Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Myhill & Partners on 8 December 2016. The overall rating for the practice was good with the practice rated as requires improvement for being responsive.

From the inspection on 8 December 2016, the practice were told they should:

• Continue to review and monitor processes for the Quality and Outcomes Framework (QOF) and continue to audit areas of high exception reporting.

• Ensure continued work to improve national GP patient survey results.

The full comprehensive report on the inspection carried out in December 2016 can be found by selecting the ‘all reports’ link for Dr Myhill & Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 October 2017 to confirm that the practice had carried out the recommended areas where they should make improvements that we identified during our previous inspection on 8 December 2016. This report covers our findings in relation to those improvements made since our last inspection.

Overall the practice is still rated as good, with a rating of requires improvement for being responsive.

Our key findings were as follows:

• Data from the latest national GP patient survey published in July 2017 showed that patients rated the practice below local and national averages for some aspects of care. There was some improvement in satisfaction scores from the previous survey published in July 2016. Satisfaction for telephone access to the practice had decreased.
• The practice had begun the installation of a new telephone system and the availability of appointments was being routinely reviewed to improve access to the surgery.
• The practice planned to undertake its own survey to monitor patients’ satisfaction with the support of the patient participation group between January and March 2018, upon completion of the installation of the new telephone system.
• The practice had improved digital information and invested in new technologies to relieve the burden on the telephone system.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

• The practice had updated their protocols for exception reporting against QOF. (QOF is a system intended to improve the quality of general practice and reward good practice. Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
• The new protocol ensured that patients were telephoned by a nurse upon their third recall before being exception reported. SMS text message reminders were also used to recall patients as an alternative to letters.

Most recent QOF data (2016-2017) had not been published at the time of our inspection and the practice was unable to provide unverified data to support improvements.

The areas where the provider should make improvements are as follows:

• Continue with efforts to review and monitor processes for QOF; auditing areas of high exception reporting.
• Continue to monitor and ensure improvement to national GP patient survey results; in particular those relating to access to services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Myhill and Partners on 08 December 2016. Overall the practice is rated as good.

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

• The practice had a clear vision and worked to meet the recognised needs of patients in the community it served.
• The practice had created and maintained an open and transparent approach to safety. A clear reporting system was in place for reporting and recording significant events. The practice had well established systems for managing medical alerts and updates.
• Risks to patients were identified, assessed and appropriately managed. For example, the practice implemented appropriate recruitment checks for new staff and undertook regular clinical audits and reviews to monitor and improve services.
• We saw that the staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff were supported to access development learning and routine training was provided to ensure they had the skills, knowledge and experience to deliver effective care and treatment.
• Data from the Quality and Outcomes Framework (QOF) showed the practice had performed well, obtaining 99.6% of the total points available to them, for providing recommended care and treatment to their patients. However, the practice had higher than average exception reporting rates across a range of outcomes.
• Results from the GP Patient Survey published in July 2016 were mixed; the majority of outcomes were lower than local and national averages.
• The practice had initiated an internal patient survey which was carried out January 2016 – March 2016 to seek feedback from patients on services provided.
• We received positive feedback from the patients who completed 27 comment cards.
• Information about services and how to complain or provide feedback was freely available in the waiting area and published on the practice website. The practice had a comprehensive and thorough process dealing with feedback. Outcomes from complaints were shared and learning opportunities identified as appropriate.
• The patient participation group (PPG) was well supported and engaged positively with the development of the practice.
• The practice had access to good facilities and modern equipment in order to treat patients and meet their needs.
• There was a clear leadership structure and we noted there was a positive outlook among the staff, with good levels of moral in the practice. Staff said they felt supported by management.
• A range of research projects brought added benefits to the practice.
• Effective arrangements for the organisation and presentation of information for discussion at partners meeting facilitated good governance.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are as follows:

• Continue to review and monitor processes for QOF continue to audit areas of high exception reporting.
• Ensure continued work to improve national GP patient survey results.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating October 2017 – Overall Good with Responsive Requires Improvement)

We undertook a comprehensive inspection of Dr Myhill and Partners on 9 October 2017 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The practice was rated as good with a rating of requires improvement for providing responsive services. The full comprehensive report following the inspection in October 2017 can be found by selecting the ‘all reports’ link for Dr Myhill and Partners on our website at

This inspection was a focused desktop inspection carried out on 14 September 2018 to confirm that the practice had made the recommended improvements that we identified in our previous inspection on 9 October 2017. This report covers our findings in relation to those improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings on areas where we previously told the practice they should make improvements were as follows:

• The practice had continued to monitor areas where the overall exception rates for the Quality Outcome Framework (QOF) results were significantly higher than the CCG or national averages. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients decline or do not respond to invitations to attend a review of their condition or when a medicine is not appropriate). We found the practice had implemented a local QOF recall protocol. We noted that the recall system reflected the QOF guidance and patients were reminded to attend three times and had been contacted by various methods that included text messages reminder letters and telephone call before being subject of exception. The protocol also took account of non- responders who may be terminally ill, medically unsuitable or housebound who had undergone a review process with a GP on the best course of action. Monitoring information supplied by the practice since implementation showed a significant reduction of excepted patients.
• Following the patient dissatisfaction expressed in the national GP patient survey published in July 2017 the practice had implemented improvements which included changes to the appointments system, the telephone system and customer service. The new GP Survey published August 2018 showed improved patient satisfaction during making an appointment. The practice’s own monitoring had shown improved access including shorter waiting times for the phone to be answered.

The areas where the provider should make improvements are:

• Continue to monitor QOF exception reporting so improvements made are sustained
• Continue to monitor patient satisfaction with access to appointments so improvements made are sustained

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.