Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection 12/2014 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those recently retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at Dr T R S Bailey & Partners, otherwise known as Orchard House Surgery, on 30 November 2017.

At this inspection we found:

• The practice had effective systems to manage risk so that safety incidents were less likely to happen. When they did happen, the practice learned from them and improved their processes. The practice shared outcomes of significant events with staff and other local GP practices.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• The facilities and premises were appropriate for the services delivered.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. Patient feedback on access to appointments was positive; this was supported by a review of the appointment system and data from the National GP Patient Survey.
• Staff had the skills, knowledge and experience to carry out their roles and there was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice was in line with, or above average for its satisfaction scores in the National GP Patient Survey.
• The practice was responsive to the needs of patients whose circumstances made them vulnerable. For example, it provided a postal address for travelling and homeless patients.
• The practice actively promoted equality and diversity. It identified and addressed the causes of any workforce inequality. Staff had received training and felt they were treated equally.
• Staff we spoke with told us they were able to raise concerns and were encouraged to do so. They had confidence that these concerns would be addressed.

We saw areas of outstanding practice:

• The practice maximised the use of their computer system, with a strong emphasis on its comprehensive quality improvement programme. We saw that various responses were implemented as a result of the various programmes; this included additional training, shared learning, reviews of prescribing, reviews of methodologies, amendments to appointment systems and other quality improvement outcomes. The practice implemented improvements in to day-to-day practice.

• Access to visits, telephone or physical appointments was responsive to the local population’s requirements. The practice continually monitored access; a September 2017 audit of appointment data of practices within the Suffolk Primary Care group indicated that the practice was the second highest in providing telephone services and above average in providing face to face appointments. Patient feedback was very positive.

The areas where the provider should make improvements are:

• Improve exception reporting performance, specifically for diabetes and mental health indicators.
• Review the recording and coding of medical records to ensure accurate and reflective care and treatment of patients, including patients who are carers.
• Audit infection rates on minor surgery interventions.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We visited Orchard House Surgery on the 11 December 2014 and carried out a comprehensive inspection. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring and responsive services.

We found the practice was outstanding for providing well-led services and services for people whose circumstances make them vulnerable. It was also good for providing services for older people, people with long-term conditions, families children and young people, working age people (including those recently retired) 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 and appropriately reviewed and addressed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. There was a strong learning culture within the practice. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with dignity and respect and were involved in their care and decisions about their treatment.

• The practice was safe for both patients and staff. Robust procedures helped to identify risks and where improvements could be made.

• Information about services and how to complain was available and easy to understand.

• The practice had good facilities and was well equipped to treat patient and meet their needs.

• Patients were happy with the appointment system because they were able to get telephone advice or be seen that day. The practice offered flexibility to help meet patients’ needs for example, by arranging a call back at a time convenient with the patient. Continuity of care was promoted by providing patients with urgent appointments that day and usually with the GP who had dealt with the initial call.

• The practice had strong visible leadership structure and staff felt supported by the management and were involved in the vision of providing high quality care and treatment. The practice proactively sought feedback from staff and patients, which it acted on.

We saw areas of outstanding practice including:

• The practice employed a dedicated auditor whose role involved working closely with the Lead GP for IT. Their responsibilities included maintaining the practice’s call and recall systems ensuring that patients who had long-term conditions or required review were invited and seen at the practice in a timely way.

• The practice had responded to areas highlighted in the 2013 Patient Reference Group (PRG) survey, (this is a group of patients registered with the practice who have an interest in the service provided by the practice). These included improvements to the practice website, patient appointment times and provision of extended hours appointments. Action had been taken to improve these areas including systems to develop the PRG survey.

• There was a comprehensive and embedded system of clinical and non-clinical audits within the practice covering a broad range of clinical and non-clinical areas. For example the practice had implemented a number of pre-programmed batch clinical reports within SystmOne that ran at pre-set intervals and automatically sent the results to clinicians as a task to action before the audit cycle was repeated. There was evidence that this had led to improvements in outcomes for patients. We saw that the results of audits had been shared routinely across clinical teams.

• All patients who required an appointment with a GP were seen on the day their request was made. Requests could be made at any time of the day, and the practice had late night GP and nurse appointments to ensure patients not available during working hours could access appointments easily.

• The practice implemented a number of telephone consultations during the evening extended hours appointments for asthma reviews. This provided long term condition reviews for asthma patients that may have found it difficult to attend the practice during normal working hours or attend on-site evening appointments.

• The practice had a clear vision that was shared and owned by all staff. Structured policies and processes were followed to deliver high standards of care. Performance and governance arrangements were proactively reviewed. Leadership responsibilities were delegated appropriately and staff were able to demonstrate this worked well in practice.

• The clinical and management team shared decision making (both clinical and non-clinical) and worked effectively with clear communication and mutual support. There was a strong culture of shared learning, improvement and achievement to ensure that patients’ needs were met.

However, there were also areas of practice where the provider should make improvements.

The provider should:

• Assess the risks relating to local post offices providing a collection centre for dispensed medicines.

• Assess the competence of reception staff to conduct prescription checks and ensure reception staff receive the appropriate training to undertake this task.

• Improve systems for the safe management of controlled drugs and improve security arrangements for the dispensary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice