Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Old Mill Surgery on 14 June. 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, including dispensary significant events.
• The practice had clearly defined and embedded systems to manage safeguarding concerns.
• The practice needed to carry out fire alarm testing as detailed in the fire risk assessment.
• The dispensary did not monitor room temperatures and the system in place for the tracking of prescription pads required review.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• The practice were performing in line with local and national averages. Unverified data for the Quality and Outcomes Framework showed improvements from 2015/16 to 2016/17.
• The practice held regular meetings with a variety of multidisciplinary teams.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• The practice had identified less than 1% of their patient population as carers; however they had an action plan in place to increase this number.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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 had good facilities and was well equipped to treat patients and meet their needs.
• The practice had completed numerous surveys to gather patient feedback and had acted upon these.
• 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw areas of outstanding practice:

• The practice had completed a survey for housebound patients to ensure they were meeting their needs. As a result of this survey, each patient had an individualised action plan to make access to and the provision of healthcare easier. For example, some patients relied on family members to book appointments and pick up medications. The practice had ensured they knew which family members were involved and liaised with them, as well as ensuring this was documented in the patient’s notes.
• The practice had completed a survey to get patient feedback about a walking group. The response was positive and as a result, the practice worked with a local Norfolk scheme to devise a route for patients to encourage 30 minutes of activity per day. Feedback from the group was positive in relation to health and social factors, including reducing loneliness in the older population. The practice also offered to weigh patients and take blood pressure measurements to monitor the benefits of this walking group and were able to evidence a reduction in blood pressure and weight for some of the group.
• The practice worked closely with the patient participation group (PPG) and had set up open evenings with the aim of educating patients. These were held twice per year and were open to all of the community, including those patients not registered with the practice. Topics included dementia, stroke, diabetes and heart disease. The turnout for these events had been positive, with 85 people attending one of the events. The practice engaged with external stakeholders to provide information, such as University of East Anglia lecturers, medical consultants, the Alzheimer’s Society and the Clinical Commissioning Group. The feedback from the open evenings was positive.

The areas where the provider should make improvements are:

• Continue to identify and offer support to carers.

• Embed a system to carry out actions detailed in the fire risk assessment on a regular basis.
• Embed a system to track blank prescription pads.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice