Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Goyt Valley Medical Practice on 20 September 2016. Overall, the practice is rated as outstanding.

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

• Patients overwhelmingly told us they received excellent care and were treated with compassion, dignity and respect. They also said they were involved in their care and decisions about their treatment. This was corroborated bythe outcomes of the latest national GP patient survey, friends and family test results, and CQC comment cards.
• There was an effective system in place for the reporting and recording of significant events. Learning was applied from events to enhance the delivery of safe care to patients.
• Clinicians kept themselves updated on new and revised guidance and discussed this at clinical meetings. Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Feedback from patients we spoke with on the day, and from CQC comment cards, demonstrated that people had excellent access to GP appointments.
• We saw evidence of an active programme of clinical audit that reviewed care and ensured actions were implemented to enhance outcomes for patients.
• The practice planned and co-ordinated patient care with the wider health and social care multi-disciplinary team to deliver effective and responsive care and keep vulnerable patients safe. Regular meetings took place to discuss and review patients’ needs.
• The practice had an appraisal system in place and supported staff training and development. The practice team had the skills, knowledge and experience to deliver high quality care and treatment.
• Longer appointments were available for those patients with more complex needs, and there was greater flexibility in offering appointments for vulnerable patients such as those with a learning disability.
• The practice had good facilities and was well-equipped to treat patients and meet their needs. The premises were accessible for patients with impaired mobility.
• There was a clear leadership structure in place and the practice had a governance framework which supported the delivery of good quality care. Regular practice meetings occurred, and staff said they felt valued and that GPs and managers were approachable and always had time to talk with them.
• The partnership had a clear vision for the future of the service, and were engaged with their Clinical Commissioning Group (CCG) in order to progress this.
• The practice had an open and transparent approach when dealing with complaints. Information about how to complain was available, and improvements were made to the quality of care as a result of any complaints received.
• The practice patient participation group (PPG) was active and helped to champion the patient voice to influence developments within the practice.

We saw the following areas of outstanding practice:

• The nurse practitioners provided on-the-day assessment and care for patients presenting with new and acute conditions, and minor illnesses. They undertook home visits and one provided regular input at a local care home for patients with dementia. This alleviated pressure on GPs allowing them more time for complex consultations and produced positive outcomes for patients. For example, input to the care home demonstrated effectiveness through the reduction in contacts with the out of hours’ service and hospital admissions. Over a 12 month period, hospital admissions fell from 67 to 43, and contact with the out of hours’ service reduced from 23 to 17 patients. There was also a decrease in falls at the home from 56 between January to March 2014, to 24 in the corresponding period the following year.
• The practice directly employed a mental health support worker. Data for emergency admissions for mental health over a three year period showed low figures for the practice. These were the lowest within their locality and one of the lowest within their CCG. The practice were able to provide evidence that over the last two years, only four of 22 patients at high risk of hospitalisation had been admitted, with two of the admissions being outside of the practice’s direct control.
• The practice demonstrated a responsive approach by taking account of the needs of their local population, and not just their registered patients. This enabled services to be delivered closer to patient’s homes.

The areas where the provider should make improvement are:

• Review the need to take emergency medicines on home visits, or consider a risk assessment to be completed for this.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Whilst the provider offers both a medical and dental service at this location, during our inspection we only reviewed the standards in relation to the primary medical services. The dental service will be reviewed at a later date.

We spoke with seven patients of Goyt Valley Medical Practice during our inspection. We did this to help us to understand the outcomes and experiences of patients who used the practice. All of the patients told us that they were happy with the care they received and that staff at the practice treated them with respect. Their comments included, “The doctors are pleasant and always helpful” and, “I tend to ask lots of questions and they always have time to answer.”

We found that patients were involved in their care and treatment which was provided in a way intended to ensure their safety and welfare.

Patients who use the service were protected from the risk of abuse. Patients we spoke with told us they trusted the GPs and nurses caring for them and felt safe receiving support from all of the staff at the practice.

Staff received appropriate professional development which included an annual appraisal and training relevant to their role. Staff told us that they felt the practice staff worked well as a team.

The practice had effective systems in place to protect the health and wellbeing of patients. There was a Patient Participation Group at the practice and they were involved in assessing the quality of care patients received.