Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Fordington Surgery on 17 May 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 been trained to provide them with 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.
• 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.

• Practice GPs maintained an ongoing review of potentially vulnerable patients using a system which showed the up to date details of those most vulnerable. Patients identified as being potentially vulnerable were discussed at formal weekly meetings and actions agreed. For example any patient who had attended accident and emergency departments, safeguarded children, adult safeguarded patients, patients with learning disabilities, patients subject to domestic violence.

We identified areas of outstanding practice:

Patients with multiple long term conditions had been identified and were able to see a GP instead of a nurse when they attended for their flu vaccinations. This was done in order to review their complex needs in a single appointment. GPs also took this opportunity to carry out health checks across a range of other conditions for example, dementia diagnosis.

The practice had introduced an innovation to support vulnerable patients responding to their needs in a more proactive and timely way. The practice GPs maintained a dedicated time slot for one hour, four times a week whereby they contacted local care homes and either visited or invited the patient from the home into the practice. Historically patients would not have been visited until the afternoon, which meant treatment could be started in the morning, potentially avoiding an unplanned admission to hospital.

The practice had recently introduced a new computer application. It sent out a text reminder to patients to confirm the appointment,  reminded them of the appointment 24 hours in advance and sent out a friends and family survey message after the appointment. This had resulted in less cancelled appointments and increased patient feedback information.

The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 3% of their patients as carers. The practice used this register to send out details of workshops which carers could attend, invited them in for annual health checks and offered signposting to relevant services. Written information was available to direct carers to the various avenues of support available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patient’s privacy and dignity were maintained. One patient told us, “I’ve never felt privacy to be the slightest problem.” Another patient said, “They are very helpful, you are never treated like you are a waste of time.”

Patients were able to get an appointment promptly and had sufficient time to discuss their problems. One patient told us, “I have no problems getting appointments, the system works very well.” Another patient said, “I’ve never felt rushed, there is always enough time to discuss my problems.”

The surgery had effective arrangements to ensure cleanliness. We found that the surgery was clean. One patient told us, “The cleanliness is excellent.” Another patient said, “The place is spotless and its always tidy.”

The provider carried out checks on staff before they started work.

The provider regularly monitored the quality and safety of the service and made improvements when necessary.