Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eastwood Group Practice on 22 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, caring, well-led, effective and responsive services. It was also good for providing services for older people, people with long term conditions, families, children and young people, working aged people (including those recently retired and students), people whose circumstances make them vulnerable and people with 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 incidents and near misses. Significant events were recorded however these records were brief and dos not include details who was responsible for actions and learning. Reviews were not recorded to demonstrate that learning had been embedded into practice.
• There were robust arrangements for managing medicines and minimising the risks of infections.
• The practice had robust systems for safeguarding adults and children and sharing information with other agencies as appropriate.
• Staff were recruited with all the appropriate pre-employment checks carried out. The induction for newly employed staff did not include details of the length of induction or specifics for what the induction covered. There were enough staff employed to keep patients safe.
• There were appropriate measures in place for assessing risks to staff and patients’ health and safety, including a detailed business continuity plan to deal with any untoward event that may impact on the delivery of service.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance and referrals to secondary care services were made in a timely way.
• Policies and procedures were written with reference to appropriate guidance. The practice worked with other health and social care providers to ensure that patients received continuity of care and treatment.
• Patients said they were treated with empathy, compassion, dignity and respect. They said that they were listened to and involved in making decisions about their care and treatment.
• Information about services and how to complain was available and easy to understand. Written responses to some complaints we saw could be interpreted as defensive in nature.
• Appointments were flexible to meet the needs of all population groups. The practice was accessible and GPs provided a flexible service to patients in their homes as needed.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff were supported by management.
• The practice sought feedback from staff and patients. They demonstrated learning from listening to staff, patients and other stakeholders.

We saw one area of outstanding practice:

• One of the GPs carried out twice weekly scheduled visits to patients in the five local care homes. This helped to effectively monitor and treat patients thereby identifying and treating changes in patients’ health. The managers of care homes we spoke with told us that these visits benefited both patients and their relatives. One care home manager told us that these visits had reduced the need for unscheduled home visits, increased confidence in the practice and allowed patients relatives to meet with and discuss any concerns or changes in treatment with the GP. The practice was monitoring the effectiveness and benefits of these visits. Initial findings suggested that the planned twice weekly visits had resulted in a reduction in requests for unscheduled home visits and the numbers of unplanned hospital admissions indicating that patients’ needs were being met effectively.

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

Importantly the provider should:

• Review the systems for recording significant and other safety events so that they describe in detail the analysis of the event, the person(s) responsible for completing actions; and a record of when these actions have been completed.
• Ensure that all new staff undertake a period of induction when the start work at the practice.
• Ensure that complaints are responded to in line with the practice policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice