Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Meadowbrook Surgery on 28 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. We also inspected the quality of care for six population groups which were, people with long term conditions, families, children and young people, working age people, older people, people in vulnerable groups and people experiencing poor mental health. We rated the care provided to these population groups as good.

Our key findings were as follows:

• There were systems in place to ensure patients received a safe service. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, reviewed and addressed.

• There were effective arrangements in place to identify, review and monitor patients with long term conditions. Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment.

• The practice was responsive to the needs of the practice population. There were services aimed at specific patient groups. The complaints procedure was accessible to patients.

• There was visible leadership with defined roles and responsibilities and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice including:

• The practice had taken action to improve the management and treatment of diabetic patients. The practice had employed a diabetic nurse specialist who worked in conjunction with one of the GPs and established a dedicated diabetic clinic two days a week. To date, 130 patients had been discharged from the hospital diabetic clinic and 280 patients were under the sole care of the practice.

• The practice had taken action to improve the number of patients aged between 40 years and 74 years who received the NHS health check. An audit had been undertaken and a protocol developed. The practice undertook a targeted approach which included the appointment of a Health Care Assistant to undertake the check. This significantly increased the number of NHS health checks offered and the practice went from a completion rate of 8% to 80% within a 10 month period. This resulted in the practice being rate within the top 5% of practices for completion of the check within the Clinical Commissioning Group (CCG).

• The practice used the Choose and Book system for making the majority of patient referrals. The Choose and Book system enables patients to choose at which hospital they would prefer to be seen. The practice had a system in place for offering choose and book which enabled 95% of patients to walk away with an appointment for their chosen hospital on the same day they were seen by the GP.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Develop a policy for significant events for staff to follow to ensure a consistent approach.

• Ensure appropriate signage is in place to alert people of the risks associated with flammable liquids and oxygen.

• Ensure reasonable adjustments are made to enable people who require the use of a wheelchair are able to access the service.

• Proactively undertake dementia screening for patients to ensure early identification and intervention.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we spoke with eight patients and seven members of staff. One patient said, “Very courteous and helpful, it is excellent really." All of the patients we spoke with said they were able to obtain appointments at a time to suit their needs. All the patients we spoke with said they felt the quality of care they received was good.

We saw that patient's views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. One patient told us, “You feel as if you are the only one." We saw that patients experienced care and treatment that met their needs.

Patients told us and we saw that care was delivered in a clean environment. However, some improvements were required in staff training on current infection control practice.

Staff required training in safeguarding (protecting vulnerable adults and children) but were aware of whom to report concerns to.

Improvements were required to the quality monitoring systems to assess and monitor the quality of service that patients received. The quality monitoring of chronic disease management required improvement. The systems of incident and accident reporting required improvement.