Letter from the Chief Inspector of General Practic

We carried out an announced comprehensive inspection at Holmwood Corner Surgery on 15 November 2016. 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Most patients said they found it easy to make an appointment with a named GP; however, following some negative feedback about accessing the practice by telephone, the practice had reviewed their phone and appointments system and made changes to improve access; they were awaiting the release of further patient satisfaction data following these improvements in order to establish whether the problem had been resolved. There was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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 and complied with the requirements of the duty of candour.

We saw three areas of outstanding practice:

The practice had a lower than expected rate of unplanned hospital admission, which was achieved as a result of their approach to collaborative working and tailoring their service to meet the needs of the population. They held fortnightly multi-disciplinary team (MDT) meetings which were attended by all GPs, practice nurses, district nurses, the palliative care nurse, health visitors and social workers, but also held six-weekly enhanced MDT meetings, which included a consultant psychiatrist, consultant geriatrician, Head of Social Care from the local authority, and representative from a local support charity for elderly people. The practice’s arrangements for working collaboratively with the MDT were being used by the CCG as a model for other practices in the locality. They also ensured that all patients received the care they needed, for example, by providing home visits by nurses to deliver long-term condition reviews.

The practice had a large proportion of Korean patients and worked closely with several organisations to develop the services provided to these patients. One of the GPs, who spoke Korean, worked with the local council to provide information sessions to members of the local Korean population, for example, sessions were provided to people who had recently moved to the UK about how the health system works and how to access health services, and topical sessions on subjects such as winter health. This GP had founded the Korean UK Medical Association, an organisation aimed at bringing together and providing mentorship to Korean speaking doctors in the UK to allow them to effectively serve the Korean community. The practice provided consultations in Korean and had written information available in Korean, such as information about fasting for blood tests and invitations to attend for cervical screening.

The practice had introduced an intranet system which had a messaging and announcement facility and was linked to the patient records system. This system was used extensively by both clinical and non-clinical staff for passing messages relating to specific patients and the practice generally, for asking clinical questions and seeking views of colleagues, and for disseminating information to staff.

The areas where the provider should make improvement are:

• Continue to monitor patient feedback to ensure changes made to the service are effective
• Review how patients with caring responsibilities are identified to ensure that these patients can be provided with information, advice and support.
• Ensure that arrangements are in place to record action taken in response to safety alerts and updates.
• Review their recruitment policy to ensure that it accurately reflects their recruitment arrangements.
• Review and address areas where their exception reporting rate is above average.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice