Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Quantock Vale Surgery on 9 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for older patients, patients with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report accidents, incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and learnt from their investigations.
• Risks to patients were assessed and appropriately managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Care and treatment of patients was carried out effectively by appropriately skilled staff.
• Patients said they were treated with compassion, dignity and respect by all staff 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.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments always available the same day.
• The practice had suitable facilities and was well equipped to treat patients and meet their needs.
• 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.

We saw areas of outstanding practice including:

• The practice had a robust and secure model to deliver dispensary services to its patients. Every prescription, new or repeat, was clinically checked by the pharmacist against the clinicians’ record. If changes were required the pharmacist would discuss these with the prescribing clinician before phoning the patient and arranging a face to face meeting with them to explain the change in detail.
• One of the nurses from the practice had initiated a swimming group for patients diagnosed with diabetes who were overweight and who were conscious of their body image. The group was currently supported and led by one of the patient participation group committee.
• Young person’s appointments were available with the nurse practitioner where young patients could discuss contraception and receive sexual heath advice and information in confidence. The practice had signed up to provide free condoms through the national ‘C’ card scheme.
• The practice was part of a locally based project, called the Symphony project, which was aiming to provide enhanced support to patients with three or more diagnosed conditions.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

• Review staff awareness of the Mental Capacity Act 2005 and establish an agreed process for recording how best interest decisions are reached.
• Review how best interest decisions can be consistently recorded in patients notes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice