Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Paston Surgery on 12 April 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.
• 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 were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• 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.

The areas where the provider should make improvement are:

• Improve the security of the dispensary area.
• Ensure that annual reviews for patients with a learning disability are undertaken in a timely manner.
• Ensure that atropine is included as an emergency medicine.
• Ensure that the learning from complaints is shared and disseminated with the appropriate staff within the practice.

We saw one area of outstanding practice:

• The practice had developed an emergency admissions toolkit which had been adopted by the local Clinical Commissioning Group (CCG) and other local practices. This toolkit processed information from the local hospital and informed the practice of the number of people that were admitted, when and why they were admitted and the frequency of admissions. This information was used to develop care plans for patients and was updated daily, which allowed the practice to be pro-active in investigating and intervening if necessary. The practice had also developed a related risk stratification toolkit, which had also been adopted by the local CCG. This toolkit assisted the practice in obtaining risk ratings based on the information in the emergency admissions toolkit.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The practice had policies in place to help ensure that patients were involved in decisions about their care. The 'promoting and offering choice policy' set out the practice's intentions to involve patients in decisions, to discuss treatment options and to gain feedback.

We read evidence of treatment options having been discussed with patients. A member of staff explained to us about the importance of "...building a trusting relationship..." with patients. One patient told us that staff "...are always willing to listen."

The computerised patient records we read were completed in a consistent style. Correspondence such as discharge letters from hospitals or details of out of hours consultations had been added to the records in a timely manner. This ensured that the doctor or nurse had up to date information on which to base their decisions.

Patients we spoke with said that it could take two to three weeks to get an appointment with a named GP. However, they also told us that they would be seen on the day if they needed an urgent appointment. The practice manager explained that the appointment system was under review. Patients told us they were very happy with the practice. One said "I certainly wouldn't go anywhere else."

The practice held regular 'clinical meetings' to discuss significant events and critical incidents. This showed us that the practice took steps to learn from such events and incidents, in order to improve services.

We carried out an announced comprehensive inspection at Paston Surgery on 15 November 2018 as part of our inspection programme. The practice was previously inspected in June 2016 and rated as good.

Our inspection team was led by a CQC inspector and included a GP specialist advisor and a second CQC inspector.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

We have rated this practice as good overall.

This means that:

• People were protected from avoidable harm and abuse and that legal requirements were met.
• The provider had a detailed action plan in place to address shortfalls within the practice, such as an overhaul of the recruitment system and addressing lower than average results from the GP Patient Survey.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• The practice was fully engaged with reviewing and monitoring the clinical service they offered and used this information to make changes and drive care. For example, they were reviewing the coding for patients with cancer and recording outcomes for patients on high risk medicines to ensure this was appropriate.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered. For example, the practice was a veteran and dementia friendly practice.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.
• The practice encouraged continuous improvement and innovation. For example, they were supporting a nurse through a masters’ degree. This included time off and mentorship.
• Staff reported they were happy to work in the practice and proud of the changes that had been made.

Whilst we found no breaches of regulations, the provider should:

• Continue to review and improve the coding of patients with cancer, diagnosed within the preceding 15 months, who have a patient review recorded as occurring within 6 months of the date of diagnosis to improve outcomes for these patients.
• Embed the new system for the recording of appropriate blood monitoring tests for patients on high risk medicines.
• Continue to review outcomes from the national GP Patient Survey and implement plans to improve these.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice