Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Merstow Green Medical Practice on 6 May 2015. Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for the older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• The practice was clean and hygienic and had arrangements for reducing the risks from healthcare associated infections.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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 named GP and that there was continuity of care, with urgent appointments available on the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

We saw several areas of outstanding practice including:

• The practice organised IT training and support sessions in conjunction with the local library to train patients to use the practice’s on-line systems, for example, how to book appointments. This has seen an increase in use of on-line appointment booking.
• The practice directly employed its own counsellor for patients to be referred to as this was found to be more efficient than using external organisations. As a result the waiting time for appointments has been reduced by approximately three to four weeks.
• The most vulnerable patients (for example, those with learning difficulties or those with severe health needs) were given a medical alert card which they were encouraged to carry with them at all times. This gave an ex-directory phone number for the patient (or someone assisting the patient) to contact the practice.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

During our inspection we spoke with nine patients and six members of staff.

When patients received care or treatment they were asked for their consent and their wishes were listened to. One patient told us,: "Yes and I ask questions until I understand". We found that when minor surgery had been carried out that the doctor had obtained written consent from the patients before the surgery had commenced.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. The patients we spoke with provided positive feedback about their care. A patient said: "Our doctor is fantastic. He always welcomes you, you never feel rushed". Patients received their medicines when they needed them and their medicines were regularly reviewed.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

Patients were cared for in modern purpose built premises that were well maintained to ensure a safe environment for patients visits.

The provider had systems in place for monitoring the quality of service provision. There was an established system for regularly obtaining opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.

This practice is rated as Good overall. (Previous rating September 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Merstow Green Medical Practice on 7 November 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes in order to prevent a recurrence.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines and best practice.
• We saw that staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a Practice Liaison Manager who acted as the interface between patients and staff.
• The practice continued to organise IT training and support sessions to train patients to use the practice's on-line systems, for example, how to book appointments.
• The most vulnerable patients (for example, those with learning difficulties or those with severe health needs) were given a medical alert card which gave an ex-directory telephone number for the patient (or someone assisting the patient) to contact the practice.
• The nurse manager was the clinical care co-ordinator, whose responsibilities included drawing up clinical care plans for patients who would benefit from a personalised plan.
• The practice took part in local pilot projects, including Active Monitoring for patients with mental health issues.
• The practice achieved maximum points in the Quality and Outcomes Framework for 2017/18.
• Patient feedback on the level of care and treatment delivered by all staff was very positive.
• Although the appointment system had been changed as a result of patient feedback, not all patients found the appointment system easy to use.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• There were strong links with local organisations which raised awareness of the support services available in the local area.
• A new salaried GP started a urogynaecology service in June 2018. 

The areas where the provider should make improvements are:

• Strengthen the audit programme to include more second cycle audits and more emphasis on learning from audit findings.
• Continue to monitor and act on the results of patient surveys in order to meet the needs of the patient population.
• Track prescriptions throughout the practice.
• Monitor expiry dates for medicines if the maximum refrigerator temperature exceeds the recommended maximum.
• Check that consulting room doors are locked when not in use for security purposes.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.