Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Frome Valley Medical Centre on April 29 2015. Overall the practice is rated as outstanding.

Specifically, we found the practice to be outstanding in providing effective and responsive services and good for providing safe, caring and well led services. We found the practice provided outstanding care for older people, people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

They provided good care for people with long term conditions; families, children and young people and working age people.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was undergoing a management restructure however 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.

We saw several areas of outstanding practice:

• The practice employed a prescribing coordinator to manage hospital discharges to increase continuity of care to patients after discharge from hospital and to implement effective systems to manage the recall of patients on medication (for blood tests).
• The practice provided additional GP support to local nursing and residential homes including weekly ward rounds, education sessions for staff and advanced care planning.
• The practice ran a monthly multidisciplinary team meeting and virtual ward round for any person registered at the practice who required additional health support. Voluntary and charitable organisations were a part of this team. For example the Independent Mental Capacity Advocacy service.
• The practice had won two awards for clinical innovation for a project for frequent attenders which resulted in increased patient satisfaction and reduced referrals to secondary care and GP consultations. The project has been taken on as a clinical trial by a local university.
• The GP’s use the BATHE (Background, Affect, Trouble, Handling, Empathy) programme during consultations to help patients learn skills and develop confidence to manage their own health.
• The practice had proactively engaged with safeguarding concerns and changed working practice in order to identify potential abuse early in residential homes. This included a falls policy which had reduced the number of patient falls by 100%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as Good overall. (Previous rating April 2015 – Outstanding)

We found that although some of the previous outstanding elements had been retained within the practice further development of these initiatives had not been implemented since our previous inspection.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Frome Valley Medical Centre on 7 August 2018 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 focus on and improvement at all levels of the organisation.
• The practice had a very active patient participation group who were responsible for initiated some innovative projects such as the Combatting Loneliness and Isolation Project to identify community links and resources which could provide social contact and support for patients.

The areas where the provider should make improvements are:

• Review document management to ensure that all recruitment documentation is held in one place.
• Review the protocol for exception reporting so that the decision making process is clear.
• Risk assess the emergency medicines which were not held by the practice.
• Review processes to establish a programme of clinical review of the effectiveness and appropriateness of the care provided.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.