Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Purton Medical Practice on 7 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 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.
• Patients said they found it easy to make an appointment with a named GP and that 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.
• 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 improvements are:

• Provide additional support and training to nursing staff in relation to the Mental Capacity Act and best interest decisions.

• Improve the number of patients identified as carers to enable supportive measures for this patient group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection with spoke with five people who used the service. Three of these people were also members of the Group for Patients (G4P). Everyone we spoke with told us that overall they were satisfied with the service they received and had confidence in the abilities of the GPs and nurses. People we spoke with told us that they could easily access appointments. One patient said “it’s quite easy to get an appointment, if I want to see a certain GP then I may have to wait a little longer but I don’t mind this”. Another patient we spoke with told us “The GPs are very proactive and quick to get things sorted.”

Patient’s views were taken into account in the way the service was provided and delivered in relation to their care. The provider took adequate steps to ensure that patients were protected against the risks of receiving care or treatment that was inappropriate or unsafe.

We found clinical and non-clinical areas were clean and tidy and free from odours. Patients we spoke with said they had no concerns about hygiene standards within the practice. They told us that the GPs and nurses always wore the correct protective equipment, such as gloves, whilst examinations took place.

Patients were cared for, or supported by suitably qualified, skilled and experienced staff. Records we reviewed showed there were recruitment and selection processes in place. The provider and practice managers were aware of the need to assure themselves that new staff were recruited correctly.

During our visit we found the practice had sought the views of patients and acted upon the feedback received. The practice undertook periodical clinical and non-clinical audits throughout the year. There was an effective system in place to identify, assess and manage risks relating to the health, welfare and safety of patients.

We carried out an announced comprehensive inspection at Purton Medical Practice on 13 March 2019, as part of our inspection programme. The service was previously inspected on 7 April 2016, and rated Good overall. 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 was because:

• Patients had good outcomes because they received effective care and treatment that met their needs.
• 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.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.
• Patients could access appointments and services in a way and at a time that suited them, with routine appointments available within two working days.
• The practice was around 11 percentage points above local and national averages for patient satisfaction with appointment times. •Reception staff were trained as 'dementia friends', and attend 'Dementia friendly community' meetings.
• The practice had a well-engaged and active patient participation group (PPG). The PPG made suggestions for improvements, and met regularly with practice staff and other stakeholder organisations such as the local clinical commissioning group and Healthwatch. Among other activities, the practice raised money to purchase additional equipment for patient care, such as a spirometer and a self check-in screen.

We found several areas where the provider should make improvements. The provider should:

• Continue to identify carers to enable this group of patients to access the care and support they require.
• Continue efforts to increase the programme coverage of women eligible to be screened for cervical cancer.
• Continue to engage patients with long term conditions like asthma and diabetes, and mental health problems, so that there is lower exception reporting and healthier outcomes for these indicators.
• Continue with efforts to lower prescribing of antibiotic medication, so that patients' use of these items is safely monitored.
• Continue with efforts to monitor the safety of prescriptions.

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

Dr Rosie Benneyworth BS BM BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care