Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Little Bushey Surgery on 03 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, responsive and well-led services. It also provided a good service for mothers, babies, for children and young people, for the working-age population and those recently retired as well as for people experiencing poor mental health.

The practice was outstanding for providing caring services. It was also outstanding for providing services for older people, for people with long term conditions and for people whose circumstances may make them vulnerable.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice used proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, it was the only practice in the area that proactively monitored the care of patients with cardio-vascular conditions through regular testing and treatment known as a level four anti-coagulant service.
• The practice’s approach to patients with coronary heart disease (CHD) had resulted in fewer admissions for CHD compared with the CCG and the rest of England.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.
• 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 National Patient Survey.
• The practice had good facilities and was well equipped to treat patients and meet their needs. Information about how to complain was available and easy to understand.
• Practice staff had been consulted about and had contributed to the development of the practice’s mission statement to provide safe, patient-centred care.
• Staff were given responsibility for key aspects of the practice’s work with patients with designated champions for bereavement, vulnerable families and carers.

We saw some areas of outstanding practice including:

• The practice’s proactive and dynamic approach to quality monitoring was highly effective giving rise to on-going change and improvement. This was demonstrated by action that the practice had taken to reduce emergency admissions to hospitals. They had done this by making additional locum appointments available during the winter months. This initiative resulted in fewer admissions to hospital of older people and people with long term conditions compared to local and national averages. The practice had been influential in enabling the rest of the clinical commissioning group (CCG) to take this up and this had also resulted in a corresponding reduction in emergency admissions across the CCG area.
• The practice was outstanding for its caring culture as demonstrated by data from the National Patient Survey, patient interviews and views expressed on comment cards. Survey data showed the practice was rated higher than other practices in the area and in England for all aspects of caring practice, with some areas being rated as significantly higher.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice