Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rahman & Staples on 30 September 2016. Overall, the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned when incidents and near misses occurred.
• 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. They commented positively about the clinical staff at the practice, words used include very good, caring and excellent and understanding.
• Information about services and how to complain was available and easy to understand.
• Most 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.
• Outcomes were above average for the locality. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring its effectiveness and had achieved 99.6% of the points available in 2014/2015. This was 5.2% above the local average and 4.9% above the national average.
• 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.
• The provider was aware of and complied with the requirements of the duty of candour regulation.

We saw several areas of outstanding practice:

• Results for the National GP Survey, published in July 2016, were above local and national averages for consultations with clinical staff. Of those who responded 100% said they had confidence and trust in both the last GP, and nurse, they saw or spoke to. We also saw that, for those who responded, 86% would recommend this surgery to someone new to the area (CCG average 79%, national average 78%).
• The practice was aware of the wider issues that faced some of their patients and that affected their health. They had participated in a pilot project to help reduce social isolation in older patients. Led by the practice, but closely involving a national charity for older people. A nurse or GP saw each patient, care plans were put in place if needed and medications were reviewed, with new medications available on the day. The practice arranged for support services for older people to attend the sessions so that non-clinical issues could also be addressed. The sessions were held over three afternoons at the practice and 22 patients took part. The national charity had evaluated the project and is considering extending the project.
• The practice had been one of two practices nationally that had taken part in an accessible information pilot. As part of this, the practice had reviewed the communication needs of all patients with a learning, hearing or visual disability (67 patients). Where appropriate, each patient met a patient liaison officer to discuss their communication needs. Following this the practice had updated their new patient registration and NHS health check forms to make sure that information about patients’ communication needs was collected regularly and produced a large print patient information leaflet. All patients identified with any communication difficulties are now offered longer appointments if required.
• The practice had carried out work with young people to improve their awareness of what general practice can offer and their rights regarding access and consent. This involved giving a lesson to year eight pupils at a local secondary school. This was delivered by a group of GPs, nurses and NHS staff. The practice manager was involved from this practice. Following this work the practice now writes to all patients over the age of 14 with information on patient confidentiality for young people.

There was one area of practice where the provider needs to make improvements.

The provider should:

• Provide all staff with infection control training, which is relevant to their roles and responsibilities.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice