exceptional and distinctive service. There were several examples of where the practice had gone the extra mile for patients.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• Services were tailored to meet the needs of individual people and were delivered in a way to ensure flexibility, choice and continuity of care. The practice understood the needs of the services users and regularly engaged in the local community.

• Care provided was reflective of the needs of the population including those who were registered as temporary residents. The appointment system was adjusted in holiday periods to employ more staff to meet these extra patient’s needs, and also to ensure the high quality of service could continue.

• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw areas of outstanding practice:

• Patients spoken to on the day of inspection reported that the practice was a caring environment and we saw evidence of several examples of where the practice had provided caring services. The practice considered themselves part of and engaged with the local community supporting such events as the annual carnival and regularly fundraising for local charities and support groups and regularly held health awareness campaigns. The practice used these campaigns as a way to complete opportunistic health checks and to promote the practice and healthy living. This was also an opportunity to engage with the public and improve rapport with patients. Where their vulnerable patients were at risk of falls and could not get a carer to assist them to the surgery, staff would walk them to and from the surgery. They also delivered medicines to the homes of these patients to ensure they had adequate supplies. The practice was a dementia friendly practice and was proactive in phoning patients who may have memory problems to ensure they attended appointments.

• The town of Wells next the Sea experienced widespread flooding through the town, the practice staff liaised with the local flood warden, and made direct contact with their patients who had chosen to remain in their own homes. The practice was aware of those who may have become vulnerable due to adverse weather conditions. They were able to ensure that they had adequate supplies of provisions and medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Staff told us that patients were treated with respect and they were involved in making decisions about their care and treatment. Patients were given information about their condition and treatment options were discussed with them. Information leaflets were also available in the waiting area. The consulting and treatment rooms were located away from the waiting area so that consultations were private and confidential. One patient told us, “I have no complaints. The staff are polite and helpful.” Another person said, “I can’t fault the staff. It’s a lovely surgery.”

The computerised records contained clear information and were kept to a consistent standard. The new patient registration process ensured that patients received a health check by the practice nurse. Arrangements were in place so that on-going treatments and medicines were not interrupted when new patients registered with the practice. A range of appointment times were available to patients, including early morning. People told us they did not have difficulty in getting an appointment. One person told us, “They usually see me the same day.”

Audits were taking place to assess and monitor the quality of the service. These included specific treatment regimes and medication audits. Arrangements were in place to investigate incidents, with action plans being developed to address any issues that were identified. People told us they knew how to complain and felt they would be listened to.