Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lapworth Surgery on 4 August 2016. Overall the practice is rated as good.

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

• The practice had a practical approach to safety and effective systems for managing incidents and significant events.

• Risks were assessed and measures implemented to protect staff and patients from harm.

• Staff were suitably skilled to carry out their roles effectively and in line with current evidence based guidance. The practice supported their continued development using a system of appraisal.

• Patients told us that clinical staff listened to them and gave them enough time in consultations. They were informed about their choices and decision making rights, and were able to be involved in their own care and treatment.
• Information for patients about the services available was easy to understand and accessible. Alternative formats such as large print were available for patients to meet their needs.
• Patients told us they were happy with the timely availability of appointments, and were able to see the GP of their choice. Urgent appointments were available on the same day for those who needed them.
• The practice had suitable facilities and was equipped to treat patients with a wide range needs.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had a clear leadership structure and staff told us they were supported by management as well as the wider team which was well established with many staff members in post for a significant length of time. The practice requested feedback from staff and patients, and was responsive to suggestions for improvement.

• Clinical rooms were kept locked when they were not in use, but staff using these rooms on occasions did not lock doors and remove computer access cards when they left the room unattended for short periods during the day. Paper patient records were stored in cabinets located in area of the building which was kept locked when not in use.

• The practice used the information collected for the Quality and Outcomes Framework (QOF) to monitor its performance. QOF is a system aimed at improving the quality of general practice and rewarding good practice. Results from 2014/15 showed that the practice was performing in line with or higher than both Clinical Commissioning Group (CCG) and national average achievements, and data from 2015/16 which has been published since the inspection was similar. The practice had higher than average exception reporting in several areas. Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects.

We saw one area of outstanding practice:

• Data from the National GP Patient Survey published in July 2016 showed the practice results were significantly higher than local and national averages, indicating a consistently high level of patient satisfaction with all areas of the service.

  Analysis of the GP Patient Survey results previously published in January 2016 had placed Lapworth Surgery as the second highest achieving practice in England. This strong level of patient engagement and satisfaction was corroborated by a high return rate of positive CQC patient comment cards (58 in total), and the positive comments by patients we spoke with during the inspection.

The areas where the provider should make improvement are:

• Improve the security at the practice in relation to computer access cards when rooms are unoccupied during opening hours.

• Continue to review higher than average exception reporting for heart failure, peripheral arterial disease, and cardiovascular disease to ensure patients are receiving the most appropriate treatment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice