Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Millbrook Surgery - Castle Cary on 5 May 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, weekly meetings with the community psychiatric team and virtual patient clinics with specialist doctors and nurses.
• Risks to patients were assessed, mitigated and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with appointments available the same day.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints, concerns, patient surveys and the patient participation group.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management and included within decision making processes to improve patient care. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. For example, staff told us the partners were very accessible, listened to concerns and implemented change process to improve the quality of the service.
• The practice undertook pilot projects and was part of the NHS England vanguard, working to deliver an integrated primary and acute care system with health and social care providers.

We saw four areas of outstanding practice:

• The practice had listened to staff and patients around access to care and treatment. For example, the practice implemented an open access system which allowed patients to phone anytime on the day they required care and treatment, speak to a GP and if necessary see a GP of their choice on the same day. This meant patients did not have to wait for routine care and treatment. The practice could demonstrate the impact of this by positive patient survey results.

• There was a focus, by the practice, on continuous improvement of the quality of care and treatment provided. Which meant improved patient outcomes. For example, the employment of health coaches who offered support to patients and their families of any age who had recently been discharged from hospital, had a chronic condition, were vulnerable or isolated. Health coaches provided lifestyle advice, assistance with day to day tasks, access and referral to community services, support and care packages and personalised care plans for those at risk.

• Staff worked together as a team to understand and meet the range and complexity of patients’ social and medical needs and to assess and plan ongoing care and treatment. For example, the practice held a staff led, twice weekly ‘huddle’ meeting for all staff. The meeting enabled any member of staff with a concern about or information about a patient to communicate it to the rest of the team and an action plan implemented. This meant the practice could be proactive and responsive to an individual patient’s care and treatment.

• The practice had a clear focus on learning and continuous improvement. For example, effective responses to feedback from patients and staff; from reviews of audits and significant events; and proactive participation in local pilot schemes and close working with other organisations to plan how services were provided and to improve outcomes for patients.

The areas where the provider should make improvement are:

• The practice should compile a full list of staff immunity against infectious diseases.

• The practice should improve the completion of incidents reporting forms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The practice had a patient list of 4700. There were three GPs and other healthcare professionals such as practice nurses, health care assistants and phlebotomists. Some community health care professionals not employed by the practice were based at the surgery. This allowed good communication between professionals and easy access to services for patients.

The practice was based in a modern purpose built building which was accessible to people with all levels of mobility.

Patients we spoke with were very complimentary about the care they received from the surgery. Comments included; “It’s all fantastic. The doctor I have now is the best GP I’ve ever had” and “I have every confidence in the staff here. I’ve been registered with the same GP for several years and have always had good care.”

The practice worked with other health care services to make sure patients received appropriate care and support.

All staff we spoke with said they felt well supported by the practice and their colleagues. There was a very low turnover of staff and staff appeared happy and competent in their roles.

The surgery participated in the annual national Quality and Outcomes Framework (QOF). There was a robust system in place to monitor how well the surgery was doing against the quality and outcomes framework. The practice had consistently high scores which demonstrated they were providing a high quality service in line with the outcomes.

We reviewed the information available to us about Millbrook Surgery - Castle Cary on 17 April 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.