Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Park Road and Old Dean Surgeries on 23 June 2016. Overall the practice is rated as Outstanding.

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

• Outcomes for patients who use services were consistently very good. Nationally reported Quality and Outcomes Framework (QOF) data, for 2014/15, showed the practice had performed very well in obtaining 97% of the total points available to them for providing recommended care and treatment to patients.
• 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 found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice engaged effectively with local community groups and charities to improve community services and patient access, working with local groups around long term conditions and community wider issues.
• Risks to patients were assessed and well managed.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with staff.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.
• 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 and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• There was a proactive approach to understanding the needs of different groups of patients and to deliver care in a way that meets those needs and promoted equality. This included patients who were in vulnerable circumstances or who had complex needs.
• There was a strong ethos within the practice for community development and engagement. The practice had arranged local talks for their patients and those living in the vicinity. For example, the practice had held sessions on understanding dementia and ‘how to look after your heart’ both events had been well attended with over 100 people attending. The practice had also held an afternoon tea party for patients that may be considered vulnerable or isolated and was planning to build on the success of this event by staging more. They also supported the local Alzheimer’s café and the local ‘safehaven’ and had given talks about access to services.
• The practice had informative care plans for vulnerable patients which were accessible to other agencies, including out of hours and ambulances services. These provided up to date and necessary information to ensure that patients choice of care was taken into account and informed these services of the route of care a patient required and had requested. This had reduced the number of patients attending hospital.
• Emergency appointments for children under five were seen within three hours of calling the practice and the practice had dedicated appointment slots available. This had reduced the number of young patients attending A&E.
• The GPs meet on a daily bases to discuss referrals for patients. This ensured shared learning for the appropriate ongoing support for patients. The practice recorded and reviewed referrals discussed at these meetings. The practice could evidence a positive decrease in unnecessary referrals showing that patients care was managed by effective different methods instead.

• The practice had translated key information and health procedures for those patients who did not have English as a first language. One of the nurses was able to use Makaton for patients with learning disabilities who used this communication method. (Makaton uses signs, symbols and speech to help people communicate) Pictorial information of procedures were also available to help patients with communication difficulties.
• Language specific information had also been sent to invite patients to attend the practice for immunisations. The practice had seen a rise in their immunisations figures from 75% to over 90% since starting this process.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. The practice had introduced the role of a patient care co-ordinator to support the practice’s vulnerable patients. This included patients over 75 years, patients considered vulnerable, patients within nursing homes, and those on the avoiding unplanned admissions register. The role involved liaising with the integrated community team and other service providers to ensure care packages were in place for these patients and also for patients post discharge from hospital. It also provided a single point of contact within the practice for patients, their relatives and other service providers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice