Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fishponds Family Practice on 4 October 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• 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.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• Fishponds Family Practice received the Customer Service Excellence Award, for demonstrating a high level of commitment to patient care. The practice’s customer care policy is one of several component parts to the award. The care policy focuses on how the practice delivers access to patient services and offers choice wherever possible. The customer care policy is available for patients to read in the practice and on its website.
• The patient participation group (PPG) were well engaged and represented across a diverse range of ages and backgrounds. The PPG suggestions for changes to the practice management team had been acted upon and as well as this, the group had raised awareness to patients about the practice’ services.
• The practice was proactive in ensuring that vulnerable patients who did not attend their scheduled appointments were contacted by the practice nurse, assessed and if necessary booked for a same day appointment at the practice.
• The practice worked closely with local organisations including a hospice, a dementia charity and a homeless charity.
• The practice participated in a social prescribing scheme to support people who attend their GP surgery but did not necessarily require medical care. Social prescribing supported patients with issues such as social isolation and coping with caring responsibilities, to connect to services and groups that could help improve their wellbeing and meet their wider needs.
• Staff had lead roles that improved outcomes for patients such as a carer’s lead.
• The practice was one of seven GP practices that had helped to develop a medical student psychotherapy scheme, for patients who did not have access to specialist mental health services.
• The practice helped to establish an additional psychotherapy service for patients to be initially assessed before referral to the private or voluntary sector, where they were provided with opportunities for work and art therapies.
• Patients were able to access a specialist dementia memory nurse. The nurse assessed patients in their own homes, advised on tests and medications and once diagnosed, referred patients to a dementia navigator to help them and their carer access available community support.
• 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.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.
• The practice hosted a talking therapy service for patients who had experienced bereavement, were carers, or were experiencing mental health issues. The service was funded by the local clinical commissioning group (CCG) and was available on referral.

We saw two areas of outstanding practice:

• There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. Fishponds Family Practice received the Customer Service Excellence Award in 2010. This government-backed scheme was open to all health sector organisations and awarded where there was a demonstrably high level of commitment to patient care. Fishponds Family Practice was the third GP practice in the country to attain the award since its’ inception in 1991. Following a reassessment in 2015, the practice was re-accredited for this Excellence Award until 2018.
• The leadership, governance and culture of Fishponds Family Practice are used to drive and improve the delivery of high-quality person-centred care. For the last three years, practice GPs have had fortnightly supervision sessions with a consultant psychotherapist. The sessions were self-funded by the GPs, and focussed on patient empathy and interaction, staff relations, and identifying and working to meet the demands of a GP’s role. The practice produced a paper about the GPs’ experiences of counselling that was published in the British Medical Journal in 2014. When we spoke to the practice, we saw that informal feedback highlighted GPs found the sessions highly beneficial to their professional practice.

We saw one area where the practice should make improvement:

• The provider should continue to make efforts to identify a greater proportion of carers from its patient list, to better support the population it serves.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice