Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Radcliffe-on-Trent Health Centre on 11 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 and near misses, and we saw evidence that learning was applied.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, the use DVDs as a form of education for patients with long term conditions and working with the local diabetes specialist nurse to improve the wellbeing of patients.

• There was easy access to appointments for patients whose circumstances made them vulnerable, for example patients from the traveller community. They were assured of an appointment on the day when they presented to the practice without a booked appointment.

• Feedback from patients about their care was consistently positive. Data from the GP survey was consistently high and this included confidence in care provided by GPs, where 99% of patients surveyed said they had confidence and trust in the last GP they saw or spoke to.

• The practice planned and co-ordinated patient care with the wider multi-disciplinary team to plan and deliver effective and responsive care to keep vulnerable patients safe. This approach had impacted on unplanned hospital admissions and attendance at Accident and Emergency. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. The practice was actively working with the patient participation group to resolve issues regarding access to non-urgent GP appointments.
• The practice actively reviewed complaints for trends and how they were managed and responded to, and made improvements as a result.
• The practice had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.

• The practice had strong and visible clinical and managerial leadership and governance arrangements, and staff told us that they were well-supported and felt valued by the partners.

We saw areas of outstanding practice including:

• The practice provided exceptional care to registered patients living in care homes, particularly those coming to the end of their life. Patients were seen every week by a nominated GP who visited the care homes with the district nursing team to ensure patient care was seamless and patients could be seen, assessed and treated (where necessary) in one visit. GPs provided urgent access telephone numbers and went the extra mile by visiting outside surgery hours to ensure that patients living in care homes received personalised end of life care.

• Staff had innovative ways to help patients who had limited literacy skills manage long term conditions by providing them with educational DVDs rather than just written information.

• One of the GPs had a special interest in dermatology and used their skills and knowledge to provide improve services for the wider community through offering clinics and educational sessions for colleagues in other practices, to medical students and trainees. This included an advice and guidance unpaid service offered to other practitioners. There was evidence of reduced inappropriate referrals to secondary care for dermatology care indicated by the low number of rejected referrals.

However, we also found an area where the practice needs to improve.

• The practice should ensure that there are procedures in place for monitoring and managing risks to patient and staff safety by having robust arrangements for health and safety assessments and following up actions on legionella assessments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice