Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greenfield Medical Practice on 18 May 2017. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. There was evidence of learning for incidents to improve the service delivered.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice actively participated in improvement activity to deliver improved outcomes for patients.
• Results from the national GP patient survey were lower than CCG and national averages. This was in contrast to feedback received through CCG comment cards and patient participation group members who highlighted many positive changes to the service since the provider had taken over and told us that they were treated with compassion, dignity and respect.
• The practice had taken action to improve access which included additional telephone lines and reception staff, the employment of a female doctor and pharmacist independent prescriber. There had also be improvements for supporting patients with long term conditions and refurbishment of the premises had led to improved disabled access. Urgent appointments were available the same day.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs. There had been recent refurbishment to the premises.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• There was a strong focus on continuous learning and improvement. For example, the practice had been involved in a pilot that had improved outcomes for patients with diabetes.

We saw one area of outstanding practice:

• The practice had made significant improvements in clinical performance and to the outcomes of patients with diabetes. The practice had a high prevalence of diabetes at 13% of the practice population (5% higher than the CCG and 6% higher than the national average) and a difficult population in terms of diabetes management. The practice had made significant improvements through the use of clinical audits and had participated in a pilot scheme for the integration of diabetes care across primary and secondary care. As the part of the pilot the HbA1c (a measure of diabetes control) was collected pre and post intervention and improvements made by the practice resulted in all patients being successfully discharged from secondary care.

The areas where the provider should make improvement are:

• Ensure equipment cleaning schedules are kept up to date to ensure cleaning has been completed.
• Continue to review and take action to improve the uptake of national cancer screening programmes for breast and bowel cancer.
• Consider and implement ways in which carers could be supported.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice