Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Malmesbury Medical Practice on 3 February 2016. Overall the practice is rated as outstanding.

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 innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice improved quality of care and improved outcomes for patients by and working collaboratively with other stakeholders and initiating an in house elderly frail service.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, with the local council to provide an in house art programme. The practice had also engaged with the local wildlife trust to develop opportunities, for patients with mental health problems.

• 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 the practice extended its opening hours further, from 8am until 7pm, following patient feedback.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.

• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice:

• The practice was proactive in ensuring services were delivered in ways that would improve patient outcomes. For example the practice worked effectively with the local referral support service which maximised appropriate local referral options. This had contributed to the practice being 19% below the Wiltshire average for emergency admissions, 6% below for elective admissions and 30% below for accident and emergency department attendance rates.

• The practice had identified from the Joint Strategic Needs Assessment (JSNA) high admissions of frail elderly patients. In response, funding was secured from the transforming care for elderly patients scheme, to set up a frail elderly clinic and a falls assessment service at the practice. Three elderly frail clinics were run each week. There was evidence to demonstrate positive outcomes, in a reduction in the number of falls and of a number of patients being able to continue to live safely at home with support.

• Dementia patients were identified as a target group that would benefit from changes in the way services were delivered. An in house service was initiated for the diagnosis, assessment and referral if appropriate for patients with possible dementia. The service was supported by the practices care coordinator, the Alzheimer’s society and a psychological course for patients and their carers. This service had reduced waiting times for assessment, diagnosis and time to start treatment from 12 months to one month. This has alleviated anxiety for patients and their families and also reduced the number of patients requiring referral to secondary care by 65%.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice