Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at North Road Surgery on 19 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed with the exception of those relating to Legionella.

• 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.
• We saw evidence of clinical audit; however, there was little evidence of this being used to drive improvements, and there was no audit schedule in place.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The practice had processes in place to identify carers, and they had identified approximately 1% of the practice’s list. They offered pro-active support to these patients.
• 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 and concerns.
• Overall, patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice made good use of the facilities they had available and were in the process of securing larger premises to move into.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• Policies and procedures were available to all staff, and there were processes in place for communicating to staff about changes to these.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw three areas of outstanding practice:

• The practice had a policy of continuing to provide a service to patients who were vulnerable or who had ongoing care needs once they had moved out of the area, until the patient was satisfied with the package of care had been established in their new area. This policy was applied, for example, to patients who were receiving cancer treatment, or who were substance misusers.
• The practice had employed an expert in their patient record computer system to interrogate the system in order to identify patients who were suffering from, or likely to develop, a long-term condition. As a result of this work, the practice’s prevalence of patients with Chronic Heart Disease increased from 1.81% in 2014/15 to 2.14% in 2015/16. The practice also reviewed their systems for calling patients with long-term conditions for reviews, and began to liaise more closely with specialist teams to co-ordinate these reviews. As a result, the percentage of the practice’s patients with chronic obstructive pulmonary disease (COPD) who had received an assessment of breathlessness in the preceding 12 months rose from 76% in 2014/15 to 91% in 2015/16.

The areas where the provider should make improvement are:

• They should ensure that they are using clinical audit in order to drive improvement.
• They should ensure that they are taking all necessary action to manage the risk of Legionella.
• They should put in place a system to track and monitor prescription pads.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice