Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Green Elms Surgery on 12 September 2017. Overall, the practice is rated as good.

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

• Staff members knew how to raise concerns, and report safety incidents.
• Safety information was appropriately recorded and learning was identified and shared with all staff.
• The infection control policy met national guidance.
• Risks to patients and staff were assessed, documented and acted on appropriately.
• The practice had arrangements and processes to keep adults and children safe and safeguarded from abuse.
• Staff assessed patient care in line with current evidence based guidance.
• The practice had an effective system to act on patient safety and Medicines and Healthcare products Regulatory Agency (MHRA) alerts.
• Staff showed they had the skills, knowledge, and experience to deliver responsive, effective care and treatment.
• There were 13 clinical audits undertaken and we saw five completed audit cycles enabling improvements to be measured.
• The system to monitor patients repeat prescriptions was effective.
• Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
• Information about the practice services and how to complain was available in the waiting room, and on the practice website in easy to understand formats.
• The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest manner.
• The practice facilities, and equipment was appropriate to treat and meet patient’s needs.
• There was a clear leadership structure and in addition, staff members felt supported by the practice clinical and management team.

The area where the provider should make improvement are:

• Improve patient satisfaction in the GP National Survey.

We saw two areas of outstanding practice:

• The nursing and practice management staff built up a positive working relationship at the local Ex-Offenders group meetings with patients, held by social workers. The practice hadrecognisedthis hard to reach group of patients as not engaging effectively or appropriately, so offered to attend the meetings for the purpose of improving their health care andto gain this group of patients’ trust. As a result, many more patients now visited the practice and they were supported to manage their health in an improved way. We were told that this initiative had identified many patients suffering with long-term health conditions that had not previously been treated. All staff members had been trained to take a tolerant approach to these patients when they did not attend appointments, or arrived late due to their specific needs and to work with them to provide support. The practice population level of deprivation, homelessness and addiction was higher than any local and national averages. The practice staff worked with these patients, local organisations and the police to build up a relationship to offer primary care services with an approach these patients needed.
• The practice community matron visited a large local residential care home twice a week to up-skill staff, and support them dealing with minor issues previously reported to the practice. The matron also provided staff training to recognise when an ambulance should be called and when the practice could deal with the concern. This training has led to a reduction in calls for visits to the practice and considerable reduction of over 60% in the ambulance calls, as seen in an independent ambulance service usage analysis audit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice