Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection 26/11/2014 – was overall rated as Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

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 – Good

People with long-term conditions – Good

Families, children and young people – Good

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

People whose circumstances may make them vulnerable – Good

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

We carried out an announced comprehensive at Dr Wilcox & Partners at Essex House Surgery on 20 December 2017. This inspection was carried out as part of our inspection programme.

At this inspection we found:

• 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. It ensured that care and treatment was delivered according to evidence-based guidelines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

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

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

• There was a focus on continuous learning and improvement within the practice. For example, improved guidelines for clinical staff in regard to medicines management which was shared across to other GP services in the federation.

• The practice has set aside a ‘safe’ area with telephone access and information for vulnerable people to have access to seek support from external organisations. Such as help for domestic abuse.

• The regular multi-disciplinary meetings held with the Health Visitor, Midwife and School Nurse team have been recognised as best practice by the Somerset Clinical Commissioning Group Safeguarding Nurse.

• The practice at the time of the inspection had on-going IT issues which had impacted upon the speed and flexibility of using patient records, templates and IT work streams. Support had been sought from the providers of the IT systems and the practice were still awaiting them to be resolved. Although challenging for the staff, they had implemented workarounds to ensure that patients care and support was not compromised.

There was an area that was outstanding:

• The practice had been recognised for its work in monitoring high risk medications as it was one of five GP practices from across the country nominated for the National Prescribing Safety Awards 2017.

The areas where the provider should make improvements are:

• The practice had detailed information of the recruitment and selection process although they should consider recording the identity of the members of staff conducting the interview and selection process to aid a good audit trail.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Dr Denner and Partners (also known as Essex House) was inspected on Wednesday 26 November 2014. This was a comprehensive inspection.

Essex House provides a service to approximately 9,200 patients in the Somerset town of Chard.

Essex House provides primary medical services to a diverse population age group and is situated in a town centre location.

There is a team of five GP partners, three males and two females. GP partners hold managerial and financial responsibility for running the business. In addition there were an additional salaried GP employed at the practice, four registered nurses, three health care assistants, a practice manager and additional administrative and reception staff.

Patients using the practice also have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

We rated this practice as good.

Our key findings were as follows:

The service is safe. There are systems in place to address incidents, deal with complaints and protect adults, children and other vulnerable people who use the service. Significant events are recorded and shared with multi professional agencies and there is evidence that lessons are learned and systems changed so that patient care is improved.

The service is effective. There are systems in place to support the GPs and other clinical staff to improve clinical outcomes for patients. According to data from the Quality and Outcomes Framework (QOF), which is the annual reward and incentive programme detailing GP practice achievement results, outcomes for patients registered with this practice are equal to or above average for the locality. Patient care and treatment is considered in line with best practice national guidelines and staff are proactive in promoting good health. There were sufficient staff working at the practice and recruitment was in place to fill vacancies.

The service is caring. The practice is pro-active in obtaining as much information as possible about their patients which do or can affect their health and wellbeing. Staff know the practice patients well, are able to identify people in crisis and are professional and respectful when providing care and treatment.

The service is responsive. The practice plans its services to meet the diversity of its patients. There are good facilities available, adjustments are made to meet the needs of the patients and there is an effective appointment system in place which enables good access to the service.

The service is well led. The practice has a clear vision and set of values which are understood by staff and made known to patients. There is a clear leadership structure in place.

There were areas of practice where the provider should make improvements.

The provider should ensure that:

• Learning points from significant events should be circulated more consistently and effectively.

• Improvements to the repeat prescriptions of named medicines should be improved to ensure safety.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice