This practice is rated as Good overall. (Previous rating, published on 26 April 2017 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Holt Medical Practice on 17 July 2018 as part of our inspection programme.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect. There was a strong caring culture throughout the organisation.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review the access arrangements to the dispensary to ensure appropriate access and storage of medicines.
• Review dispensary standard operating procedures to ensure they are up to date.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Holt Medical Practice on 15 December 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. The systems in place included reporting to external agencies such as the National Reporting and Learning System (NRLS).
• Risks to patients were assessed and well managed. The practice regularly reviewed their risk registers and took appropriate action when required.
• Practice 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. Staff skills were maximised by the practice to enhance the care to their patients.
• 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.
• Patients said they found it easy to make an appointment with a named GP and 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.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had a robust and comprehensive range of governance arrangements that were regularly reviewed to ensure their effectiveness.

We saw areas of outstanding practice:

·In December 2015 the practice and PPG set up and attended a promotional campaign in the practice with posters and a bath full of one weeks’ worth of wasted medicine. This then achieved public relations exposure across local newspapers and television. One paper reported that unused medicines from the practices patients alone cost approximately £15,000 a month, or £180,000 a year. The practice issued a plea to patients to only order what they need, and called on patients to let their GP know if they were no longer using their medicine. As a result of the medicines wastage campaign, which the practice described as highly acclaimed by the local CCG, the bath display was then used in a publicity tour of other practices and other services to promote the message. The PPG worked with the local CCG, with the chairperson involved in the CCG community engagement panel and conducted presentations for other external groups such as rotary clubs, parish councils and Women’s Institute meetings.

• The practice worked closely with other organisations and with the local community planning how services were provided to ensure they meet patient needs. For example the practice were active participants and were part of a local steering group to promote dementia awareness and make Holt a dementia friendly town. All practice staff were dementia friends and one practice nurse was dementia trained and attended the monthly local dementia support group. Practice staff attended local meetings and the practice worked closely with a local caring society, a local dementia café, a youth group and a local day centre/lunch club.
• The practice undertook an audit of those patients who failed to respond to the bowel cancer screening programme and had sent personal letters to these patients from their GP. Following this the practice reported an increase of 3% in bowel cancer screening uptake.

The areas where the provider should make improvement are:

• Ensure actions identified at annual infection control audits are undertaken to address any improvements identified.

There was scope to improve the process for the management and replacement of medicines required for GP bags.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We reviewed the information available to us about Holt Medical Practice on 9 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.