This practice is rated as good overall. (This is the practice’s first inspection for this service)

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? - Outstanding

We carried out an announced comprehensive inspection at Milton Road Surgery on 28 August 2018 as part of our inspection programme.

At this inspection we found:

• There were clear governance arrangements to manage all aspects of care. We found staff were aware of their responsibilities and carried out their roles with passion and motivation to improve patient outcomes.
• The practice had clear 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. Safety incidents were well reported and reviewed during practice meetings.
• The practice told us that verbal complaints were not always documented and could not ensure that themes could be identified. The practice responded to this by ensuring future verbal complaints would be documented.
• The practice routinely reviewed the effectiveness and appropriateness of the care they provided. They ensured that care and treatment was delivered according to evidence- based guidelines. We saw evidence of audits that drove improvements throughout all levels of care.
• We found there were established safeguarding processes for all staff to follow. Staff were encouraged to report safeguarding concerns which were investigated by an internal safeguarding team who fed back information. The information was regularly shared with other relevant agencies.

• Patients in care homes receiving palliative care were visited every two weeks by the GPs to ensure they had continuity of care and to reduce admissions into accident and emergency.

• The practice had a dedicated learning disability co-ordinator and team who were passionate and responsive to patient’s needs. They had restructured the communication with patients with learning disabilities to make it easier for patients to communicate with them. The lead advance nurse practitioner had provided training to practices in the local area to improve the quality of health checks for patients with learning disabilities.
• The practice had employed a paramedic to carry out home visits, who also visited members of the travelling community known to the practice.
• The practice had appointed a clinical and non-clinical sepsis lead. Staff had appropriate training and equipment needed to diagnose sepsis was available.
• The practice had considered emergency medicines however; as they had been reviewing an older recommended list of emergency medicines they had not considered three nationally recommended medicines that had been added. Before the end of the inspection all three recommended medicines were stocked at the practice.
• We reviewed multiple examples of where staff had gone beyond their responsibilities to help patients.
• There was a deeply embedded system of leadership development and succession planning, which aimed to ensure that the leadership represented the diversity of the workforce.
• Staff took part in teaching and training to ensure they could adapt to the wider health economy and its needs.
• Every staff member we spoke with during the inspection was passionate about their role and proud to highlight the improvements they had implemented into the practice.
• There was a strong organisational commitment and effective action towards ensuring that there was equality and inclusion across the workforce.
• Pop-up clinics had been organised by the practice at the local church and library to review patients who would did not usually engage directly with the practice.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There were mixed reviews regarding the appointment system. Some patients found the appointment system easy to use and reported that they were able to access care when they needed it, however some patients felt there were not enough appointments and it was difficult to access the surgery by telephone.
• There was a strong focus on continuous learning and improvement at all levels of the organisation. Learning was routinely shared amongst the other locations managed by the provider and at practice manager meetings in the local area. A number of staff members had the opportunity to develop their roles within the practice.

We saw one area of outstanding practice:

• The practice focused on communication for patients with learning disabilities in order to improve attendance for health reviews. They had redesigned their appointment letters sent to patients with learning disabilities to make it easier for them to understand. They had designed picture invites with very little writing as they found this helped patients engage. They had also redesigned their information leaflets to include pictures. Other important information was displayed in an easy-read format. The practice had shared their methods with other local practices to improve the quality of the checks they carried out. They found that as a result of this it had been easier to complete the health checks and at an improved quality.

The areas where the provider should make improvements are:

• Strengthen the complaint process by documenting verbal complaints.
• Review and update any emergency medicines held to ensure appropriate medicines are available when needed.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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