Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Frome Medical Practice on the 10 and 11 June 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding for providing safe, responsive, effective services and for being well led. They were also outstanding for providing services for all the population groups. They were good at providing caring services to patients.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the practice had a hub team to reduce hospital admissions, which worked well to provide support to high risk patients and working in collaboration with the multi-disciplinary teams.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patient’s needs.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).

• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand
• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

We saw several areas of outstanding practice including:

• There were comprehensive systems in place to keep patients safe from harm and the team actively reviewed their safeguarding systems in order to do this. This included regular bi-weekly review of domestic violence notifications with all GPs.
• There was a comprehensive system in place to keep patients safe when taking high risk medicines. The system included when it was determined patients required outstanding diagnostic tests, patients had ease of access of the daily nurse led drop in clinic to enable them to have these checks completed quickly and enable them to continue with their medicine safely.
• The practice had a dedicated unplanned admissions hub team and had 3.5% of care plans completed working alongside multidisciplinary teams to aid the reduction in being urgently admitted to hospital. The practice had seen a slower rise in admissions in comparison to the previous year and had a lower percentage of admissions than other local practices in the area.
• The newly developed Health Connections Mendip service which was based in the practice and partly facilitated by the practice to build patients confidence to manage their own conditions and to develop and use services available to them for support. This had benefitted patients who have specific and not necessarily common conditions by new support groups being established and successfully represented by these patients.
• The safe use of innovative and pioneering approaches to care and how it was delivered were actively encouraged. Nurses led minor surgery clinics within the practice, 89% of patients seen in the last year had minor surgery completed by a trained nurse. They had been running since 2002 and received a practice nurse award in 2002 for making a difference.
• The practice had increased carer registration from 250 in January 2012 to 850 in May 2015. They linked with the local community hospital to increase awareness of the service provided by the practice and encouraged carers to register. The practice had a trained carers champion and often linked with Carers UK for advice and updates on information to provide to patients. All new carers were contacted by the carers champion and had a direct dial number to contact them in the future. New carers were provided with a carers information pack and there was an information stand for carers displayed in the practice.
• The practice had set up a weekly ‘leg ulcer club’ through The Lindsay Leg Club foundation in October 2014. The leg club was held in a non-medical setting enabling patients and others to receive a high standard of care for patients experiencing problems with their legs including leg ulcers. This occurred in a social and friendly setting that promoted understanding, peer support and informed choices. The practice funded the attendance of health care professionals during these clinics and the foundation funded the use of the facilities and refreshments. Since October 2014, 90 patients from the practice had been seen at the club for on-going treatment. The lead nurse for the leg club received a Mayor’s Civic Award on 1 April 2015 for outstanding contribution to the community and was a reflection of how many leg club members were attending in a short period of time proving the club to be already successful.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice