Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr JA Sutherland’s practice (Killamarsh Medical Practice) on 14 December 2015. 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, and we saw evidence that learning was applied from events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment, and clinicians had lead areas of responsibility.
• Feedback from patients about their care was consistently and strongly positive.
• 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.
• Patients said they found it easy to make an appointment with a GP, and usually this was with a GP of their choice. Routine appointments could often be booked on the day and if not, they were available within two days. Urgent appointments were available the same day, and the practice offered additional appointments on a sit and wait at the end of each morning surgery.
• The practice offered a minor injuries service and data demonstrated that 28 of 30 patients who had accessed this service since April 2015, had been treated without the need for referral to another unit such as the Accident & Emergency (A&E) department.

• The practice used clinical audits to review patient care and took action to improve services as a result.

• The practice had good facilities and was well equipped to treat patients and meet their needs. This was to be enhanced by an extension, including seven new consulting rooms, which was under construction at the time of our inspection.
• The practice worked well with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe. This approach had impacted on unplanned hospital admissions and attendance at Accident and Emergency.
• There was a clear leadership structure and staff felt supported by management.
• The practice reviewed feedback from patients acted upon it. For example, further to comments made on the NHS Choices website, the practice ensured that a member of the reception team was always placed at the front of the reception desk during opening hours.
• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, as part of the extension to the building, the access road would be widened with a footpath to aid patient access from the car park.

We saw two areas of outstanding practice:

• A community pharmacist visited weekly and worked with the practice and the CCG medicine management technician on a variety of prescribing matters. The pharmacist reviewed spirometry results (spirometry is a test used to help diagnose and monitor some lung conditions by measuring how much air can be expelled in one forced breath) and reviewed patients with diagnosed lung disease for advice and medication reviews. The pharmacist had also audited patients with atrial fibrillation to determine if anti-coagulation therapy was required in line with recognised guidance.Approximately 20-25 patients were seen by the pharmacist each month.

• The practice employed their own community matron and care co-ordinator who managed patients by developing individualised care plans involving the wider health and social care team. This helped to keep patients safe in their own home (and in care homes), and also facilitated earlier hospital discharges. Alongside the practice’s proactive approach in providing good access to GP appointments, a measurable impact was seen in the lower attendance at out of hours and A&E services, and the lower rates of unplanned hospital admissions for this practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice