We carried out an announced comprehensive inspection at Great Witley Surgery on 14 February 2019 as part of our inspection programme.

At the last inspection in January 2016 we rated the practice as good overall with outstanding for proving responsive services.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected

• information from our ongoing monitoring of data about services and

• information from the provider, patients, the public and other organisations.

We have rated this practice as outstanding overall.

We rated the practice as outstanding for providing responsive services because::

• The practice had taken an active role to engage with the rural community in aspects of social prescribing since 2017. It had secured funding for a social prescribing project and to reach out to services in the local community to create a directory to enhance residents’ health and wellbeing. They initiated a social prescribing event in October 2018 which was attended by 40 local services. The day included an afternoon tea and jazz event which was attended by over 80 residents. The day brought community services together and enabled services such as Age UK to sign up six new volunteers, as well as the fire service carry out six home assessments. Following this the practice presented the rural aspects of social prescribing at The Midlands Social Prescribing Network Conference in January 2019. During the past twelve months the practice had seen an 11% reduction in its hospital admissions during 2018, which the practice attributed to the positive effect that social prescribing initiatives had on patients’ general well-being.

• The National GP Patient Survey Results for 2017 and 2018 were significantly higher than local and national averages in outcomes relating to access. The practice had achieved the second highest GP Patient Survey results in Worcestershire for the past two years and voted in the top ten nationally during 2017. Comment cards and patients who we spoke with on the day of inspection were overwhelmingly positive about the flexibility the practice offered its patients in responding to their needs.

• The practice continued to offer its annual Christmas lunch to the older population and vulnerable patients. It was now in its fourth year and had been expanded to all members in the local community. The event was provided in the adjacent village hall and entertainment and a Christmas gift was provided to those who attended. Numbers had continued to grow and had been attended by over 60 in 2018. The practice had received feedback from patients on the benefits this event had to their overall wellbeing.

We have rated the practice as outstanding for providing caring services because:

• Patient satisfaction through the National GP Patient Survey was higher than both the CCG and England averages across all indicators relating to caring.
• Patient feedback through comment cards, reviews on NHS Choices and patient consultations on the day of the inspection were very positive about the caring nature of the practice.
• The practice demonstrated an understanding and commitment to valuing, respecting and showing compassion to their patients. The practice could evidence that they went the extra mile to ensure patients dignity was respected and they were committed to their patients care.
• The practice had identified and supported 103 carers which represented 1.5% of the practice list size. In addition, the practice kept a register of 45 patients who were unofficial carers to ensure they were aware of support and information to support them.

We

also rated the practice as good for providing, safe, effective and well-led services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.

• Patients received effective care and treatment that met their needs.

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.

• The practice worked proactively with other organisations to ensure patients had access to a range of services to support their health and wellbeing.

• Services were tailored to meet the needs of individual patients. They were delivered in a flexible way that ensured choice and continuity of care.

• The practice worked proactively with the Patient Participation Group (PPG) to undertake a number of surveys and respond to patients’ needs.

• The culture of the practice and the way it was led and managed drove the delivery and improvement of high-quality, person-centred care.

Whilst we found no breaches of regulations, the provider should:

• Complete a risk assessment for the security of keys in the dispensary.

• Continue to review antibiotic prescribing to check that it is in line with best practice.

• Record minutes of meetings in a timely manner.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Great Witley Surgery on 12 January 2016. The practice provides primary medical services to approximately 6,500 people who live in the surrounding area. The practice covers approximately 120 square miles of rural area. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report and follow through incidents and near misses. Opportunities for learning from incidents were shared with staff during meetings and action taken to prevent similar recurrences.

• There were safe systems in place for dispensing prescribed medicines to patients.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. They told us they were satisfied with the standards of care they received. Information was provided to help patients understand the services and care available to them.

• Practice staff worked closely with other organisations and external professionals in planning how services were provided to ensure that they meet people’s needs. People with complex needs had care plans in place that were regularly reviewed.

• As a consequence of feedback from patients and the Patient Participation Group (PPG) practice staff had made improvements to the way it delivered services. The PPG were proactive in representing patients and assisting the practice in making improvements.
• Senior staff had a clear vision for taking the practice forward which had quality and safety as its priority. Plans for the future were in place to improve patient access to the premises. There was a clear leadership structure and staff felt supported by management. It was evident that there was a strongly motivated staff team.

We saw some areas of outstanding practice including:

• Patients who had been assessed as presenting a suicide risk were given a card with a telephone number that took them straight through to the GP who was on call. Patients were able to access to the on call GP from 8am until 6.30 pm each weekday. On average 20 green cards were in circulation and GPs received contact once a month.

• Practice staff had made efforts to reach out to patients who lived in isolated areas. They hosted a Christmas lunch in December 2015 in the adjacent village hall for 50 identified patients. The patients were also provided with entertainment and a Christmas gift. Practice staff told us that patients said they had benefitted personally from the event and that they were prepared to hold the event again.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice