Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Giltbrook Surgery on 28 January 2016. The overall rating for this practice is outstanding.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework (QOF) data, this relates to the most recent information available to the Care Quality Commission (CQC) at that time.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events, and we saw evidence that learning was applied from events.
• 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.
• Feedback from patients about their care, and their interactions with all practice staff, was consistently and strongly positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a GP. Routine appointments could be booked within a week, with urgent appointments being available the same day. Advanced bookings could be made without restriction on timescales.

• The practice used clinical audits to review patient care and we observed how outcomes had been used to improve services as a result.

• The practice had good facilities and was well-equipped to treat patients and meet their needs. The size of the building limited the number of services provided on site, but the practice were actively exploring opportunities for re-location in the future with service commissioners.
• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe. This approach had impacted on unplanned hospital admissions and attendance at Accident and Emergency.
• There was a strong and proactive leadership structure within the practice, and staff told us that they were well-supported and felt valued by the partners.

• High standards were promoted and owned by an enthusiastic and motivated practice team with evidence of highly effective team working.

• The practice reviewed the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, it had reviewed its use of the patient name display facility in the waiting area in response to concerns about confidentiality.

We saw several areas of outstanding practice including:

• The practice had commenced a community pharmacy pilot project from November 2015. This placed a prescribing community pharmacist within the practice for two days each week. Although a full evaluation was awaited, the project had already received positive feedback from patients. More than 100 patients had been seen in the first two months and initial outcomes demonstrated improvements in care. For example, a reduction in the number of medications prescribed with between 10-15% patients having at least of one of their prescribed medications stopped.

• A ‘homely remedies for minor ailments’ system had been developed by the practice in conjunction with the pharmacist for use within a local care home. This enabled the care home to commence agreed drugs for minor ailments such as indigestion and constipation to ensure the patient received treatment at the earliest possible opportunity. This was used with the proviso that the GP was contacted if symptoms persisted beyond 48 hours.

• The practice undertook a comprehensive analysis of the Friends and Family Test (FFT) returns, and had formulated action plans in response to suggestions from patients to enhance patient satisfaction and experience. For example, in response to late running appointments, the practice were informing patients to book longer appointments if they had more than one issue to discuss, and were also auditing waiting times for each clinician.

• The practice had achieved highly in delivering NHS health checks and had consistently overachieved against target figures. For example, current data showed that the practice had achieved 124% of its target in the first three-quarters of 2015-16.

• We saw many examples in which the practice team delivered outstanding care for their patients to keep them safe and well. For example, checking vulnerable patients had access to heat and food during poor weather, and ensuring that patients with a mental health condition were collecting their prescribed medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice